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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
AND TYPE
DATE
SUBJECTtriTLE
RESTRICTION
001 a. letter
Hillary Clinton to Barbara Mendel Mayden. [partial] ( 1 page)
03/31/1993
P6/b(6)
001 b. letter
Barbara Mendel Mayden to Hillary Clinton. [partial] (1 page)
02/03/1993
P6/b(6)
002. resume
Curriculum Vitae for Kelly Clark Pinkard. (Partial) (1 page)
n.d.
P6/b(6)
003.1etter
Ellen Roseman-Curtis to Hillary Clinton. [partial] (1 page)
02/23/1993
P6/b(6)
004a. letter
Hillary Clinton to George H. Bergdoll. [partial] (1 page)
03/3111993
P6/b(6)
004b. letter
George H. Bergdoll to Hillary Clinton. [partial] (1 page)
02/10/1993
P6/b(6)
005. resume
Paul W. Willihnganz [partial] (1 page)
[none]
P6/b(6)
006. resume
Vivian Riefberg [partial] (1 page)
[none]
P6/b(6)
007a. letter
Hillary Rodham Clinton to Bruce R. Brookens. [partial] (1 page)
03/29/1993
P6/b(6)
007b. letter
Bruce R. Brookens to Hillary Clinton. (Partial) (1 page)
03/10/1993
P6/b(6)
OOS.letter
Hillary Rodham Clinton to Sister Margaret Vincent Blandford.
[partial] (1 page)
03/29/1993
P6/b(6)
009a. letter
Hillary Rodham Clinton to June Kozak Kane, M.S., RD [partial] ( 1
page)
03/24/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. 1104(a))
Freedom of Information Aet -IS U.S.C. SS2(b))
Pl National Seeurity Classified Information ((a)(l) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(Z) Release would disclose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) ofthe FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
P2 Relating to the appointment to Federal office ((a)(Z) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
---- ----~-------'
�Withdrawal/Redaction Sheet
•
Clinton Library
DOCUMENT NO.
AND TYPE
009b. letter
DATE
SUBJECTffiTLE
June Kozak Kane, M.S., RD to Hillary Rodham Clinton [partial] (1
03/10/1993
RESTRICTION
P6/b(6)
page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad -144 U.S.C. 1104(a))
Freedom of Information Ad- (S U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(1) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
fmancial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy ((a)(6)ofthe PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(1) Release would disclose internal personnel rules and practices of
an agency ((b)(1) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmaneial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disdose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disdose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
�---
----- - - - - - - - - - - - - - - - - - -
THE WHITE HOUSE
March 31, 1993
Mr. James Harold French, Jr.
3299 Woodburn Road
Annandale, Virginia 22003
Dear Jim:
Thank you for your thoughtfulness in writing to offer your
assistance as solutions are developed for the incredibly complex
health care issues. I appreciate your generosity and will certainly
keep you in mind.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
We will be grateful for your ongoing support for the success
of our endeavors.
Sincerely yours,
~+Cllnron
�--~~~--
,
I
'S"Lct"=t
()/~
~
&lA-
PJ...
'Z-.2..00
"J
I
I
JAMES HAROLD FRENCH, JR.
111~
1Cf'~"3
/'"7
I
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
OOla. letter
SUBJECTffiTLE
DATE
Hillary Clinton to Barbara Mendel Mayden. [partial] (1 page)
03/31/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad - [44 U.S.C. 2204(a))
Freedom of Information Ad- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commerdal or
· tinaneiallnformation [(a)(4) of the PRA)
PS Release would dlsdose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security elassified Information ((b)(l) of the FOIA)
b(2) Release would dlselose Internal personnel rules and pradices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would dlselose trade secrets or confidential or financial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disdose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would dlsdose information concerning the regulation of
finandallnstltutlons [(b)(8) of the FOIA)
b(9) Release would diselose geological or geophysieallnformatlon
concerning wells [(b)(9) of the FOIA)
C. Closed in accordance with restridions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�---------------
THE WHITE HOUSE
March 31, 1993
Barbara Mendel Mayden
[oo\
o.1
Dear Barbara:
I appreciate your thoughtfulness in taking time to write and
provide the names of Drs. Claire M. Fagin, Linda Aiken and Mary
Naylor, nurses whom you deem well qualified to assist in the work
of the Task Force. I value your personal recommendation and will
pass the information along to the appropriate working group of the
Task Force.
/
./
/
/
/
/
/
The Inaugural week was an exciting and exhilarating time
indeed for our family, and it was so gratifying to us, knowing that
friends had come from near and far to experience the historic events
with us. I am pleased to learn of the most memorable highlights,
both for you and for your relatives from Georgia.
There have been all sorts of comments about my hat, but I
loved it, and I'm glad you did too!
Hope to see you soon.
Sincerely yours,
~ IJ__
(J"Vv
Jb~Clinwn ~fu._ ~
~ ~~ ~
~to
N----
lJ1v.,._
l ' " ( \ (.
w-e__
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
001b. letter
SUBJECfffiTLE
DATE
Barbara Mendel Mayden to Hillary Clinton. [partial] (1 page)
02/03/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number:
10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
•
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad- (44 U.S.C. 2204(a)J
Freedom of Information Ad- (S U.S.C. SS2(b)J
Pl National Security Classified Information ((a)(l) ofthe PRAJ
Pl Relating to the appointment to Federal office ((a)(2) of the PRAJ
P3 Release would violate a Federal statute ((a)(3) of the PRAJ
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRAJ
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRAJ
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information ((b)(l) of the FOIAJ
b(2) Release would dlsdose Internal personnel rules and practices of
an agency ((b)(2) of the FOIAJ
b(3) Release would violate a Federal statute ((b)(3) of the FOIAJ
b(4) Release would dlsdose trade secrets or confidential or financial
information ((b)(4) of the FOIAI
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIAJ
b(7) Release would disclose Information compiled for law enforcement
purposes ((b)(7) of the FOIAI
b(8) Release would disclose Information concerning the regulation of
financial Institutions ((b)(8) of the FOIAJ
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�[oo\ ~1
February 3, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear Hillary:
My nieces and nephew (and sister) tell me that
they met you in washington. You should be pleased to
know that you rank an admirable third on their list of
best parts of their trip - (1) riding in an airplane (2)
ice skating (they are, after all, from Macon, Georgia)
and (3) meeting the President and First Lady. Thank you
for being so gracious to them.
I was very pleased to read that you will be
spearheading the President's health care task. force.
This gives me great reason for optimism. I assume that
you are in the process of assembling your focus groups,
and also that you will be including the largest group of
health care providers, those most directly involved with
patients 24 hours a day/7 days a week - the nurses.
I am taking the liberty of submitting a few
names for your considerat.ion. These are very qualified
nurses about whom I am familiar through a colleague in my
law firm:
Claire M. Fagin, RN, PhD, recently stepped down
as Dean of the University of Pennsylvania School of Nursing. Currently president of the National League for
Nursing, Dr. Fagin co-authored the position statement on
nursing for the transition team. Her
ne numbers are
(215) 898-9581 (O) and
I
�.- .·
Ms. Hillary Rodham Clinton
February 3, 1993
Page Two
Linda Aiken RN, PhD, is Trustee Professor of
Nursing and Professor of Sociology at the University of
Pennsylvania. A past vice president of the Robert Wood
Johnson Foundation, Dr. Aiken is considered the leading
nurse-spokesperson for health and social policy. Dr.
Aiken was the second co-author for the transition's position paper on nursing. Her office phone number is (215)
898-9759.
Mary Naylor, RN, PhD, is Associate Dean and
Director of Undergraduate Studies at the University of a
Pennsylvania School of Nursing. Currently, Dr. Naylor is
a part-time legislative fellow with Senator Wofford in
Washington, D.C. Her Penn office phone number is (215)
898-8285.
These women are also in a good position to make
recommendations of other nurses from other parts of the
country.
I had a wonderful time during inauguration
week. I think the highlight of a week full of highlights
was the "ABA Friends of Hillary Dinner" where we all
looked "mahvelous" in our fancy dresses, and got a little
misty eyed toasting you (and, of course, Bill). I miss
you and wish you the best.
J
Very truly yours,
r-·b(,U"LbGL\C'-
~. \ Yl (1~_£/)
Barbara Mendel Mayden
P.S. I liked the hat.
(
IP
�----- ----------------------\
THE: WHITE: HOUSE:
WASHINGTON
March 31, 1993
Mrs. Elliott Roosevelt
7307 East Valley Vista Drive
Scottsdale, Arizona 85250
Dear Mrs. Roosevelt:
Betsey Wright has forwarded to me your letter recommending Dr. Kay Pinckard for
participation in the work of the Health Care Task Force. The Task Force includes the
Secretaries of the Treasury, Defense, Commerce, Labor, Health and Human Services, and
Veterans Affairs; the Director of the Office of Management and Budget; the Assistant to the
President for Domestic Policy; the Assistant to the President for Economic Policy; the Chair
of the Council of Economic Advisors; and the Senior Advisor to the President for Policy
Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with Dr. Pinckard's curriculum vitae to the appropriate working group.
The President and I will appreciate your support for the success of our endeavor. He
is committed l9 reforming our nation's health care system-- controlling runaway costs and
providing security to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
Sincerely yours,
�dl1.u..
7307
Ea~t
ELliott d?oo~euelt
rvaLLey
rvl~ta
March 17, 1993
1
!Duue
~A
Ms. Elizabeth Wright
1317 7th St. N.W., Suite 600
Washington, D.C. 20004
Dear Betsy:
It was such fun talking to you yesterday and I hasten
to write this letter so that me may resolve and
confirm our telephone conversations.
I am enclosing the Curriculum Vitae of Dr. Kay
Pinckard who is so highly respected in the southwest
as well as nationally for her studies and work in
pediatrics.
The health care and the treatment of
young people is of paramount importance to Kay and she
has worked long and diligently in this field since
graduating with Honors from Baylor Medical School in
1973.
I feel that her dedication and expertise in
these fields will certainly add to the President's
Task Force on National Health Care Reform chaired by
Mrs. Clinton.
It is really super that we have made our acquaintance
via the telephone and I look forward to a visit by you
in Scottsdale in the near future.
Lady, you did a great job for our President and some
day soon I expect fully to see you as Ambassadress to
the Court of St. James, at least.
Seriously, I urge you to give Kay Pinckard's CV to
Hillary Clinton at the earliest opportunity, as she
has just ended a three year term as Chairwoman of the
American Academy of Pediatrics Committee on Careers
and Opportunities. She has also, in this busy life,
found time to volunteer her time to provide medical
exams and care to children of the Navajo Nation in
Northeastern Arizona and has accompanied the American
Voluntary Medical Team on two medical missions to
Micronesia and on numerous health care screenings in
low income communities throughout Arizona.
In each
case, she utilized vacation time from her position on
i
\
I
\
�Ms. Elizabeth Wright, March 17, 1993
Page 2
staff at Phoenix Children's Hospital to pursue these
worthwhile endeavors.
As Associate Director of the Phoenix Children's
Hospital Outpatient Clinic, a primarily non-profit
facility that focuses on treating the working poor -those whose income is too much to qualify for health
care under Arizona's Health Care Cost Containment
System, but too little to be able to afford private
medical insurance
she knows all too well the
defects in the current health care delivery system.
Kay is Hillary Clinton's kind of person and I just
know they would get along marvelously.
Regarding the painting of Eleanor Roosevelt, I must
get Polaroid film and will send a photo under separate
cover.
Betsy, again, it was such fun talking to you. After
hearing Jesse George extol your virtues, I really feel
that we will be good friends. Thanks again, and I am
looking forward to hearing from you very soon. Please
come and visit me in ~ beautiful house.
With warm regards,
Tel:
Fax:
( 602) 443-3370
(602) 596-1091
P.S. Thank you for finding out.about the books I sent
to the Clinton's before Thanksgiving.
I am really
anxious to hear how they liked them, as I thought they
would be logical introductions to the White House
before they took possession on the 20th of January.
P.P.S. Remember, ~ dear, when you do sleep over at
the White House to ask for the Lincoln bedroom. As I
told you, Elliott and Rose Kennedy both slept there
but not together.
Affectionately,
~~
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
002. resume
SUBJECI'ffiTLE
DATE
Curriculum Vitae for Kelly Clark Pinkard. (Partial) (1 page)
RESTRICTION
n.d.
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 1104(a))
Freedom of Information Act -IS U.S.C. SS1(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(1) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(1) Release would disclose internal personnel rules and practices of
an agency ((b)(1) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or f"maneial
information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
-----
----------
-------
�CURRICULUM VITAE
NAME:
(Linda) Kay Clark Pinckard, M.D., F.A.A.P.
OFFICE ADDRESS:
Phoenix Children's Hospital
909 East Brill Street, Phoenix, AZ 85006
Phone: (602) 2.39-4822
DATE OF BIRTH:
November 24, 1947
PLACE OF BIRTH
Auburn, New York
MARITAL STATUS
Married: Kenneth R.
CHILDREN:
Justin Todd Pinckard,
Meghan Ashley
EDUCATION:
Undergraduate:
State University of New York at Binghamton,
Harpur College, B.A. Degree In Biology,
1965. 1969
Graduate:
The (Woman's) Medical College of Pennsylvania,
Philadelphia, Pennsylvania, 1969 • 1971
Baylor College of Medicine, Houston, Texas,
M.D. with Honors, 1971-1973
Internship:
Baylor College of Medicine Affiliated Hospitals,
Department of Pediatrics, Houston, Texas,
1973. 1974
Residency:
Baylor College of Medicine Affiliated Hospitals,
Department of Pediatrics, Houston, Texas,
1974. 1976
Fellowship:
Baylor College of Medicine, Department
of Pediatrics, Pediatric Development •
Awarded but not taken 1976 • 1977
Yoo<d-J
�'
.
CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 2
STATE
LICENSURE:
Texas: August 18, 1973 - 1989 (E 1229)
Arizona: November 27, 1987 (17256)
BOARD
CERTIFICATION
Diplomate, American Board of Pediatrics,
February 2, 1979
HONORS:
Alpha Omega Alpha, an honor medical society,
elected 1973
Graduated with Honors, Baylor College of Medicine,
1973
Outstanding Woman Graduate, elected by American
Medical Women's Association, Houston
Chapter, 1973
H.J. Ehlers Award in Surgery, Baylor College of
Medicine, 1973
AOA Award for Research: Use of the Direct
Fluorescent Antibody Test for Identification
of Bacterial Cultures, 1970
Physician's Recognition Award, American Medical
Association, 1980, 1983, 1986, 1988, 1992
J\1 EMBERS HIP IN
PI~OFESSIONAL
SOCIETIES:
Alpha Omega Alpha (honor medical society)
Fellow, American Academy of Pediatrics
Arizona Chapter of American Academy Pediatrics
Phoenix Pediatric Society
Treasurer, 1991-1992
Ambulatory Pediatric Association
Baylor College of Medicine Pediatric Alumni Assn
American Medical Association
American Medical Women's Association
Texas Pediatric Society (through 1988)
Houston Pediatric Society (through 1988)
Texas Medical Association (through 1988)
Harris County Medical Society (through 1988)
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 3
ACADEMIC
APPOINTMENT:
Associate Director Ambulatory Clinic, and full-time teaching
faculty, Phoenix Children's Hospital, 1987 • present
Clinical Teaching Staff, University of Arizona Medical College
-pending
Clinical Associate Professor, Department of
Pediatrics, Baylor College of Medicine
1985 • 1988
Clinical Assistant Professor, Department
of Pediatrics, Baylor College of Medicine,
1981 • 1985
Clinical Instructor, Department of Pediatrics,
Baylor College of Medicine, 1976 - 1981
OTHER MEMBERSHIPS
AND SERVICES: Pediatric News, Editorial Advisory Board, 1993-1996
American Academy of Pediatrics Committee on Careers
& Opportunities, 1986-1992; Chairperson 1989- 1992
AAP Council on Pediatric Practice, 1989 - 1992
AAP/AZ Chapter Day Care Committee, 1990- present
Phoenix Children's Hospital, PHAPP faculty and attending teaching
staff, 1987 - present
Ambulatory Operations Committee, 1988
Curriculum Committee, 1988 - 1990
Outpatient Care Committee, 1988 - 1991
Patient Services Task Force, 1988
Professional Advisory Committee, 1989 • present
Children's Miracle Network Telethon, 1989, 1990, 1991, 1992
Public Relations Advisory Committee, 1990 - present
Social Calendar Committee, 1991-present
Special Tracks Committee, 1991-present
Pediatric Update Conference Committee, 1991-present
Sick Child Day Care Committee, 1991
Emily Anderson Family Learning Center Operational
Advisory Committee, 1990 - present
Governor's Office for Children/School Age
Child Care Coalition, 1990 - Present
Conference Subcommittee, 1991
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 4
Good Samaritan Regional Medical Center Pediatric Committee,
1988- 1991
"Current Decisions in Infant & Children", Consultant to
Editorial Board, Health Learning Systems, Inc., 1989-1991
"Practice Management" - Reviewer
"Pediatrics" - Reviewer
Arizona Volunteer Medical Team- medical missions to
Micronesia, Arizona communities, etc; Officer and
First Vice President, 1989 - present
Primary care physician for children brought from Bangladesh and El
Salvador with cleft lip/palate and congenital heart disease
American Cancer Society Jail-a-thon, 1989
Baylor College of Medicine, Department of Pediatrics
attending teaching staff and preceptor, 1977 - 1987
Texas Pediatric Society
Accidents and Environmental Hazards Committee,
1984- 1986
The Woman in Pediatrics ad hoc Committee,
1986- 1987
Kelsey-Seybold Clinic, P.A., Houston, Texas
Executive Board, 1983 - 1985
Marketing and Practice Development, Chairperson,
1983- 1985
International Patient Relations Committee, 1978 - 1979;
Chairperson, 1979 - 1983
Professional Committee, 1978 - 1982
Finance Committee, 1980 - 1985
Pr·actice Development ad hoc Committee, 1979 - 1980
Pre-term Labor Study Committee, 1987
Texas Children's Hospital - Houston, TX
Joint Emergency Services Committee, 1983
Nursing Service Committee, 1979 - 1983
Medical Audit/Tissue Committee, 1986 - 1987
Infectious Disease Committee, 1987
St. Luke's Episcopal Hospital - Houston, TX
Newborn and Premature Records Screening
Committee 1981 - 1982
Perinatal Advisory Committee, 1982 - 1987
The Woman's Hospital of Texas - Houston, TX
Pediatric Service Record Review Committee, 1981 - 1983
Quality Assurance Control Committee, 1978-79
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 5
St. Martin's Lutheran Church, Houston, Texas
Fellowship Committee, Secretary, 1978-1980
Sunday Church School Teacher, 1978-1980, 1986
Vacation Church School Teacher, 1981, 1982, 1986
Church Council, 1985-1986
Crippled Children's Services Program, participating physician,
1983 -present, Texas and Arizona
HOSPITAL PRIVILEGES:
Phoenix Children's Hospital • Associate Staff Membership,
1987 - present
Good Samaritan Regional Medical Center - Active Staff Member
in Pediatrics, 1988 - present
Maricopa County Medical Center - Provisional Visiting Medical Staff,
1988 - present
St. Joseph's Hospital - Courtesy/Provisional, 1988 • present
Arizona Children's Rehabilitative Services • Provisional Status
and Membership on the Pediatric Staff, 1988 -present
Texas Children's Hospital - Active Staff (through 1988)
St. Luke's Episcopal Hospital - Attending Staff (through 1988)
The Woman's Hospital of Texas - Courtesy Staff (through 1988)
The Methodist Hospital - Courtesy Staff (through 1988)
Hermann Hospital - Courtesy Staff (through 1988)
PUBLICATIONS,
PRESENTATIONS AND
LECTURES:
Research Paper: "Use of the Direct Fluorescent
Antibody Test for Identification of
Bacterial Cultures", 1970
"Pragmatics of Pediatrics", October 1977
"Genetic Counseling in Pediatrics", October 1978
"The Woman in Pediatrics" Workshop at Baylor
College of Medicine Intern Retreat, September 1980, 1981, and 1982
The Tabletop Grandmother, May 1981
"Comprehensive Ambulatory Management of the High Risk Infant", Texas
~edical Assoc. Annual Meeting, May 1982; 7th Annual West Texas Perinatal
Conference, Odessa, Texas, February 1983
Conference for Women Chapter Representatives by
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 6
American Academy of Pediatrics' Provisional
Committee on Careers and Opportunities • Workshops:
"Balancing Career and Family", San Francisco, California,
May 8-9, 1987
"Immunization and Back to School" Brown Bag Lunch,
Enron Corporation, Houston, Texas, August 12, 1987
"AAP Recommendations on Pediatric Manpower" revision,
American Academy of Pediatrics' Provisional Committee on Careers
and Opportunities, May 1987; under revision, 1991
Women in Pediatrics Conference, participant and speaker,
65th Annual Meeting Texas Pediatrics Society, Houston, Texas,
September 12, 1987 ·
American Academy of Pediatrics Executive Director's Designee
to Specialty Society Luncheon of American Medical Women's
Association, 72nd Annual Meeting, Orlando, Florida, October 28, 1987
Second Conference for Women Chapter Representatives by
American Academy of Pediatrics' Provisional Committee on Careers
& Opportunities- Workshops: "Building a Support System", Chicago,
Illinois, June 25-26, 1988
"Prevalence of Cytomegalovirus Antibody in Subjects Between the
Ages of Six and Twenty-two Years", Journal of Infectious Diseases, Vol.
159, No. 6, pp. 1013-1017, June 1989
Phoenix Children's Hospital Love Magazine articles on
Pediatric Clinic, and Outreach, 1989, contributor
"Breastfeeding" combined seminar, Phoenix Children's
Hospital PHAPP core teaching lectures, 1988, 1989, 1991
"Phoenix Children's Hospital General Pediatric Clinic",
presentation to Cinquentas, 1988; Dairy Queen Conference, 1989
"Estimation of Gestational Age", Well Baby Lecture series,
Maricopa Medical Center, 1988-90, and Phoenix Children's Hospital,
1990-present
Television and radio interviews: "Immunizations", 1988;
"Back to School", 1989; "Flu", 1990; "Outreach", 1990; "Babies of Drug
Abuse", 1990; "Parents call-in to Pediatrician", 1990; "Outreach", 1990;
"Immunizations in Arizona and Pertussis Epidemic", 1990; "Arizona's
Dismal Statistics", 1991; "Kids Count Data Book", 1991; TV and radio
interviews on Pertussis Epidemic, Legislation for Health Care, Cardiac
Surgery on AVMT patient from El Salvador
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 7
AAP Annual Fall and Spring Meetings, chaired "Breakfast Forum
for Women Pediatricians", 1989- 1992
Grand Rounds PCH ''Whose Watching the Children? The
Arizona Day Care Crisis", February 20, 1990
Third Leadership Conference for Chapter Women Representatives
by AAP/COCO, presided as chairperson, April 6-8, 1990
"Delivery of Medical Care to the Third World", Phoenix Children's
Hospital Pediatric Review, Vol. 3, No. 1, pp. 12-16, Spring, 1990
AAP Spring Meeting Roundtable, "Balancing Career and Family",
May 1, 1990
AAP brochure for medical students, Pediatrics as a Career, written with
AAP/COCO, 1990
"When To Call The Doctor", Parent Pages, May, 1990, contributor
"Fluoride Supplementation", Phoenix Children's Hospital
Pharmacy and Therapeutics News, pp. 2-3, September, 1990
"Outreach Program to Isolated Towns and Navajo Reservation",
NACHRI Newsletter, Sept, 1990, contributor
"Holiday Safety", Mesa Tribune, November, 1990, contributor
AAP Annual Fall Meeting Residents' Section Roundtable "Women in
Medicine/Balancing Career and Family", October 6, 1990
AAP Annual Fall Meeting Starting In Practice Workshop
"Part-time/Interrupted Practice" and "Part-time Employment/Shared
Positions", October, 1990
Series of monthly articles on "Development in the First Year of Life",
Phoenix Gazette, February, 1990- January 1, 1991
Testified before the Arizona House of Representatives' Committee
on Health on "Children's Health Initiatives", January 1991
American Medical News article on shared practices, 1990, contributor
"Balancing Career and Family" University of Arizona
Medical School Pediatric PL 3 Resident Retreat, November 1990;
PHAPP Core Lecture Series, January 1991
"Increase in Female Medical School Applicants Good for
Pediatrics", Pediatric News, January 1991, contributor
"Hospital Works to Reverse State's Dismal Statistics", Phoenix
Children's Hospital press release, February 1991, contributor
American Academy of Pediatrics Task Force "Report on the Future
Role of the Pediatrician in the Delivery of Health Care", Pediatrics, Vol 87,
No 3, March 1991
AAP District VIII Leadership Workshop, March 1991
AAP Membership Recruitment Brochure, June 1991 ·
�CURRICULUM VITAE
Kay C. Pinckard, M.D., F.A.A.P.
Page 8
PR Videos for Phoenix Children's Hospital "Outreach to Page,
AZ", "Outreach to Indian Health Services"; "A Special
Place for Children"
AAP packet for Women in Medicine Month, contributor, September 1991
"Career Opportunities", AAP/AZ Chapter Breakfast for Women
Pediatricians, guest speaker, September 1991
Ross Roundtable "Children and Violence", participant, September 1991
"Primary Care Perspectives ·in Pediatrics", Physician Services,
The Samaritan Foundation, Medical Update V for the Primary Care
Physician, October 1991
AAP Manual on Pediatric Practice II. contributor, October, 1991
AAP/COCO Leadership Conference, AAP Annual Fall Meeting,
chaired, October 1991
AAP Starting In Practice Workshop/Career Day for Residents,
AAP Annual Fall Meeting, chaired, October 1991
AAP/COCO Booklet on Employment Issues for Medical Students
Entering Pediatric Residency, in progress
"Children and Violence" presentation of 15th Annual Pediatric Update, Phoenix
Children's Hospital/Maricopa Medical Center/AAP AZ Chapter, March 7,
1992; core lecture series, GSRMC Family Practice Residency Program,
May 19, 1992.
"Children and Violence", Audio-Digest Pediatrics, Vol 38, No 8, April 28, 1992.
"Family Violence" presentation to PCH Child Protection Committee, June 1992.
"Healthy Mothers-Healthy Babies 1992 CARE Fair", AAP/AZ Chapter participant,
July 14, 1992
AAP/AZ Chapter, Committee on Child Abuse, 1992-present
Maricopa County Coalition of Healthy Mothers, Healthy Babies C.A.R.E. Fair,
August 14-15, 1992.
Maricopa Medical Center Resident Lecture, Children and Violence, September 4,
1992
Phoenix Children's Hospital Resident Lecture, "Children and Violence",
September 18, 1992
Re\i sed 01/9.1
�THE WHITE HOUSE
March 31, 1993
Ms. Ellen Roseman-Curtis
Cooperative Adoption Consulting
54 Wellington Avenue
San Anselmo, California 94960
Dear Ellen:
I appreciated receiving your letter expressing concern that
health insurance coverage be expanded to include family building and
infertility treatment. A copy of your letter is being directed to the
Task Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you for sharing your suggestions and for your support
for the success of this tremendous undertaking.
Sincerely yours,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
003.letter
SUBJECTffiTLE
DATE
Ellen Roseman-Curtis to Hillary Clinton. [partial] (l page)
02/23/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet -(44 U.S.C. ll04(a))
Freedom of Information Aet -IS U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commerelal or
finaneial information ((a)(4) of the PRA)
PS Release would diselose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(l) Release would diselose internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or financial
Information ((b)(4) ofthe FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(S) Release would disclose information concerning the regulation of
financial institutions ((b)(S) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined In accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�ELLEN A. CURTIS
54 WELLINGTON AVENUE. SAN ANSELMO. CA 94960
(415) 453-0902
February 23, 1993
Hillary Rodham Clinton, Chairperson
Task Force on National Health Care Reform
The White House
Washington, D.C. 20510
Dear Ms. Clinton:
Growing & Learning
go hand In hand
On January 20, 1991 you and I met and talked when you and your
friend,Mary Steenburgen 1 attended the Sausalito First Presbyterian
Church near San Francisco. You had come with Mary and another
friend for a weekend stay, each with a daughter, I think I remember you mentioning that the girls were not with any of you because they opted to "sleep in."
I will always remember our conversation which covered adoption in
this country (open and closed) as well as the Children's Defense
Fund and its focus. Although I did not know you would one day be
First Lady, I will always remember the conversation as being personal, focused, and genuine. It delighted me when your husband
was elected and I knew you would be carrying on your work for families an~ children.
I believe that having a family is a fundamental right for all
Americans, regardless of class, ethnicity, medical history or any
other factor. I hope myself and others can count on your support
for expanding health care coverage so that we may realize our dreams.
Sincerely,
Ellen Roseman-Curtis
COOPERATIVE ADOPTION - A LOVING OPTION
�(
•
..•
.' ..
CODER:_ _
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAL SORT:
_Personal stories
POSTCARD 1:
_Letter Campaign
_Other Health Providers
POSTCARD 2:
_Offers to help/Employment
FORM LETI'ER:
_Letterhead
_Policy
REROUTE:
_Casework
_Scheduling _President
_Jihy&icilm&
_Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (ll)
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTURE/WORKFORCE (ill)
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_ DoD
_Indian health
_COST ISSUES (VI)
_drug prices
__physician fees
_hospital fees
. _medical equipment
_fraud & abuse
_FINANCING
(VII)
_MENTAL HEALTH (IX)
_LONG-TERM CARE (X)
_PUBLIC HEALTII/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OTHER._________________________
�THE WHITE HOUSE
March 31, 1993
Thomas W. I..angfitt, M.D.
President
The Pew Charitable Trusts
One Commerce Square
200S Market Street, Suite 1700
Philadelphia, Pennsylvania 19103-7017
Dear Dr. l..angfitt:
I appreciate your offer to send me a copy of The Pew Trusts'
recommendations for health care reform when they have been
finalized. This will be helpful both to me and to the Task Force as
we consider various options in finding solutions to the incredibly
complex health care issue.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
We will appreciate your continuing support for the success of
this enormous undertaking.
Sincerely yours,
�- -
THE PEW CHARITABLE TRUSTS
One Commerce Sq11are
2005 Market Street. S11ite 1700
Philadelphia, Penmylvania 19103-7017
Thomas W. Langfitt. M.D.
President
Direct Telephone: 215.575.4710
Telephone: 215.575.9050
Facsimile: 215.575.4939
February 24, 1993
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Dear Mrs. Clinton:
I appreciated the opportunity to speak to you at Senator
Wofford's health reform meeting in Harrisburg last week.
For several years The Pew Trusts have supported a Health
Professions Commission which has recommended profound changes in
the way physicians and other health professionals are educated and
trained so that they will be more responsive to the health needs of
the public. Toward that end, we are in the process of preparing a
number of specific recommendations for federal action for health
care reform. They link the development of a system of universally
accessible primary care to a shift in the current level of
resources away from educating and training specialty-based health
care practitioners to producing a greatly increased pool of primary
care givers.
The result should be real cost containment in a
system with improved quality. As you requested, I will send you
these recommendations in the near future.
Again, my best wishes for the success of the crucial and
difficult work you are undertaking.
Please call upon me or the
staff of the Trusts at any time if you believe we can be helpful in
your endeavors.
/v:'v,
!
Th~:s
I
J~
w.iLangfitt, M.D.
TWL:dm
cc:
Melanne Verveer
The Peu' Memorial Tmst
The]. Howard Pew Freedom Tmst
The Mabel Pew Myrin Tmst
The]. N. Pew Jr. Charitable Tmst
The Medical Trust
The Mary Anderson Trust
The Knoi/Brook Trust
�-·
THE. WHITE. HOUSE.
WASHINGTON
March 31, 1993
Daniel B. Kopans, M.D.
Department of Radiology
Massachusetts General Hospital
Boston, Massachusetts 02114
Dear Dan:
I greatly appreciated receiving your letter with the copy of your letter regarding breast
cancer screening to Dr. Bernadine Healy enclosed.
Thank you for your offer of assistance to the Health Care Task Force. The Task
Force includes the Secretaries of the Treasury, Defense, Commerce, Labor, Health and
Human Services, and Veterans Affairs; the Director of the Office of Management and
Budget; the Assistant to the President for Domestic Policy; the Assistant to the President for
Economic Policy; the Chair of the Council of Economic Advisors; and the Senior Advisor to
the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to hear from knowledgeable and concerned people like you - people
with firsthand experience or particular expertise in the health care field. I am sending your
letters along to the appropriate working group. Again, thank you for your offer of assistance
and your contipued support for the success of our endeavor.
Your positive comments about the President and me are uplifting indeed. Both of us
are committed and more than willing to make whatever sacrifices are necessary as the new
Administration implements its agenda to get our country moving in the right direction again
and make a significant difference for Americans.
Sincerely yours,
�MASSACHUSETTS GENERAL HOSPITAL
DANIEL B. KOPANS, M. 0., F.A.C.R.
Associate Professor of Radiology
Assistant Director of Ambulatory Care Radiology
Director of Breast Imaging
HARVARD MEDICAL SCHOOL
•
Massachusetts General Hospital
Department of Radiology
Boston, Massachusetts 02114
Tel. (617) 726-3093
January 27, 1993
Ms. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW.
Washington, D.C. 20500
Dear Hillary:
Please forgive my informality. I dated Kit Schneider (Tower Court and Bates) through
most of college. Kit was a good friend of Eldie Acheson and, given the amount of time I
spent at Wellesley, I'm sure we met. Al Gore was a classmate in Dunster House, and
Roger Altman was the goalie on my lacrosse team in high school. Government certainly
seems less abstract as I think back to those days and now see faces from the past at the
pinnacle of responsibility.
I am writing to wish you well in your effort to reform the health care system. As you know,
breast cancer is a major health problem as the leading cause of non-preventable cancer
death among American women. Screening, and access to it, for all women is likely to be
one of the issues that you will consider in your planning. As a leading expert in breast
cancer detection and diagnosis in this country I would be happy and honored to assist you
in any way with questions you may have concerning this important health challenge. The
National Cancer Institute is hosting a meeting next month to review the data on screening.
The issues are complex, and I am enclosing a copy of a letter I wrote to Dr. Bernadine
Healy that addresses a few of the problems.
I admire youP strength and determination. I cannot imagine the pressures that you and the
President are under, but I am impressed by the grace and confidence with which you both
have handled the problems you have faced.
Once again, best wishes. I hope that you will feel free to call on me.
srryours,
'/
'
'i
J
{/\;;;./--~
Daniel B. Kopans, M.D.
�MASSACHUSETTS GENERAL HOSPITAL
HARVARD MEDICAL SCHOOL
DANIEL B. KOPANS, M. D., F.A.C.R.
Associate Professor of Radiology
Assistant Director of Ambulatory Care Radiology
Director of Breast Imaging
I
T
'
•
v.
Massachusetts General Hospital
Department of Radiology
Boston, Massachusetts 02114
Tel. (617) 726-3093
December 2, 1992
Bernadine Healy, M.D.
Director
The National Institutes of Health
Bldg. 1 Room 126
9000 Rockville Pike
Bethesda, Maryland 20892
Dear Dr. Healy:
I am writing in follow-up to a letter that I sent last spring concerning breast cancer
screening. At that time there was a great deal of discussion concerning the anticipated
results of the National Breast Screening Study of Canada (NBSS). As I am sure you are
aware, the results have just been published (1,2) and I understand that the National Cancer
Institute will be convenmg a meeting to review the data to decide whether screening
guidelines should be altered. Since I am not sure that I will be invited, or if invited will be
able to attend, I wanted to express my concerns about this study as well as the 9uestion of
screening guidelines. In case you have not had a chance to reVIew the publications, the
investigators concluded that there was no benefit from screening women 40-49 with either
mammography or physical examination, and that mammography did not add to ehysical
examination screening for women 50-59. This was a large study, and as such is likely to
have significant im.Pact. Unfortunately, there are major problems with the design and
execution of the tnal that raise serious questions about the validity of its results.
MAMMOGRAPHIC QUALITY IN THE NBSS
I have had direct involvement with the NBSS having spent considerable time over the years
with the principal investigators as well as having been asked by them to review the quality
of the mammography with two other radiologists. Our review confirmed that, for much of
the trial, the mammography was of poor quality. The NBSS published the results of our
review (3,4) and this clearly showed that through the fourth year of the trial more than 50%
of the mammographic studies were graded as poor or unacceptable. Since this was a study
purportedly designed to evaluate mammograpby, it is surprismg that the performance of
the test itself had not b.een given priority.
The quality of the mammography had certainly been a concern to outside advisors since the
planning phases of the trial in the late 1970's. Laszlo Tabar, the principle investigator of
the Swedtsh Two County Trial and a leading expert in mammography, had urged that the
NBSS require quality mammograms from the participating centers. He offered to train the
technologists and radiologists (5), but his concerns were ignored and his offer rejected.
Despite the fact that the nurses who performed the clinical breast examinations for the
NBSS underwent special, intensive training (6), there was no training for the technolo~ists
performing the mammograms, and no training for the radiologists who were interpretmg
the images. Furthermore, the sites were permitted to utilize whatever mammo~aphic
equipment they had available, and the quality control monitoring by the NBSS mvolved
primarily the maintenance of low doses. This latter concern meant that scatter reduction
�grids were not employed for much of the trial with the attendant loss of image quality (see
enclosure). Dr. Wende Logan Young (Rochester N.Y) was enlisted as an advisor to the
NBSS. She was concerned about image quality, but was repeatedly denied access to the
images. As a consequence she resigned. Dr. Stephen Fei~ (Philadelphia, PA) was then
brought in as an advtsor. He was permitted to review the Images and expressed his concern
over the poor image quality. When his concerns were ignored he, too, resigned.
Poor image quality reduces the ability to fmd small cancers. Problems found with the
NBSS images included poor exposures, unsharp images, and areas of the breast that were
not even included on the mammogram due to poor positioning. The NBSS's own
"reference" radiologist found that the untrained "Center" radiologists overlooked numerous
cancers. In fact, he reported that 25% of the cancers that were ultimately diagnosed in the
screened group should have been detected on mammograms 1 - 5 years earlier (7). These
were cancers that were visible on the mammograms, but had been missed. There has been
no estimate of how many additional cancers could have been detected earlier if more
breast tissue had been included on the mammograms with better positioning by trained
technologists.
ADVANCED CANCERS AND PROBABLE RANDOMIZATION ERRORS IN TilE
NBSS
There are significant other problems that are apparent in a review of the published data.
What many oo not realize is that the NBSS did not use a blind randomization. In order to
increase the statistical power of the study, symptomatic women were permitted to
participate and allocations occurred after a physical examination. The investigators cannot
explain how, but significantly more advanced cancers (women with positive nodes) were
"randomly" assigned to the screened groups. This disproportionate "loading" of the study
group with women with poor prognoses amounted to a 30% difference in the prevalence
year (at the time of randomization). This difference actually increased over the incidence
years so that for women 40-49 there were, overall, 102 women in the screened group with
positive nodes at the time of diasnosis as compared to 66 women in the control group. This
not only indicates faulty randoiillZation, but tlie fact that the number of excess advanced
cancers increased over the course of the trial rather than converging suggests that the poor
quality of the screen actually resulted in a delay in diagnosis for many of the screened
women. Delayed diagnosis occurs among screened women when they are falsely reassured
by a negative screen. This phenomenon has been documented in a screening program in
Finland (8). When a breast problem occurs between screens they may delay seeking
attention assuming that, since they had had a negative screen, they could not have breast
cancer or they delay seeking evaluation awaiting the next screen. Counterparts in the
control group, without such false reassurance, seek help earlier and are diagnosed sooner
when a problem develops.
The problem of false reassurance would be amplified by poor quality mammography.
Coupling the failure to detect a cancer at a smaller size and earlier stage with false
reassurance and delayed diagnosis could convert a curable cancer into an advanced stage
and incurable process. If the assignment in the NBSS had been random, then there should
ultimately have been the same total number of advanced cancers in each group (assuming
no benefit from screening). Not only were there more in the prevalence year among the
screened women, but rather than decreasing over time, the disparity increased. These
results suggest faulty randomization in addition to poor mammography failing to detect
cancers earlier.
A further suggestion of faulty randomization lies in the observation that, among women 5059, if the women who died from cancers detected in the prevalence year- when faulty
�randomization would have the greatest impact - are eliminated, the mammography group
actually had a 30% reduction in mortality compared to the physical-examination-only
control group over the "incidence" years.
The investi~ators insist that there was no problem with the randomization since there is a
balanced distribution of other demographic factors. What they have ignored is the fact that
a shift of women with advanced cancers to the screened group would not have any impact
on the demo~aphic distribution of the other thousands of women in the study. The fact
that the surv1val for control women 40-49 at five years is 90% when the background survival
for women in Canada is 70-80% at five years suggests that some of the advanced cancers
may have been shifted to the screened group proaucing an abnormally high survival rate
among the controls.
WHY WAS CANCER SIZE DISTRIBUTION IN THE NBSS NOT REPORTED ?
The excess of advanced stage cancers in the screened women was even ~eater than
reported by the investigators. It is extremely unusual that the authors d1d not include the
size distribution of the cancers in this trial. Based on their previous presentations at
meetings, the number of advanced cancers in the screened group was much greater than
the papers would indicate. Instead of the 49% stage ll implied by nodal status alone
among women 40-49, 65-75% of the cancers eventually "detected" by their poor quality
screen were stage ll or worse if size is included. Such a high percentage ofadvanced
cancers would confirm the poor quality of the screen.
ASCERTAINMENT OF MORTALITY AMONG CONTROL WOMEN
Another possible reason for the apparent high survival rate among the controls may lie in
ascertaimng cancer deaths among these women. The investi~ators have no direct follow-up
of the control women, but must rely on linkages to other national databases to try and
determine who has died, and what were the causes of death. Either their control group has
an exceptional and inexplicable survival record, or there has been a transfer of advanced
cancers from the screened group to the controls, or they have under-ascertained deaths
among the controls.
WHY VAUDITY FOR 40-49 AND NOT 50-59?
The poor quality of the mammo~aphy in this trial is reflected in the fact that it did not
even show the benefit for scree~ women 50-59 with mammography that other programs
have clearly demonstrated. I find 1t surprising that Prof. Miller stated on Canadian
television that he would, nevertheless, recommend women 50-59 be screened because other
studies have shown this to be efficacious. H the quality of the mammography was so poor
that it is not valid for "older women", where mammography is more sensitive and specific,
how can we expect it to have any validity for younger women?
"BUT IT'S A LARGE STUDY"
Those who insist that the size of the study eliminates the major problems with its design
and execution fail to understand the importance of the technical issues involved in
mammography screening. The enclosed example demonstrates the difficulty in perceiving
a large cancer with poor mammography. Perceiving small cancers would, obviously, be
even more difficult. A large number of poor quality mammograms is no better than a small
number of poor quality mammograms. It merely means that more cancers will not be
detected at an earlier stage. Enormous time, effort, and resources were spent on the NBSS
and it is truly unfortunate that the results have little validity given the basic and critical
�---
-------~
flaws in this study, but these flaws were pointed out repeatedly since the outset and were
ignored by the investigators. It would mlly compound these errors if the results are used to
withdraw support for screening women 40-49.
IS THERE A BENEFIT FROM SCREENING WOMEN 40-49 ?
Those who oppose screening women 40-49 cite the lack of data to demonstrate an absolute
benefit for these women. This is a specious and disingenuous argument. What they neglect
to acknowledge is that no studies have been properly designed (with the appropriate
statistical power) or executed (appropriate image quality, screening interval, and
interpretive expertise) to answer this question. With the exception of the NBSS, all the
other studies have been retrospectively stratified by age, and fiave lacked the statistical
power and study design to even address the _question. Even the NBSS was designed with a
statistical power that could only detect a 40% or greater benefit and this is larger than
should have been expected. Furthermore, 25% of the "control" women 40-49 underwent
mammograph}' further illluting the power of the study. Their analysis actually comes too
soon with insufficient follow-up.
In fact there are data that show that there is benefit from screening younger women. This
was seen in the Health Insurance Plan of New York study (9) where there were 25% fewer
deaths in the screened women age 40-49. A recent analysis of all the Swedish screening
programs is now showing a 13% mortality reduction for women 40-49 even thouJdt the
screens were not optimized for these women. The curves appear to parallel the lnP results
(10). The benefit for younger women does not appear as qwckly as for older women. This
is likely due to the fact that breast cancer is not as rapidly fatal among younger women
(11). It takes 7-8 years before deaths among the unscreened women begin to exceed the
controls. This "delayed" benefit is no less important merely because it does not occur
immediately. It is a reflection of the fact that mammographic screening and earlier
detection can down-stage cancers among women at all ages, and this translates into
deferred mortality.
SCREENING INTERVAL
Screening guidelines for women 40-49 should be modified. The option of mammography
every 1-2 years should be changed to annual screening. The present guidelines are the
result of a "political" decision made in the early 1980's. As a response to the varied, and
sometimes conflicting guidelines that were promulgated by various medical organizations
that were confusing women and their physicians, a consensus meeting was held. A few
organizations, including the NCI, did not want to support any mammographic screening for
women 40-49. In order to produce a consensus, and despite concerns raised by many of us
who had studied the questton, the compromise of every 1-2 years was reached. The
available data suggest that mammography can detect breast cancer, on average, 2 years
before a woman m her forties will feel the tumor (12,13). A two year interval between
screens means that screening will detect the cancer at about the time the woman will feel it.
Thus, a two year screening interval will only slightly advance the time of detection. If we
are going to expend the effort and resources to screen women in their forties, they should
be screened every year.
I know that there are those at NCI who have been waiting for the results of the NBSS to be
made public so that those data can be used to withdraw support for screening women 4049. There may be legitimate economic arguments to do so, but opponents of screening
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should not invoke ..science.. as having not shown benefit. Until biostatisticians can devise
faster, more valid methods, the randomized controlled trial is the only method we have for
assessing the question of efficacy. However, simply because a study is randomized with
controls does not guarantee its validity. One cannot merely put women into the front end
of a trial and expect that, since it is ..scientific.., what comes out the end is ..truth... The
parameters of the performance of the trial are critical to the validity of the results.
There are legitimate concerns over the cost of screening, but before we decide not to
screen because it is too expensive, we should develop more efficient and cost effective
approaches as long as they do not compromise earlier detection.
Thank you for taking the time to read these comments. If you have any questions please
don't hesitate to call me.
Wif.
~el
B. Kopans, M.D.
cc.
Peter Greenwald, M.D.
Vivian W. Pinn, M.D.
Samuel Broder, M.D.
Senator Albert Gore
References
1. Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 1.
Breast Cancer Detection and Death Rates Among Women Aged 40-49. Can Med Assoc J
1992;147;1459-1476.
2. Miller AB, Baines CJ, ToT, Wall C.Canadian National Breast Screening Study:2.
Breast Cancer Detection and Death Rates Among Women Aged 50-59. Can Med Assoc J
1992;147;1477-1594.
3. Baines CJ, Miller AB, Kopans DB, Moskowitz M, Sanders DE, Sickles EA, ToT, Wall
C. Canadian National Breast Screening Study: Time-related changes in Mammographic
Technical Quality- An External Review. AJR 155:743-747, October 1990.
4. Kopans DB. The Canadian Screening Program: A Different Perspective. AJR 155:748749, October 1990.
5. Personal communication from Laszlo Tabar, M.D.
6. Miller AB, Baines CJ, Turnbull C. The Role of the Nurse-Examiner in the National
Breast Screening Study. Can J Public Health 1991;82:162-167.
7. Baines CJ, McFarlane DV, Miller AB. The Role of the Reference Radiologist.
Estimate of Inter-Observer Agreement and Potential Delay in Cancer Detection in the
National Breast Screening Study. Invest. Radiology Vol. 25. 1990:971-976.
8. Joensu H, Klemi PJ, Tuominen J, Rasanen 0, Parvinen I. Breast Cancer Found at
Screening and Previous Detection by Women Themselves. Letter to the Editor Lancet
1992;339:315.
9. Shapiro S, Venet W, Strax P, Venet L Periodic Screenin\{ir Breast Cancer: The
Health Insurance Plan Project and its SeQ.Uelae. 1963-1986.e Johns Hopkins University
Press, 1988.
10. Tabar et al in Press. Data presented at the Swedish Medical Society Meetings Nov. 26,
1992.
11. Adami H, Malker B, Holmberg L, Persson I, Stone B. The Relation Between Survival
and Age at Diagnosis in Breast Cancer. New Engl. J. Med. 1986; 315:559-563.
--
�12. Moskowitz M. Breast Cancer: Age-Specific Growth Rates and Screening Strategies.
Rad. (1986) 161:37-41
13. Tabar I., Faberberg G, Day NE, Holmberg L. What is the Optimum Interval Between
Mammographic Screening Examinations? - An Analysis Based on the Latest Results of the
Swedish Two-county Breast Screening Trial. Br. J. Cancer 1989,55:547-551
�------------
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THE WHITE HOUSE
March 31, 1993
Jack B. McConnell, M.D.
Volunteers in Medicine Clinic
P. 0. Box 23287
Hilton Head Island, South Carolina 29925
Dear Jack:
Thank you for your letter to follow up on our conversation at
Renaissance Weekend. The President and I really appreciated your
sharing the concept and practice of the Volunteers in Medicine
Clinic. I am pleased to receive the additional infonnation provided
in your letter and have passed a copy of it along to the Task Force.
The President is committed to reforming our nation's health
care system -- controlling runaway costs and providing security to
every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining
quality medical care and preserving the choice so important to us all.
Again, thank you for your suggestions and for your continuing
support as we develop solutions to this incredibly complex issue.
Sincerely yours,
�VOLUNTEERS IN MEDICINE CLINIC
P. O.Box 23287
Hilton Head Island, South Carolina 29925
Telephone 803 681-6612 Fax 803 681-66J.I
February 5, 1993
Ms. Hillary Rodham Clinton
The White House
Pennsylvania Avenue
Washington, DC
Dear Hillary,
Pursuant to your new assignment in the health care field, I wish to update you on an idea
we discussed at the Renaissance Weekend over New Years, in which you seemed to be
interested.
You may recall that I visited briefly with Bill, and then with you (inexplicably calling you
Valerie) at the recent Renaissance Weekend on Hilton Head. I was introducing the two of
you to the Volunteers in Medicine Free Clinic which a group of retired professionals on
Hilton Head are developing.
Our Mission is to understand and serve the health and wellness needs of the medically
underserved population segments who live or work on Hilton Head Island using the
retired health care professional community to staff the clinic.
Our scope of services includes the following: primary health care, physical examinations,
inoculations, special disease diagnostics and treatment clinics, target-community medicine,
pre-natal and well baby clinics, and consultation on the wellness issues of the target
population. Screening and referrals to the more comprehensive medical and social
resources of the island and county, when necessary, are primary functions of the Clinic.
.
In the course of this we will be addressing three questions:
•
Do the retired physicians, nurses and dentists represent a new and untapped
resource for the delivery of no-cost/high-quality medical care?
•
What must a community or State do to facilitate the development of a clinic using the
retired professionals?
•
What difference in health and wellness can we demonstrate in the target population by
our efforts?
A Not-For-Profit Clinic No"' Being Established for the MedicaUy Undersened on Hillon llead Island
�--------- .--------
As I mentioned to you and Bill, essentially as many physicians retire as enter medical
school each year. If we can provide the proper environment for them to donate their
services free of charge in a not-for-profit clinic, we could, in four yours, have as many
physicians providing free care as are now training in the medical schools.
Since the inception of the idea a year ago we have:
•
Incorporated
•
Obtained a 501(c)(3) designation (in six weeks)
•
Obtained malpractice coverage for the health care professionals donating their time
•
Obtained a grant of $50,000 from the Robert Wood Johnson Foundation for the
development of the project
•
Encouraged the 1992 South Carolina General Assembly to pass an amendment
directing the Board of Medical Examiners to promulgate regulations leading to the
creation of a "Special Volunteer License" (which I believe to be the first in the United
States) for physicians wishing to donate their services free of charge in a not-for-profit
clinic.
o
Structured an Honorary Board and Operating Board of outstanding citizens from the
Town ofHilton Head and across the state.
During this same time we have recruited 44 Physicians, 55 Nurses, 8 Dentists, 2
Chiropractors, and 2 Nutritionists all of whom are residents ofHilton Head Island.
While we have a large number of retired medical personnel on Hilton Head Island, we are
developing the program so that a free clinic can be developed anywhere using only one
physician and one nurse providing malpractice coverage, a special volunteer license, a
facility, and funding (by local community) are made available.
The Town ·council of Hilton Head has just voted to provide a 1.1 acre piece of land for
the siting of our free clinic. Design plans are now underway and we hope to be open by
early fall.
Not a dime of Federal, State, County, or Local Government funds has been involved,
with the exception of the grant of land. It is an idea that started from a need and
developed by ordinary citizens in response to that need.
�Hillary, I hope you have forgotten my calling you "Valerie", but I hope you have not
forgotten the idea I presented. I feel strongly that we must ask more of all sectors of
society, especially the recently retired. We are able, experienced, mature and, for the most
part, willing to give back to society some of that which has been given to us.
I have provided you only a brief description of the Volunteers in Medicine clinic. If you
would like to know more, please let me know and we will provide whatever you want or
need.
Our best wishes to you in your attempt to reorganize our health care system.
Sincerely yours,
~B~MD.
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004a. letter
DATE
SUBJECTfi'ITLE
Hillary Clinton to George H. Bergdoll. [partial] (1 page)
03/3111993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence (3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Freedom of Information Act- (S U.S.C. SS2(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commereial or
financial Information ((a)(4) of the PRA)
PS Release would diselose confidential advice between the President
and his advisors. or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(2) Release would disclose Internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
Information ((b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) ofthe FOIA)
b(8) Release would disclose Information concerning the regulation of
finaneial institutions ((b)(8) of the FOIA)
b(9) Release would diselose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
I
I
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THE WHITE HOUSE
March 31, 1993
George H. Bergdoll
,
Director of Development
and Public Relations
United Methodist Family Services
3900 West Broad Street
Richmond, Virginia 23230
Dear
George:
I am grateful for your affirmation of my role in tackling the
health care issue. The President is committed to reforming our
nation's health care system- controlling runaway costs and
providing security to every American family. It won't be easy and it
won't happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
We will appreciate your continuing support as the new
Administration develops solutions to the incredibly complex issues
before us.
Sincerely yours,
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
004b. letter
SUBJECTffiTLE
DATE
George H. Bergdoll to Hillary Clinton. [partial] (1 page)
02/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Reeords Act - (44 U.S.C. ll04(a))
Freedom of Information Act- (5 U.S.C. 552(b))
PI National Seeurity Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(l) of the PRA]
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade seerets or confidential commercial or
fmancial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA]
b(l) National security classified information ((b)(l) of the FOIA]
b(l) Release would disclose internal personnel rules and practices of
an agency ((h)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
Information ((h)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((h)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal reeord misfile defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�.._..
,.
.....
..... ,.
/~-;.,
United Methodist Family Services
3900 West Brood Street. Richmond. VA 23230
FAX (804) 355-2334
(804) 353-4461
SINCE 1900
February 10, 1993
Mrs. Hi 11 ary Rcdham Clinton
The White Hause
1600 Permsylvania Avenue
washinqtcn, IX: 20500
It is great to kna.i' that you are dimcting the efforts of the new
National Health Pl:OCJLam. The country is very fortunate to have you in such an
iDpartant position. One of the areas that is of gmat concem is health em
far yamg people just out of high school, or college, who can not afford
health benefits.
1/
i
I
I
I am DDSt illpressed with the way Bill has handled
issues sillce heccmi ng Pl:esident.
SCDe
very difficult
I will keep you advised on the elderly project which includes the day ·
care center. You kna.i' of nw willingness to serve on airJ carmi.ttees that would
be of benefit to you, or Bill, dealing with children or elderlyissues.
The country is very fortunate to have the Cl.intons in the White Bouse at
this time.
GBB/tjp
UMFS Tidewater Reglonol Center
715 Boker Road, Suite 201. Virginia Beach, VA 23«l2
(804) 490-9791
UMFS Northern Vlrglnla Regional Center
6335 Uttfe River Turnpike, Alexandria, VA 22312
(703) 941-9008
�----- - - -
THE WHITE HOUSE
WASHINGTON
March 31, 1993
Ark Monroe, ill, Esquire
Mitchell, Williams, Selig,
Gates & Woodyard
320 West Capitol Avenue, Suite 1000
Little Rock, Arkansas 72201-3525
Dear Ark:
Thank you for forwarding to me the resume of Paul W. Willihnganz for participation
in the Health Care Task Force. The Task Force includes the Secretaries of the Treasury,
Defense, Commerce, Labor, Health and Human Services, and Veterans Affairs; the Director
of the Office of Management and Budget; the Assistant to the President for Domestic Policy;
the Assistant to the President for Economic Policy; the Chair of the Council of Economic
Advisors; and the Senior Advisor to the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter with the attached letters and resume to the appropriate working group.
The President and I will appreciate your support for the success of our endeavor. He
is committed to reforming our nation's health care system-- controlling runaway costs and
providing secqrity to every American family. It won't be easy and it won't happen
overnight, but we can bring costs under control while maintaining quality medical care and
preserving the choice so important to us all.
Perhaps our paths will cross at sometime while you are working in Washington.
Sincerely yours,
I
I
I
I
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LAW OFFICES
MITCHELL, WILLIAMS, SELIO, GATES
& WOODYARD
320 WEST CAPITOL AVENUE, SUITE 1000
l.rrri.E Roox, .ARKANsAS 72201·3525
TELEPHONE 501-688-8BOO
TELEPAX 501-688-8807
1420 NBW YoBX AVEN1J'1!, N.W, StnTB 7t10
WASHINGTON, D.C. 2000tl-2122
T~HONE202~7~00
TELBFAX 202~7-7tl00
ARK MONROE, Ill
OIRECT
CIA~
501·688·8833
100 WJ!Hr CENTRAL AVENUE
POST OPPlCE Box 6tl8
BENTONVILLE. ABx.ufBAS 72712-oBt\8
T~HONE tl01·273-9t161
TELBFAX ti01·27IJ.Ot127
February 1, 1993
IBI~I&:::::::I::::::::a&IIBUI
Mrs. Hillary Rodham Clinton
The White House
1600 Pennsylvania Avenue, NW
Washington, D.C. 20500
Dear Hillary:
Congratulations on agreeing to head the task force on
health care reform for the administration. I remember quite well
our discussion on this subject back in August of 1991 at the
National Governors• Association conference. It seems like that
was the last time we had a chance to visit at any length before
the campaign began. Nancy and I had a wonderful time at the
inauguration and appreciate all that you did for us during that
week.
I am enclosing a resume that was forwarded to me by
Donna Mundy, a close friend from Portland, Maine, regarding Paul
w. Willihnganz who has an interest in working with Judy Feder on
the health care reform. I am also enclosing information
regarding his background. If I can supply additional
information, please let me know. Thank you for your
consideration of this recommendation.
I look forward to seeing you soon. I am spending a
great deal'of time in Washington because I am currently
representing the District of Columbia Insurance Superintendent
regarding his supervision of the Blue Cross and Blue Shield plan
in the District of Columbia. If you ever need to get in touch
with me, you can reach me at my office in washington.
Sincerely,
Ark Monroe, III
TAM:la
Enclosures
cc: Donna T. Mundy
---.
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••
,/
1.
Paul W. Willihnganz
Attorney at Law
5214-F Diamond Heights Blvd., Suite 601
San .Francisco, California 94131
Telephone (415) 206-9229
Facsimile (415) 206-0414
December 9, 1992
PERSONAL
Ms. Donna Mundy
Vice President, External Affairs
UNUM Life Insurance Company of America
2211 Congress Street
Portland, Maine 04122
Dear Donna:
It was good talking with you, and.! really do miss
Sugarloaf.
I sincerely appreciate your willingness to serve as a
reference in my quest, and your offer to contact the Mitchell law
firm in Little Rock on my behalf.
Along with the resumes you requested, I am enclosing a copy
of my letter to Senator Mitchell that summarizes my goals, his
reply letter and his letter to Judy Feder recommending me.
Together with your recommendation, I would appreciate any
information you can provide regarding UNUM's position and
industry positions on the new Administration's health care reform
agenda.
Again, many thanks.
You are a true F.O.P.
Very truly yours,
Paul
w.
Willihnganz
�I. ..
I
·------------
. ,.
I
Paul W. Willihnganz
I
55 Ora Way, Apt. B-108
San Francisco, California 94131
Home: (415) 282-7143
Office: (415) 206-9229
November s, 1992
PERSONAL
The Honorable George J. Mitchell
Majority Leader's Office
United States Senate
Washington, DC 20510
Dear Senator Mitchell:
I once told you I wanted to serve in government someday-after Joseph and Heather finished college (now done) and
when there is a real need I could fill.
With the election of Bill Clinton, the need is there and
"someday" is now. I would like to join the Clinton team.
I know the health insurance industry from the inside, and
I share Governor Clinton's conviction that our health
care system needs fundamental change. I could help shape
that change and enlist the support of the key players--or
take them on if need be. With my business and legal
background, I could work effectively with the insurance
industry, the health care industry and the trial lawyers.
And I would enjoy working with you, your staff, and my
Georgetown Law classmate Mickey Kantor.
If you would recommend me to President-elect Clinton or
put me in touch with the appropriate people on his
transition team, I would be most grateful.
Hope to see you in Washington.
Sincerely,
Paul
w.
Willihnganz
�.. . ..
Gr:ORGE J. MITCHEll
'·
• MAINE
1lnittb jltattl jtrnatt
$fhtt of tbt .fl\aioritp lrabu
•••b•n~ton,
Ja( 205\o-7010
November 25, 1992
Mr. Paul Willihnganz
55 Ora Way, Apt. B-108
San Francisco, CA 94131
Dear Paul:
Thank you for informing me of your interest in serving with
the Clinton-Gore administration. My colleagues in Congress and I
are looking forward to working with the new Administration to
produce real and positive change.
I have personally forwarded your resume and expressed your
interest in serving with the new Administration to Judith Feder,
Director of Health Policy for the transition team. Enclosed
please find a copy of my letter to Ms. Feder for your
information.
Again, thank you for your letter and for your interest in
serving with the new Administration. I hope that my efforts on
your behalf prove helpful in the weeks ahead.
Si~
George J. Mitchell
•
�' •'GEOA'Ge J. MITCHELL
MAIN I
11niteb litatel lienate
emcc of tbc jlajaritp lcabcr
•••bia;aon,
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205\o-7010
November 24, 1992
Ms. Judith Feder
Director for Health Policy
Presidential Transition Office
P.O. Box 8086
Little Rock, AR 72203
Dear Judy•
Congratulations on your appointment to the Clinton-Gore
transition team. As you know, you and your colleagues have an
extremely important task before you in seeking individuals who
possess the talents, abilities and dedication necessary to
effectively serve with the new Administration and to work for
real change in America.
As you continue moving into the transition period, I would
like to recommend to you such an individual, Mr. Paul
Willihnganz. Paul has expressed to me his interest in serving
with the Clinton administration, and I believe he could provide
valuable insight and expertise on the health care and health
insurance industries .
.I have known Paul for many years and not only have the
highest regard for his integrity, but I also know he is firmly
committed to President-Elect Clinton's vision of a fundamentally
reformed health care system. I have enclosed Paul's resume for
your information, and would welcome the opportunity to provide
additional thoughts on his qualifications. Please don't hesitate
to call me should you feel this necessary.
·-- --·
•
~Y·~c£/
George J. Mitchell
�'
•
I
"''
•
•
PAUL W. WILLIHNGANZ
55 Ora Way, Apt. B-108
San Francisco, California 94131
Home: (415) 282-7143
Office: (415) 206-9229
Fax: (415) 206-0414
April 1992-Present
LAW OFFICES OF PAUL W. WILLIHNGANZ
San Francisco, California
Counsel life insurance companies (including my former employers, American General and UNUM) regarding
legislative, regulatory and risk management matters related to life and health insurance. Represent clients in
_litigation. Serve on the California Insurance Commissioner's Advisory Task Force on Unfair Claims Practices.
Although I am extremely busy with profitable legal work, it was never my intention to have a limited private
practice-something I left behind years ago. I would now like to use my background as a senior executive in the
life insurance industry to help the Clinton administration attack and resolve America's health care crisis.
April1991-April1992
KORNBLUM, FERRY & FRYE, P.L.C.
San Francisco, California
Shareholder
While serving as General Counsel of American General Life Insurance Company, I was invited to become a senior
shareholder of this San Francisco based, 33 lawyer insurance litigation firm. I accepted because the position offered
an attractive challenge, a substantial increase in compensation, and an opportunity for equity participation in a
growing, prosperous firm representing some of the country's leading insurers. Although I accepted this offer in
December 1990, we agreed that I would delay joining the firm until April1991 in order to give Bob Devlin, my
CEO at American General, time to conduct a search for my successor.
When I arrived in April, things bad changed. A serious rift bad developed between principals Kornblum and Frye.
Mr. Frye left in August, taking lawyers and clients with him. This produced financial problems which caused more
lawyers to leave; this in turn created client service problems. I did what I could to help, bringing in new clients and
working the litigation I bad been hired to manage. By year end, however, the firm had shrunk to 15 lawyers-with
fixed overhead for 40-and it was clear that my own efforts could not solve the firm's problems. Concerned about
my clients, especially my fonner employers whom I had brought to the firm, I concluded that it was not in their
best interests or mine to stay with the finn. I left, and so did they. Because Bob Devlin had hired my successor at
American General and I bad a personal client following, I decided to establish my own practice.
1988-1991
AMERICAN GENERAL LIFE INSURANCE COMPANY
Houston, Texas
Senior Vice President, General Counsel & Secretary
Recruited as chief legal officer for the $5 billion Houston-based life insurance subsidiaries of American General
Corporation, one of the nation's largest financial services holding companies. As one of six members of the Senior
Management Team reporting to President and CEO Robert M. Devlin, I actively participated in planning and dayto-day management of the company. As General Counsel, I directed the full range of legal and government
relations services needed by the company, managed a 17 person Law Department with a budget of $1.6 million,
and managed all outside counsel~th directly and through staff. Some highlights:
�. •'
. ..
Cost4ectiveness: Improved the quality and effectiveness of a downsized Law Department through
restructuring, staff changes, work elimination, computer technology and a strong emphasis on projects directly
supporting business objectives. Despite a bigger law department role in company operations and a more aggressive
litigation stance, better expense management held total legal costs per million dollars of revenue to
$2,623-approximately 62% of the industry average per Cantor & Co. Survey of Corporate Law Departments.
Litigation: Achieved excellent results in high risk litigation, including defense verdicts in multi-million
dollar punitive damage trials in Texas and California. In my first full year, we closed 20 cases with claims totaling
$95 million, plus a Texas discrimination suit claiming $1 billion, for total loss payments of only $19 thousand.
Regulation: Obtained a reversion of $1.6 million in plan assets for the company upon terminating a
defined-contribution retirement plan for General Agents and Managers. We persuaded the IRS, on a question of
first impression, that the company was entitled to a reversion of the present value of an erroneous contribution
made to this plan by the company ten years previously.
Competition: Personally renegotiated American General's contract with the State Bar of California to
retain our position as underwriter of the State Bar Approved Life Insurance Program (20,000 participants, $12
million annual premium, and $2 billion insurance in force) after a competitor cballenged our position.
Conservation: Reorganized the faltering Separate Accounts of Cal-West Life (a subsidiary) into a unit
investment trust. obtaining SEC and insurance department approvals and a favorable proxy vote of over 1,500
participants. This allowed us to retain major clients such as the California State Employees Association and save
over $100,000 annually in administrative costs.
Litigation avoidance: After a corporate decision to tenDinate the company's managerial distribution
system, worked with Marketing to design and implement a successful transition without triggering any litigation.
Strategic support: Successfully implemented the strategic divestiture of marginal individual health and
disability business through assumption reinsurance, thus reducing claims staft: sharpening the company's strategic
focus on interest-sensitive life and annuity products, and increasing our competitiveness in our chosen market
Government relations: Served on the Executive Committee of the American General Corporation
Political Action Committee, the Board of Directors of the Association of California Life Insurance Companies, and
the Legislative Action Committee of the Texas Life Insurance Association. Chaired a working group of the
American Council of Life Insurance task force developing recommendations on assumption reinsurance for the
National Association of Insurance Commissioners; guest lecturer on this subject at an NAIC Annual Meeting.
1977-1988
UNUM LIFE INSURANCE COMPANY
Portland, Maine
Second Vice President and Counsel
UNUM, the nation's 17th largest life insurer (assets $9 billion), is the successor to Union Mutual Life Insurance
Company, the first major mutual company in the United States to demutualize and convert to public ownership
(NYSE 1986). UNUM is the largest provider of group long-term disability insurance in the U.S. and the U.K.
'87
Second Vice President & Counsel: Claims & Litigation
Created and headed UNUM's first centralized litigation management team (7 lawyers and
support staft) which directed all UNUM litigation. Developed and implemented a new litigation strategy which
brought more litigation functions in-house, reduced aggregate company exposure by $20 million in one year, and
established favorable legal precedent on the application of ERISA to employee group insurance. Achieved excellent
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
005. resume
DATE
SVBJECffi'ITLE
Paul W. Willihnganz [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -144 U.S.C. 2204(a))
Freedom of Information Act -IS U.S.C. SSl(b))
PI National Security Classified Information )(a)(l) of the PRA)
P1 Relating to the appointment to Federal office ((a)(l) of the PRAJ
P3 Release would violate a Federal statute )(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information )(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRAJ
b(l) National security classified Information [(b)(l) ofthe FOIAJ
b(l) Release would disclose Internal personnel rules and practices of
an agency l(b)(l) of the FOIA)
b(3) Release would violate a Federal statute l(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or fmancial
Information )(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted Invasion of
personal privacy [(b)(6) of the FOIA)
b(7) Release would disclose Information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions l(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record minde defined In accordance with 44 U.S.C.
1101(3).
RR. Document will be reviewed upon request.
�. ,.
.,
-·
results in litigated cases. Developed a computerized management information system for litigation.. Member of the
management team of the Legal and External AJfairs Division (59 people, budget $7 million), in charge of
recruiting. budgeting, and computer systems for the Division.
'84
Second Vice President & Counsel: Employee Benefits & Reinsurance Division
Chief counsel, with a staff of 6 lawyers. for UNUM's largest operating division. Planned and
directed a tax issue management program which enabled UNUM to establish a leadership position in the flexible
benefits market Key member of a risk management task force which significantly improved benefit loss ratios
without materially increasing legal risk. My staff and I managed all group insurance and reinsurance litigation
with excellent results. Through legal judgments on a crucial "prohibited transactions" question, I helped UNUM
accomplish its landmark demutualization. Member of the Legal and External A1fairs Division management team.
'80
Second Vi6:e President & Counsel: Personal Financial Servkes Division
As chief counsel for this newly formed profit center, I recognized the strategic need for an
amendment of the Internal Revenue Code to permit tax-free exchanges of Union Mutual whole life policies for new
universal life policies being issued by our stoCk subsidiaries, and I initiated the action by Senator George Mitchell
which brought this about I planned the legal as~ of the termination of UNUM's general agency system and
managed the resulting litigation; the result was a net 10-year saving in distribution costs of over $50 million.
'77
Assistant Counsel, Insurance Operations
Primary legal adviser to the Marketing, Product R&D. Corporate Communications, Underwriting
and Administrative areas of the Company before its restructuring into divisional profit centers.
1969-1977
'74
TRIAL LAWYER
San Diego, California
Wll.LmNGANZ, MANNING & SUDMAN
Partner: Insurance law and litigation
'71
BRUNDAGE, WU..LIAMS & ZELLMANN
Partner: Insurance, product /lability and personal injury litigation
'69
moos. FLETCHER & MACK
Associate: Insurance defense and coverage litigation
1967-1968
1959-1967
BYDROTRONICS DIVISION, DATA-DESIGN LABORATORIES
Falls Church. Virginia
Program Manager & Contracts Administrator
UNITED STATES NAVY
Destroyer and submarine officer; Program Manager, Submarine and Nuclear Power Training, Washington, D.C.
Secretary of the Navy Commendation for Achievement in submarine training program management
EDUCATION:
PERSONAL:
Georgetown University Law Center, JD 1968
University ofNotre Dame, B.S.M.E. 1959
�-- - - - - - - --- - - - - - , -
• ·
-.
-~
~·-. ..
' ' HEALTH CARE TASK FORCE SORTING SHEET
'IYPE OF MATERIAL:
_o.meral mail
_P81'801U11 stories
_Letterhead
_Offers to help
_Letter Campaip
_PoUcy
_C888WOI'k
~oyment
_Advocacy
ExpbmaUmM.__________________________________
_Requesta
-sPeech
-meeting
·_Other
~-r------------
v.r· p. '
ADVISORY PANEL?
_r.u.
_other h8alth provider
·~
_..,._emplo~
small busines&
~
other OOD81Diler&
fee~
f,-.m L.~ /(.
pmMARY INTEREST:
COST ISSUES
_Drag Prices
_PUBUC BEALTBJSPECUL POPULATIONS
Prevention
-~cbm.Fees
AIDS
Women's Health
_Hospital Fees
_
UDDecB8881'7 Procedures
_Medical Equipment
Fraud and Ab1188
Immunizations
Rural
U:rban
COVERAGE
_
Wo~ Families
_Unemployed/Low Income
Benefits
Providers
ORGANIZATION
hun:arance Premiums
hun:arance Reform
hun:arancePools
_Boards and Ovendpt
GOVERNMENT PROGRAMS
Medicare
Medicaid
Veterans
DoD
_INFRASTRUCTURE/WORKFORCE
_
Quality A&surance (Guidelines)
_Administration, RelmbU1'11811lent
& Patient Information 8)ratems
_Malpractice & Tort Reform
_
Manpower Issues
LONG-TERM CARE
MENTAL HEALTH
FINANCING
<'l'nlnina>
OTHER
ExpbmaUom.____________________________________________________
PLAN PREFERENCE: (Support=+; Oppose=-)
CP
SP
OP
CUnton Plan
Single Payer
Other Plan
MC
PP
CV
Managed Competition
Pay or Play
Credits, Vouchen,
Medical Savinp Aoots.
CA
BR
GE
Canadian
British
German
�----\·
----
..
' '
THE WHITE HOUSE
WASHINGTON
March 31, 1993
Sam Boyce, Esquire
Boyce Law Firm
Post Office Box 38
Newport, Arkansas 72112-0038
Dear Sam:
Thank you for recommending your friend, Vivian Riefberg, for work with the Health
Care Task Force. The Task Force includes the Secretaries of the Treasury, Defense,
Commerce, Labor, Health and Human Services, and Veterans Affairs; the Director of the
Office of Management and Budget; the Assistant to the President for Domestic Policy; the
Assistant to the President for Economic Policy; the Chair of the Council of Economic
Advisors; and the Senior Advisor to the President for Policy Development.
In addition, the Senior Advisor to the President for Policy Development will lead
interdepartmental working groups which will gather information for, and provide information
to, the Task Force. The working groups, which are working closely with Members of
Congress and their staffs, are comprised of government employees.
While the working groups have begun the process of preparing policy options for
reforming our health care system, their work is an ongoing process. The members of the
Task Force are anxious to consult with knowledgeable and concerned people. I am directing
a copy of your letter and her resume to the appropriate working group.
Again, thank you for your recommendation and especially for your continued personal
support for the success of our endeavor.
Sincerely yours,
lcAll~
Hillary
Rodhajn Clinton
�'
'
BOYCE LAW FIRM
307 MAIN STREET
SAM H. BoYCE
HENRY H. BOYCE
PosT OF'F'ICE Box 38
NEWPORT. ARKANSAS 72112-0038
NEWPORT OFFICE
(501) 523-3626
FAX (SOl) 523-4839
BETTY BUTLER
JONESBORO OFFICE
PARALEGAL
(501) 932-7189
TOLL-FREE 1-800-794-2850
February 4, 1993
Ms. Hillary Rodham Clinton
White House
Washington, D. C. 20500
Dear Hillary:
I am enclosing a resume for a dear friend of mine, Vivian
Riefberg, who has enormous abilities plus a desire to work in
the health care field for the Clinton Administration. I am
sure that you can tell from her resume that she has extensive
abilities in public relations as well as health care.
Vivian and her husband, John Ashford, have been close friends
of mine for several years; and I sincerely believe she would
be of great assistance to you in carrying out the health care
initiative.
Our thoughts and prayers are with you and the President
during the harsh weeks of a new administration, and you know
any assistance that I can offer is yours for the asking.
With warmest personal regards, I am
Sin~ yours
....... ~
-·~Boyce
SB/sc
�r
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
006. reswne
DATE
SUBJECTfi"ITLE
Vivian Riefberg [partial] (1 page)
[none]
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet -144 U.S.C. ll04(a))
Freedom of Information Aet -IS U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) ofthe PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would disclose Internal personnel rules and practices of
an agency ((b)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a dearly unwarranted Invasion of
personal privacy ((b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose Information concerning the regulation of
financial institutions ((b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning wells ((b)(9) of the FOIA)
C. Closed In accordance with restrictions contained In donor's deed
of gift.
PRM. Personal record misflle defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
- - - - --------~----------~
�. - ·--
(ooc, 1
~es~onalExperten~
McKINSEY&. COMPANY, Management Consulting. Washington, DC
Member, Healthcare Practice
1991-present
Engagement Manager Direct all aspects of analysis and manage client and consulting finn
resource allocation for major client studies. Complete written reports and present findings to senior
client executives. Counsel senior executives on a full range of management issues. Studies focus on
strategy and operations management for leading health care participants:
.
• Developed 3-5 year strategy for major player in healthcare information technology including
developing an overview of future structure of US health care system.
• Designed entry strategy in less-inv~ve surgery for leading hospital supply company.
• Created and initiated turnaround strategy for non-profit insurance plan including divestiture of
subsidiaries.
• Designed change management and strategy development program for major national insurance
earner. Program developed to assure immediate profit impotvement and to develop long term
managed care strategy.
t9S9 ·1990
Senior Asspeiate. Lead analyst for major client studies:
• Analyzed market opportunities for development of products 1services leading to major reform of
healthcare billing, collecting, and claims proces~ng systems.
• Designed program to effect major change in management approach among senior management at
leading home center retailer.
• Completed market analysis and designed implementation plan for client participation in
hazardous waste field.
t9S7 - 1988
AssoCiate. Team member and lead researcher on major client studies:
• Developed new model for healthcare delivery systems on medical and surgical wards for
leading hospital system.
• Analyzed HMO market for finn healthcare practice.
THE SIGAL-ZUCKERMAN COMPANY, Real Estate Development, Washington, DC
Project Manager De~gned and implemented creation of $150 million planned unit development
(Franklin Plaza) in downtown Washington. Franklin Plaza project included land assembly and
major rezoning efforts as well as negotiations for amenities with D.C. Board of Education (historic
presetvation of Franklin School) and DC Department of Public Housing (Rehabilitation of
multiple public housing units).
'1988 -1989
Lead Staff DC Mayor's Commission on Downtown Hou~ng. Setved as research and editorial staff
to this majCilr public-private initiative on downtown housing.
AMERICAN MEDICAL INTERNATIONAL. Healthcare Marketing Communications, Atlanta, GA
t9S4 -1985
Manager. Marketing Communications and Community Relations, Southern Region Planned and
directed $4 million marketing communications and public affairs program for 18 hospitals in five
southern states resulting in a 15% increase in hospital emergency room use and a 22"/o increase in
hospital awareness levels. Supervised a marketing field staff of 20 and created a network
marketing approach in two target markets. Analyzed and developed a hospital service cost
accounting program to improve pricing strategies. Developed community relations and government
affairs programs.
·-~
-:;---
-.
�• OGIINY & MATHER, Public Relations, NewYorl<, NY
: ~~;1 -1984
Account Syperyjsor/At}anta. Served as interim manager of the public relations division.
Developed over S300K in communication consulting bt11ings. Trained and supervised three
professionals in the analysis, development and implementation of marketing communications
programs including programs for regional participant in emergency health care clinics.
Senior Accoynt Exerntiye I Washington. Designed and executed comprehensive communications
programs to reach key government personnel and community decision makers.
Account Executive I New York. Completed marl<.et analysis and designed national consumer
promotions for Dove Beauty Bar and Silhouette Book. Won David Ogilvy Award for
implementing promotion that increased Silhouette Book sales by 35%.
I
THE MAC GROUP, Management Consulting, Cambridge, MA
AsSOCiate. Team member on major client studies:
• Arranged and conducted on-site customer interviews, analyzed industty data and devised
market segmentation approaches for a major manufacturer of diagnostic imaging equipment.
• Developed industty background materials for a firm training program on the psychiatric
healthcare market.
summer1986
]. WALTER THOMPSON CO. Public Relations, NewYorl<, NY
Account Coordjnator. Wrote press releases and developed media training program
summer1980
ABC-TV "GOOD MORNING AMERICA•, New Yorl<, NY
Research Assistant. Created background papers on guests for use by program writers.
summer 1979
Education:
MASTER IN BUSINESS ADMINISTRATION, WITH DISTINCTION, JUNE, 1987
Harvard University Graduate School of Business Administration . Focus on heahhcare management.
Admission Counselor- HBS Admission's Office. Chaitperson- Women's Student Association Career Day.
Member of the Health Care, Venture Capital and Real Estate Industry Oubs. Completed field study on
congregate care living for the elderly.
BACHELOR OF ARTS DEGREE, MAGNA CUM LAUD4 IN HISTORY, JUNE, 1981
Harvard-Radcliffe College. Elizabeth Agassiz Certificate of Merit for academic excellence. ChairmanAdams House Harvard-Radcliffe Fund; Events page editor- Harvard Independent; Coordinated Harvard
Institute of Politics I WGBH-TV programming project resulting in joint production of two television series.
Publications:
"Healthcare Industty Overview: Is It Time for Cost Effective Bold Initiatives" co• authored with Fred Eppinger in The Healthcare Payor Annual, McKinsey & Company,
1992.
Articles on the press and politics co-authored with Edwin Diamond have appeared in
Adweek Magazine, American Film Magazine and the Washington journalism Review.
Community Service:
"Mentor" for DC public high school student- Mentors, Inc.
Memberships:
Harvard- Radcliffe Oub - Interviewing Committee; Old Town Civic Association; City
Oub of Washington; Harvard Oub at the National Press Club.
·
REFERENCES AVAILABLE UPON REQUEST
�•
....• ':.!
POSITIONS IN THE CLINTON ADMINISTRATION --VIVIAN RIEFBERG
Office of Management and Budget
- Associate Director, Human Resources, Veterans, and Labor
- Deputy Director for Management
Council of Economic Advisers
- No particular position identified -- health care interest
Department of Health and Human Services
Immediate Office of the Secretary
- Executive Secretary to the Department
-Executive Assistant to the Secretary and White House Personnel
Liaison
Office of the Deputy Secretary
- Director of Intergovernmental Affairs
Office of the Assistant Secretary for Legislation
- Principal Deputy Assistant Secretary
- Deputy Assistant Secretary for Legislation (Health)
Office of the Assistant Secretary for Management and Budget
-Deputy Assistant Secretary
Health Care Financing Administration
- Deputy Administrator
Office· of the Associate Administrator for Legislation and Policy
-Director
Food and Drug Administration
- Deputy Administrator for Policy
�..
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CODER:_ _
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAJ, SORT:
_General mail
_Personal stories
_Other Health Providen
POSTCARD 1:
_Letter Campaign
POSTCARD 2:
_Offei'B to help/Employment
FORM LETTER:
_Letterhead
REROUTE:
-
_Polley
-~cilms
Casework
1 -Sched.uliner -President ·
v) ~ - ('tJOI... ¥-· d.1J~:
~AAA k{)vJ
u
~
Other
I<JVV-·
POLICY AND PERSONAL STORIES:
_ORGANIZATION <D
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE (ID
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTUREJWORKFORCE (liD
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_ DoD
_Indian health
_COST ISSUES (VI)
-~prices
__physician fees
_hospital fees
_medical equipment
_fraud & abuse
_FINANCING
(VII)
_MENTAL HEALTH
(IX)
_LONG-TERM CARE (X)
_PUBUC HEALTH/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural·
_urban
_OTHER.________________________
•
�-
THE WHITE HOUSE
March 31, 1993
Ms. Victoria Bigelow
President
Suburban Primary Health Care Council
2235 Enterprise Drive #3501
Westchester, Dlinois 60154
Dear Ms. Bigelow:
Thank you for writing and sending a copy of the Summary of
your ACCESS TO CARE PROGRAM. I appreciated receiving it and
will pass it along to the Task Force for further review.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again, thank you for sharing information about your unique
program and for your support for the success of this tremendous
undertaking.
Sincerely yours,
�- - - - - - - - -------- --- ------·
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February 20, 1993
Hillary Rodham Clinton
The White House
Washington, D.C.
Dear Mrs. Clinton,
On behalf of the Suburban Primary Health Care Council I submit the enclosed information concerning our Access to Care Program. This program is a unique public-private partnership making
primary health care, and the ancillary pharmacy, laboratory, and
radiology services, available to medically indigent, uninsured
residents of suburban Cook County at a yearly cost of only
$226.41 per person.
Because you are now considering health care delivery alternatives as national models, we wished to bring the Access to Care
program to your attention.
This model seems particularly applicable to suburban areas.
I would be happy to answer any questions you may have about
this program. You may reach me at (708) 531-0680.
Sincerely,
i I,
(-'-· <
~/t:~
;;;:;'.
"' · ·:'
.<_z__ ~--/~ c11(/
'-·-
Victoria Bigelow
President
Suburban Primary Health Care Council
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Suburban Primary Health Care Council
ACCESS TO CARE PROGRAM
Summary
The
problem of the medically indigent and the uninsured
compromises good community health status, drives up the cost
of
I
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medical care, and generates significant hardships for
individuals.
The Suburban Primary Health Care Council was created with
and remains dedicated to a single purpose: to facilitate access
to primary health care for suburban Cook County residents who are
medically indigent.
The Council is a private not for profit
confederation of four health and social service organizations:
the Community and Economic Development Association of Cook
County, Inc.
(CEDA), Cook County Department of Public Health,
Northwest Suburban Cook County Health Care Task Force, and Park
Forest Health Department.
Access to Care, the program developed by the
Council,
enables low-income, uninsured residents of suburban Cook County
to receive basic health care services including physician office
visits, prescription drugs, lab and radiology services £or no
more than a five dollar payment.
Services are delivered through
a unique decentralized system utilizing private physicians
throughout a 735 square mile area.
Most of our patients live in
the far south or northwest areas.
In 1993 we also began serving
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northeast suburban Cook County.
The Problem
According to a report of the American Hospital Association,
only 58% of persons in Illinois with incomes below the poverty
level receive Medicaid benefits (the federal-state medical care
program for the poor).
With the spiraling costs of health care
and health insurance, there is an increasing gap between persons
covered by public medical programs and the privately insured.
Individuals and the families of low-income workers, contract and
part-time workers, as well as the unemployed fall into this gap.
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The poor and uninsured face great difficulty in obtaining
and paying for health care. Many are forced to go without care,
to delay seeking care until a crisis exists, or to use costly and
inappropriate resources such as hospital emergency rooms for nonemergencies.
More than half of persons currently enrolled in Access to
care have family incomes below the poverty level ($13,900 for a
family of four) but make too much money to qualify for Medicaid.
Women and children under the age of eighteen are overrepresented
in the program (57.1% and 42.7% respectively), bearing out
national statistics that they are more likely to live in poverty.
Minorities, too, are overrepresented in relation to the general
population. In 1992, 37.2% of Access To Care participants were
Hispanic, 22.% were African-American, 3.6% were Asian, and 37%
were white.
Seventy-two percent of the heads of household in
the program work, but have no insurance.
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The Access to Care Program
This innovative program was developed tailored to the needs
of the suburban poor, who are dispersed over a large geographic
area with poor transportation resources.
The program is open to persons with incomes less than twice
the federal poverty level who are uninsured by public or private
programs for primary health care.
The Council estimates that
there are 99,000 persons in suburban Cook County in this
situation.
The Council contracts with local providers throughout the
area and pays them a discounted rate to provide services to
persons enrolled in the program.
Covered services include office
visits to a primary care physician, routine lab and x-ray
services and prescription drugs.
Patients pay only a nominal fee
($5.00) for each visit, and pay no more than $5.00 for other
services.
There is no charge to enroll in the program.
Screening for eligibility and enrollment occur at local township
offices, health departments and community agencies, where
patients are also linked to other needed services not provided
through the program.
Coordination agreements are maintained with
the providers of these services.
It is the intent of the Council
to utilize existing resources to the fullest extent possible and
to fill in the gaps.
The services provided through Access to
Care are scarce to non-existent in suburban Cook County for the
uninsured.
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Physicians volunteer to participate in Access To Care, and
choose the number of patients they will add to their practices.
Currently, one-hundred eighty-seven physicians participate in the
program, providing the capacity to serve 10,079 patients. They
are paid a nominal $52 per patient per year, yet their response
to participation has been enthusiastic:
11
I am working in the
program because I want to do something for my community" says
Yahya Ahmadian,M.D., a Homewood pediatrician.
Many feel that the
program addresses a major cause of serious afflictions, lack of
treatment in the early stages: "I saw a patient ••• who needed his
medication. 11 says Vasantha Kumaraiah, M.D.
11
He knows he has
diabetes. He knows he has hypertension, but he quit taking his
medication months ago because he couldn't afford it."
The Benefit
Access to Care removes the financial barrier to primary
care and provides an entry point to the health care system.
Early detection and treatment of illness should reduce and, in
most cases, obviate the need for more costly secondary care.
Thus, although the program covers only "sick care" office visits,
it is preventive in that it helps keep people out of the hospital
and, particularly, out of the emergency room.
The types of prescriptions and services utilized by patients
as well as the most common diagnoses show that patients are being
treated for acute and chronic conditions which could become
serious or require hospitalization if left untreated. For adults,
the most frequent diagnoses are hypertension and diabetes, and
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for children, ear infections. These diagnoses affirm the need for
primary care to prevent more serious sequelae.
The Access To Care program offers more than diagnosis and
on-going treatment. Patients choose a personal physician, with
whom they form a relationship. Access To Care participants have
the security of knowing that they can get care if they need it,
without a serious financial sacrifice. This saftey net creates
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peace of mind even before the medical need arises.
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costs. Patients are referred to local hospitals or Cook County
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The Access To Care program does not cover hospitalization
Hospital for inpatient admission. Council staff facilitates
referrals to county-operated specialty clinics to help provide
continuity of care. The small number of these referrals, under 4%
of the patient population, validates the program's concentration
on primary care.
Everyone pays indirectly for uncompensated care for the
uninsured through higher charges for medical care, higher
insurance premiums, and higher taxes to support Medicaid and
Medicare.
Access to Care provides compensation to providers for
patients who cannot afford to pay. Because Access To Care is not
facility-based, it can operate more economically than other
primary care delivery systems.
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Access To care's costs are surprisingly low, especially when
compared to the cost of an emergency room visit or inpatient
admission. Total costs per person for one year's participation in
Access To care are estimated at $226.41 for 1993.
5
�Endorsement
In 1991 the Access To Care program received the endorsements
of the Illinois Chapter of the American Academy of Pediatrics,
the Illinois Academy of Family Physicians, and the Institute of
Medicine of Chicago. In 1992 the program received the full
support of the Chicago Medical Society. Each of these organized
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medical societies is concerned about the problem of the uninsured
and encourages its members in suburban Cook County to participate
in the Access To Care program.
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Evaluation
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In 1992 the Council conducted its annual physician satisfaction
survey.
93% of participating physicians reported being either
satisfied or very satisfied with the program. The Council also
conducted a patient survey which contrasted patient experience
before and after joining Access To Care. 29% reported that in the
year prior to joining the program,· a family member skipped taking
prescription medication because of the cost, and 58% had
postponed medical care when they needed it. Use of the emergency
room decreased by 18.4% after joining the program. Most
importantly, patients reported an improvement in health status
since joining the program. Only 39.6% of adults reported good or
excellent health before Access To care compared to 80.4% after
being in the program for a year.
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The Organization
The Council was formed in 1986 in response to The Chicago
Community Trust's "Health Care in Cook County Initiative". The
Council received a planning grant in 1987 to design a delivery
system of primary care for the medically indigent in suburban
Cook County. The Council was incorporated as an Illinois notfor-profit corporation in April, 1988, and received tax-exempt
status in April,1989.
The four organizations which make up the Council bring many
years of experience in health and social services to the program.
The Board of Directors is composed of four representatives from
each of the four member organizations and four at-large members.
Three community advisory boards advise the Council and serve as a
liason with the community.
Funding
The program was originally supported by a grant from The
Chicago Community Trust. Additional support has been provided by
the Baxter Foundation, Square D Corporation, Robert R. McCormick
Charitable Trust, Washington Square Health Foundation, Inc.,
Blowitz-Ridgeway Foundation, Children's Care Foundation, Special
People in Need, the Ford Motor Company, the Searle Charitable
Trust, and the W.P.& H.B. White Foundation. Five municipalities
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and eight townships have also supported the program. Funding by
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the Cook County Board of Commissioners in 1991 and 1992 has
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expanded the program and institutionalized it as a primary care
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delivery system to the medically indigent in the suburban area.
7
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At current funding levels, Access to Care can serve only 5.2%
of those eligible for care in suburban Cook County.
There is
currently a waiting list for the program in the entire service
area.
II
Although the program's physician capacity is 10,079
patients, present funding will cover just 5,497 patients.
Of
99,000 estimated eligible, most uninsured children and adults
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continue without adequate care.
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Conclusion
While providing health care to low-income, uninsured persons
is a major topic today, the Access to Care program actually provides a mechanism to do something about the problem.
In addi-
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tion to the human suffering caused by lack of access to health
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care, society bears a cost in terms of low productivity resulting
from the postponement of needed medical care, reduced school
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attendance, and higher insurance premiums and health care costs
due to subsidization of uncompensated care.
Locally based pri-
mary care can fill in the gaps in large areas with dispersed
indigent populations, without involving capital funds, costly
facilities, or equipment.
This model gives physicians a partner-
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ship with private and public funders working to solve a growing
national problem in a cost-effective manner.
Access to Care is a local solution to a local problem. How-
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ever, we believe that our efforts may serve as a prototype for
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addressing a serious problem which exists not only in suburban
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Cook County but in many communities throughout the nation.
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8
�Clinton Presidential Records
Digital Records Marker
This is not a presidential record. This is used as an administrative
marker by the William J. Clinton Presidential Library Staff.
This marker identifies the place of a publication.
Publications have not been scanned in their entirety for the purpose
of.digitization. To see the full publication please search online or
visit the Clinton Presidential Library's Research Room.
�Annu-al Report
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March .31
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
007a.letter
DATE
SUBJECTffiTLE
Hillary Rodham Clinton to Bruce R Brookens. [partial] (1 page)
03/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -(44 U.S.C.ll04(a))
Freedom of Information Act- (5 U.S.C. SSl(b))
PI National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(J) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) of tbe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would c:onstitute a c:learly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) ofthe FOIA)
b(l) Release would disclose internal personnel rules and practlc:es of
an agency ((b)(l) oftbe FOIA)
b(3) Release would violate a Federal statute ((b)(J) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�r
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THE WHITE HOUSE
March 29, 1993
Dear Bruce:
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Thank you for sending the photographs from that memorable
evening together. Although I have received some others, these are
among the best, and I especially appreciate having them to add to my
treasured collection. That was a grand opportunity for us to be
together, celebrate and catch up after all these years.
I am grateful for your writing and sharing your views on
health care reform. I readily understand that physicians who rely on
news accounts may be frustrated by descriptions of our process, but
most of them are not aware that the Task Force and working groups
have been meeting with every group of physicians which has
requested meetings and been giving careful consideration to the
letters, proposals and suggestions received from many concerned
health care professionals. In fact, many of the groups which claim to
be "locked out" have been part of these meetings on a regular basis.
We want to have doctors part of the process for the very reason you
suggest- to be "invested" -and, even more important, to help design
the system they will be part of implementing.
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I appreciate the invitation to speak at the Annual Legislative
Conference of the American Society of Anesthesiologists on April 26
or 27. You indicated .we have already received this request, but I
will direct a copy of your ·letter to my scheduler as well.
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Bruce R. Brookens, M.D.
March 29, 1993
Page Two
Thank you again for sharing your views and those of your
colleagues, and for your support as we endeavor to find workable
solutions to the incredibly complex health care issue.
I haven't had much time to practice that pitch lately, but
perhaps I'd better get started! The season is upon us, and I can
hardly wait.
Sincerely yours,
cc: Scheduling
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�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
DATE
SUBJECTifiTLE
RESTRICTION
AND TYPE
007b. letter
Bruce R. Brookens to Hillary Clinton. (Partial) (1 page)
03/10/1993
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act -(44 U.S.C. 2204(a))
Freedom of Information Act- [5 U.S.C. 552(b))
Pl National Security Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
rmancial information [(a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National security classified information [(b)(l) ofthe FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions [(b){8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misnle defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-----·-
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(g)(q)J9d
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��..
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
008.letter
DATE
SUBJECfffiTLE
Hillary Rodham Clinton to Sister Margaret Vincent Blandford.
[partial] (1 page)
03/29/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number: 10813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Ad- [44 U.S.C. 2204(a))
Freedom of Information Ad- [S U.S.C. SS2(b))
PI National Seeurity Classified Information [(a)(l) of the PRA)
P2 Relating to the appointment to Federal office [(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
P4 Release would diselose trade secrets or confidential commereial or
financial information [(a)(4) of the PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advison [a)(S) of the PRA)
P6 Release would constitute a dearly unwarranted invasion of
personal privacy [(a)(6) of the PRA)
b(l) National seeurity elassified information [(b)(l) of the FOIA)
b(2) Release would diselose internal personnel rules and practices of
an agency [(b)(2) of the FOIA)
b(3) Release would violate a Federal statute [(b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or f'maneial
Information [(b)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) ofthe FOIA)
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) ofthe FOIA)
b(8) Release would disclose information concerning the regulation of
f'maneial Institutions [(b)(8) of the FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs [(b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misfde defined in accordance with 44 U.S.C.
2201(3).
RR. Document wiD be reviewed upon request.
�- - - - - - - - - - ...........-.. .----·->~- _-;;..,.-;;:::;:;;;;::,::.;.,;;--_;:,-;:::::::;:;..-. __,._,.~~···-
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THE WHITE HOUSE
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March 29' 1993
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Dear Sister Margaret Vincent:
Thank you for sending me a copy of the Executive Summary
prepared for the hospitals operated by the Sisters of Charity. It will
be helpful both to me and to the Task Force as we consider various
options in finding solutions to the incredibly complex health care
issue.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
On a personal note, I want you to know of my genuine,
heartfelt gratitude for the excellent care and attention St. Vincent
Infirmary Medical Center has provided during my father's illness.
The ongoing support for our family during a difficult time has been
extraordinary and extremely helpful.
Do continue to remember our family - and our nation - in
your prayers in the challenging decisions before us.
Sincerely yours,
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J[ovvQ~.ff ~vv-
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January 26, 1993
EXECUTIVE
SUMMARY
The design presented here is the product of a broadly based team representing
healthy people, patients, providers, employers, healthcare administrators, people
who work in in-patient and out-patient care facilities and healthcare related
foundations and organizations, consultants, academics, students and others with
an interest in changing healthcare in the United States. A common belief of the
participants is that healthcare must be redisgned, not reformed.
As a
consequence, the group•s design contrasts from most of the published efforts at
reform in that it approaches healthcare systemically; that is, it recognizes that
healthcare as a system is a product of the interaction of its parts, not the sum of the
actions of each of its parts considered separately or independently. This means
that if the system as a whole is to be changed effectively, all of the significant parts
and the ways they interact must be changed (redesigned).
Current reform efforts are unlikely to succeed because they focus only on
reimbursement and neglect other aspects of the healthcare system. This design
presented here includes changes not only in how the system is paid for, but also in
how care is accessed, how consumers and providers behave, where responsibility
for and control of the system is located, and its focus on disease and disability as
.
opposed to wellness. The design brings about these changes because it does the
following:
1.
Provides Universal Access to Essential Healthcare
Each resident of the United States would receive a voucher that entitles him or
her to essential healthcare for one year.
The voucher would be issued
annually by the IRS and its value would reflect the age, health status, and
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January 26, 1993
2
characteristics of the residential environment of the recipient.
(Wellness
stamps, discussed below, would also be issued at the same time.)
2.
Relieves Employers and Government•s Current Burden of Paying
for Care
Care would be paid for by a combination of taxpayer and employer. The
taxpayer would be taxed according to his/her ability to pay, number of
dependents, lifestyle (for example, a smoker would pay more than a
non-smoker, a race car driver would pay more than an accountant)
residential environment. The
employers~\
and
contribution would be in the form of
a healthcare tax proportional to the health hazards, stresses, etc. associated
with the particular industry or employment circumstances.
However,
employers could cover part or all of the healthcare costs of their employees as
a benefit, if they so chose.
All U.S. residents who are required to file income tax returns would file a
healthcare tax forms at the same time and pay any taxes that are due
regardless of whether the filers 1 incomes are large enough to require payment
of a tax.
3.
Reduces Total Costs as Compared to the Current System by (a)
Reducing Administrative Costs, (b) Inducing Competition and
Utilizing Free-Market Controls, and (c) Providing Incentives for
Cost-Effective Provider and Consumer Behavior
Placing responsibility for administrative costs with the community and
substantially reducing third-party involvement would reduce administrative
costs to a fraction of those in the current system.
�. ..
January 26, 1993
The role of insurance companies would be to provide catastrophic coverage
to healthcare providers whose patient mix results in costs that do not allow the
primary care provider to earn a suitable income. They would also continue to
provide malpractice insurance but the threat and cost of malpractice suits
would be significantly reduced as described in Section 6 below.
Competitive behavior is induced through a mechanism that (a) gives bonuses
to healthcare providers for each patient that renews his or her registration with
them each year, (b) allows patients to transfer to other providers for justified
dissatisfaction, and (c) use of both internal and external markets. Providers
and administrators within each system would be able to purchase healthcare
services_ and products from within that unit, or from units external to the system
if they charge less and their quality is considered to be at least as good as that
obtained from internal suppliers.
Incentives for cost-effective provider behavior would come principally from the
providers' control of their patients' vouchers, but also from a mechanism that
allows physicians to discontinue service to patients who seek inappropriate
and/or excessive use of healthcare services or products.
lncenti~s
for cost-effective patient behavior (healthy life style) would come
through reduction of their healthcare tax rates or enlargement of the list of
services to which they are entitled.
4.
Places Responsibility for and Control of the Health care System in
the Combined Hands of the Users and Providers of Care and
Provides Choices for Both
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3
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January 26, 1993
Recipients of the vouchers would register them with primary care providers of
their choice.
These providers would then pay all essential healthcare costs
incurred by those registered with them including the costs of hospital stays,
specialist visits, tests and pharmaceuticals. These costs could not be incurred
without approval of the primary care provider except in an emergency. The
value of the vouchers would provide the primary care providers with a suitable
income after paying all their patient's bills.
Primary care providers could practice in either the public (National Health
Plan) or private system, but not both.
Primary care providers who participate in the National Health Plan could
practice individually, in groups or be employed in an integrated healthcare
system.
Patients could choose providers who practice outside the system but have to
pay for the services they receive. However, this would not relieve them of the
obligation to pay the healthcare tax.
5.
Establishes a System as Close to the Users as Possible for
Determining What Care is Covered and What Is Not.
This System
is Con"trolled and Varies by Communities According to Their
Needs.
Each community would assure access to essential primary, secondary,
tertiary, quaternary, and extended-stay healthcare services either within that
or another community. Essential healthcare services would be determined by
a Community Healthcare Board established within each community. These
services would reflect the environmental and healthcare characteristics of that
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January 26, 1993
community. Non-essential (elective) services would be available at a fee.
These Healthcare Boards would certify wellness services for which the
wellness stamps issued by the IRS could be used. The Community
Healthcarre Information Systems managed by these boards would provide
each resident with an annual healthcare printout that would be filed with their
healthcare tax form. These healthcare board activities would be funded by the
IRS.
6.
Reduces the Potential for Malpractice Suits
Each community's healthcare board would receive funds from the IRS to
conduct quality audits of the healthcare services provided and establish a
healthcare court that address appeals concerning services and costs.
7.
Simplifies and Significantly Reduces the Inconsistencies and
Redundancies Associated with Healthcare Information Systems.
The Healthcare Information System established by each Community
Healthcare Board will maintain a complete healthcare record of each resident
of that community. Access to the record could only be obtained with the
individual's permission, except in an emergency. All records would adhere to
nationally specified standards and be accessible through a national network.
8.
Places Emphasis on Well ness
Rather Than Illness
Each recipient of a healthcare voucher would also receive wellness stamps
that could be used to purchase membership in certified programs of wellness
education, nutrition, exercise, immunization and so on. Participants in these
�January 26, 1993
programs would become part of the individual•s healthcare record and affect
the individual•s healthcare tax rate or healthcare service.
9.
Makes Physical Access to Providers Easier
Primary healthcare services would be within walking distrance of most people
living in population centers (in Healthcare Malls where feasible). Those who
are not ambulatory would receive care either at home. from mobile units, or be
transported to care-providing units. In-home healthcare services would be
provided wherever possible and economically feasible.
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�HEALTH CARE TASK FORCE SORTING SHEET
nPE OF MATERIAL:
_O.eral mall
_P81'801U11 stories
_Letterhead
_Offers to help
_LetterC8Dlpaip.
_Policy
_CII8eWOI'k
_ . _ . . empl.,_.
_r.n.
_&eDioN
_small busineas
_other h8alth provider
Expbmatiom~--------------------------------------~------pRIMARY INTEREST:
COST ISSUES
_ Dra8 Prices
_ PhJ&lciaD Fees
_Hospital Fees
_
UDDece•ary Procedures
_Medical Equipment
Fraud and Abuse
_PUBUC HEALTH/SPECIAL POPULATIONS
Pievention
AIDS
Women's Health
Immunization&
Rural
urban
COVERAGE
_
GOVERNMENT lPROGRAMS
Work:iDg Families
Medicare
Medicaid
Veterans
DoD
_Unemployed/Low Income
Benefits
Providers
ORGANIZATION
Insurance Premiums
Insurance Reform
Insurance Pools
_Douds and Oversilht
_
INFRASTRUCTUB.FJWORKFORCE
_
Quality AIBurance (Guidelines)
_
Administration, Relmb1li'88Dlent
& Patient Information s,atema
_Malpractice & Tort Reform
_
Manpower l&&ues ('l'rainlna)
LONG-TERM CARE
MENTAL HEALTH
FINANCING
OTHER
Explanatiom~------------------------------------------------
PLAN PREFERENCE: (Support=+; Oppose=-)
CP
SP
OP
Cllnton Plan
Sinpe Payer
Other Plan
MC
PP
CV
Manaaed Competition
Pay or Play
Credits, Voucher&,
Medical Savina& Aceta.
CA
BR
GE
Canadian
British
German
�THE WHITE HOUSE
March 29, 1993
Mr. Joseph A. Califano, Jr.
Chairman and President
Center on Addiction and Substance Abuse
Columbia University
152 West 57th Street
New York, New York 10019
Dear Joe:
It was indeed a pleasure to meet with you and Mrs. Ford on
an issue of mutual concern to all of us. I appreciate your sending for
my review a copy of the Bush and Clinton responses to the CASA
questionnaire during the campaign.
Thank you for your offer of assistance and especially for your
affirmation and expectation of •great things. • I will work hard to
measure up to that.
Sincerely yours,
�Center on Addiction
and Substance Abuse
at Columbia University
March 2, 1993
15!2 West 57th Street
New York, NY 10019
phone !21!2 841 5!200
fax !21!2 956 80!20
Board of Directors
Joseph A. Califano, Jr.
Mrs. Hillary Rodham Clinton
Office of the First Lady
The White House
1600 Pennsylvania Avenue, N.W.
Room 100-0EOB
Washington, D.C. 20500
Dear Hillary:
Chairman and President
James E. Burke
Betty Ford
Douglas A. Fraser
Barbara C. Jordan
Donald R. Keough
LaSalle D. Leffall, Jr., M.D.
Manuel T. Pacheco, Ph.D.
Linda Johnson Rice
E. John Rosenwald, Jr.
Michael I. Sovem
Frank G. Wells
Thank you for meeting with Betty Ford and me. It was a
stimulating and productive meeting. We greatly appreciate the
opportunity to discuss the importance of addressing the problem of
substance abuse and addiction in the context of health care
reform.
Although I did not mention it at the meeting, I am sure you are
aware of the President's response to the questionnaire CASA sent
to him and President Bush during the campaign. In his reply,
President Clinton stated ... "we will require that every insurance
plan includes a core package of benefits to be defined by a
National Health Board. Treatment of drug addiction for those who
need it will be incorporated in this core package .... " He also
committed to increasing the resources devoted to prevention and
treatment. (I have enclosed a copy of the President's full
response.)
We applaud these policy directions and look forward to assisting
you in any way we can.
Enclosure
�Center on Addiction
and Substance Abuse
at Columbia University
CASA Questionnaire and Candidates' Complete Responses
Question 1 : The National Cancer Institute and the National Heart, Lung and
Blood Institute each spend $7 billion a year on basic science research. The
federal government spends no more than $300 million a year on basic science
research involving substance abuse and addiction. Do you support increasing
federal expenditures for basic science research on substance abuse and
addiction to an amount comparable to that spent for basic research on cancer
and cardiovascular disease?
Bush Response: I have strongly supported research increases in the drug budget each of the
last four years. This year total spending on research involving substance abuse and addiction
will be $360 million. Unfortunately, the Congress has not been willing to appropriate all the
funds for substance abuse addiction research and services that I have requested. Federal efforts
in basic scientific research on substance abuse and addiction have increased by 64% between
1989 and 1992, and the Administration is requesting an additional increase of $17.5 million for
Fiscal Year 1993. I also strongly support increases in funds for applied research to help develop
more effective and targeted treatment and prevention programs.
We can and must do more in both the basic and applied research areas. I have fully
outlined my research goals in the National Drug Control Strategy, and I am encouraged that we
will see a real contribution from the additional research effort we are undertaking.
Clinton Response: I believe our nation has to find ways of treating more addicts more
effectively. Too little is known about addiction, and too little has been done to explore different
cures. Further research into substance abuse and addiction-both into the causes of addiction and
into possible cures-is essential to improving treatment. I strongly support the comprehensive
approach and substantial, long-term commitment made by CASA in this field.
Federal funding of basic science research is obviously constrained by budgetary
considerations, and I would be unwilling to cut other vital medical research projects.
However, substance abuse costs our country $300 billion a year. Our nation cannot afford to
delay serious investment in solving this problem.
Question· 2: The Congress has appropriated nearly $12 billion for this year's
budget for the •war on drugs. • More than two-thirds of that amount will go to
law-enforcement efforts and less than one-third to treatment and prevention.
Do you agree with this allocation of resources? If not, what do you consider the
appropriate
allocation?
Bush Response: Treatment and prevention are essential parts of our comprehensive
National Drug Control Strategy. With my 1993 budget request, Federal funds supporting the
drug strategy would almost double to $1 2. 7 billion since I took office. This includes a 121 %
increase for prevention and a 94% increase for treatment.
The primary goal of the strategy is to reduce illegal drug use and I am encouraged to see
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�-··-
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-2that we are making significant progress, particularly with America's youth. For example,
overall drug use declined by 13% from 1988 to 1991. Adolescent drug us declined by 27% and
adolescent cocaine use declined by 63% over the same period.
Our comprehensive strategy is working. I believe that in the second term we should
continue to expand and improve our programs on reducing the demand for drugs-on treatment,
education and prevention. We also need to improve our interdiction, law enforcement and
international efforts in order to help make prevention and treatment more effective.
Clinton Response: The present administration has concentrated on badly coordinated
policies to cut the supply of drugs at the expense of more cost-effective measures to decrease
demand. Yet what successes we have had so far in cutting casual use of illicit drugs and cigarettes
have been primarily through education and prevention, not through making drugs or tobacco any
less accessible.
Any sensible policy on drug abuse must tackle both cutting the demand for drugs and
reducing supply. And I will increase the resources that are devoted to prevention and treatment.
But I do not believe this is simply a matter of counting the dollars allocated in the ONDCP budget.
I propose expanding and improving treatment, education and prevention. The first thing
we have to do is make sure existing resources .are· being spent in the most cost-effective way, by
for example, improving aftercare facilities so that fewer people relapse after they leave
treatment, and ensuring school drug education programs include training for teachers to make
them work. Then we will expand treatment-targeting first pregnant women-and implement
new prevention programs aimed at kids in high-risk situations. Policies such as a Youth
Opportunity Corps, urban investment, fully funding Head Start-described by one expert as the
best drug-prevention program we have-will be funded through other budgets, not from the
ONDCP budget.
I do not favor shifting resources away from local law enforcement-unlike George Bush,
who proposed this several times. Police in our neighborhoods are in the front line against drugs,
keeping people safe frpm drug-related violence, keeping dealers off the streets where children
play. I support community policing which gives law enforcement a preventive role. Cops on the
beat working with local residents is as much a preventive strategy-stopping crack houses and
dealing networks growing in the neighborhood-as it is retrospective law enforcement. And as we
improve treatment in prison and explore court-mandated treatment options along the lines of
the Miami Drug Court, law enforcement will become a key way to direct more people into
treatment.
Other supply reduction strategies have been a failure under the present administration.
Billions have been poured into high-tech surveillance and interdiction equipment, whilst the
quantity of drugs entering the country has only increased. We have to fundamentally reexamine
our interdic~ion policies, to ensure that resources are being used in the most efficient and costeffective way to stop drugs entering the United States.
Question 3: In your proposal to reform the health care insurance system, what
kind of coverage for the treatment of substance abuse and addiction do you
provide?
Bush Response: My health reform program allows states to define a basic benefit package.
Any mandated benefits within the package require approval from the Secretary of Health and
Human Services. States would base the composition of the basic benefit package on the needs of
their citizens, therefore basic health benefit plans are expected to vary by state. Insurers could
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�-3offer more extensive packages with greater coverage of benefits; however, coverage for
particular services or procedures could not be mandated. Individuals would be able to select
from a variety of health plans that best meet their health care needs. To the degree that
substance abuse and addiction treatment are cost-effective and are needed by the citizens of a
particular state, the state may include such treatments as part of a mandated set of benefits.
Clinton Response: I am proposing fundamental and far-reaching reform of America's
health care system, and treatment of drug addiction will become a part of that. I have a plan to
control costs through reforming the insurance market to make it competitive and efficient,
and global budget targets to provide added discipline. Then as costs are controlled we will phase
in universal coverage building on the current employer based system of coverage. Businesses
will have to do their fair share and cover all their employees, whilst financial assistance from
government will help small businesses and nonworkers, so that every American is covered.
As part of our reforms of the insurance system, we will require that every insurance
.. plan includes a core package of benefits to be defined by a National Health Board. Treatment for
drug addiction for those who need it will be incorporated in this core package along with
ambulatory physician care, inpatient hospital care, prescription drugs, and basic mental health
services, expanded preventive. treatments. .
Question 4: Canada is experimenting with a significant tobacco tax increase to
discourage people from smoking. The United Kingdom uses liquor taxes to reduce
consumption. Do you favor increasing the taxes on liquor? Wine? Beer?
Tobacco? If so, by what amount?
Bush Response: In the United States, most excise taxes on alcohol and tobacco are levied at
the state and local level and are an important source of state revenue. States have been active in
this sphere. Cigarette taxes, for example, rose in 11 states from 1990 to 1991, and the median
state tax rose from so:21 to $0.24 per pack. Excise taxes should best remain an issue whose
focus is at the state level.
Clinton Response: In Arkansas we have raised the tax on tobacco products on more than one
occasion, but an increase on .alcohol and tobacco-related products is not included in my national
economic strategy. Despite raising taxes on tobacco products in Arkansas, we have maintained
one of the lowest state tax burdens in the nation. The federal tax code already penalizes middleclass families and low-income families whilst benefitting the rich. Substantially raising
consumption taxes will make the system even more regressive. I want a more progressive tax
code that will ask the top 2% of income earners to pay their fair share and give low- and
middle-income families a tax break.
There are other steps we can take, however, and as Governor of Arkansas I have played
an active role in tobacco-related issues. I have signed legislation making it illegal to place
tobacco vending machines in public places that are accessible to people under 1 8 years of age and
prohibiting the free distribution of tobacco products in public areas around schools and
playgrounds or to any person under 1 8 years of age.
I have signed a law requiring all state agencies to implement a smoking policy for their
general office space. I vetoed a bill that would have prohibited employers from hiring only
nonsmokers and potentially given smokers rights in the workplace itself, which I believe is
inappropriate. While Americans plainly may smoke in many circumstances, smoking is an
acquired behavior and given the overwhelming evidence of the toll it takes every year in disease
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�-4and death, it should not be accorded legal protection like freedom of speech, nor should smokers
be a protected class like those who have been wrongly discriminated against because of race,
sex, age or physical handicaps.
Question 5: Do you favor a ban or further restrictions on the advertising of
tobacco? What kinds of restrictions, if any, do you favor on the advertising of
alcohol? For example, should beer advertising be allowed on television?
Bush Response: I believe the present restrictions on tobacco advertising are appropriate;
but that does not relieve either the tobacco or the advertising industries from exercising
responsible self-restraint in promoting tobacco products. I also favor the current health
warnings and the efforts of the Department of Health and Human Services to educate the public
on the serious health consequences from their use.
I do not want to see our youth gain access to cigarettes or other tobacco products. I
strongly favor the actions many states have taken to restrict where these products are
displayed, and how they are sold through vending machines.
With respect to restrictions on advertising alcoholic beverages, I believe the broadcast
and media industries must balance the promotion of these products with legitimate concerns for
public health. As I mentioned with respect to tobacco, there is more that can be done by the
alcoholic beverage industry and the advertising industry.
For example, I am gratified that members of the Outdoor Advertising Association of
America have agreed that they do not want to display such advertising in places where children
are likely to view it frequently. I am also encouraged that the alcoholic beverage industry has
indicated to the Administration its willingness to review its practices, particularly with regard
to promoting products in a manner that has little to do with the quality of the product, but
associates it with a certain kind of lifestyle.
In summary, the answer to this problem is not another rule or Jaw from Washington,
but a cooperative partnership with health and prevention organizations, the industry, and the
Administration to work with communities across our nation to reduce the misuse and abuse of
alcohol, and to exercise good judgment in the promotion of these products. We must also ensure
that existing laws are strictly enforced.
Clinton Response: I support the current advertising restrictions and warning
requirements for alcohol and tobacco products, and my administration will be dedicated to fully
enforcing these laws. My administration will move quickly to stop any efforts to relax the
current restrictions. We will consider any new and appropriate scientific data that suggest that
the current restrictions or labeling requirements should be updated.
As a· former professor of constitutional law, however, I believe that we must also make
sure that we consider the possible First Amendment implications of broader restrictions. Any
new restrictions or requirements must meet constitutional standards.
Question 6: In 1990, more than half the inmates in federal prisons were there
for drug-related crimes. An even larger percentage of state prison inmates
were under the influence of drugs and/or alcohol at the time of their offense.
Should the federal government condition financial support for state prison
systems on states' providing substance abuse treatment to all inmates who need
it?
(more)
�-5Bush Response: We spent $10.7 million in 1991 and will spend $22 million in 1992 for
drug treatment programs in Federal prisons. Our FY 1993 budget request is for nearly $28
million. In addition, to provide substance abuse services to persons awaiting Federal trials, we
have requested another $44 million for FY 1993.
Today, Federal assistance is being provided for drug-related pilot programs in a number
of States. Most States also fully recognize the benefits of providing substance abuse services to
inmates.
While the Federal government has encouraged, directly and by example, new substance
abuse treatment programs for State inmates, the Administration has not conditioned Federal
assistance on substance abuse treatment and has no plans to do so at this time.
Clinton Response: I am committed to expanding treatment for substance abuse in prison.
We have to treat inmates while they are in prison to stop the revolving door of recidivism. It is
wholly irresponsible of both state and fede-ral governments to release inmates back onto the
streets after lengthy sentences-but having had no treatment for substance abuse. Reducing
recidivism is essential both to protect American citizens from crime, and to make space in
prisons for violent offenders.
But first the federal government has to get its own house in order. In 1991, the GAO
reported that although an estimated 44% of federal inmates needed substance abuse treatment,
only 1% were receiving any. We will also expect states to increase treatment in state prisons
and we will encourage them to explore court mandated treatment options along the lines of the
Miami Drug Court.
Question 7: Do you favor removing criminal penalties for possession of
marijuana for personal use? Do you favor removing criminal penalties for
possession of any other drugs for personal use? Do you favor legalization of
marijuana or of any other drugs that are now illegal?
Bush Response: No. I strongly oppose legalizing or decriminalizing marijuana or any illegal
drug.
Clinton Response: No. I do not favor removing criminal penalties for the possession of
marijuana or other drugs, nor do I support the legalization of these drugs. I believe we should
expand drug and alcohol treatment and education. The current administration has not made
improving drug treatment and education the priority it needs to be, and my administration will.
But we cannot move to reduce or remove criminal penalties before we have made a serious effort
to reduce demand. Otherwise, we risk encouraging personal drug use in the short term.
Question
8: Do you favor increasing criminal penalties for drug users or drug
dealers? Do you favor the death penalty for drug dealers of for drug dealers who
sell to minors? Do you favor mandatoty life imprisonment for drug dealers of
for drug dealers who sell to minors?
Bush Response: My Administration has vigorously pursued the War on Drugs, obtaining
more than 46,000 convictions between 1989 and 1991. We have worked hard to establish
appropriate penalties for drug offenses, and current laws are generally adequate. There are,
however, some areas that need improvement.
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�-6My "Comprehensive Violent Crime Control Act of 1991 ," which Congress still has not
enacted, proposes the death penalty for drug-related felony violations which result in the death
of another person.
Whether a drug dealer deserves the death penalty depends on a variety of factors, and
these sanctions should be reserved for the most serious cases. I also strongly support stiff,
mandatory minimum sentences contained in current law for drug trafficking and for involving
minors in any aspect of the drug trade.
Clinton Response: In Arkansas, I have increased penalties for drug traffickers. I will
continue to support lengthy and severe sentences for drug traffickers, including the death
penalty for drug kingpins.
Despite the efforts of Congress and the President to severely punish drug
traffickers, our anti-drug laws have filled our prisons with first-time and low-level drug
offenders while many of the drug kingpins continue to evade the system. In fact, despite the
administration's efforts to create a federal death penalty offense for drug
kingpins, this statute remains virtually unused. We need to make sure that the worst offenders
are receiving appropriately tough sentences.
Question 9: Do you favor pre-employment testing for drugs and alcohol for all
federal employees? For law-enforcement personnel?
Military personnel? Others?
Transportation
workers?
Bush Response: I strongly support drug-free workplace programs, not only for the Federal
government, but also for the private sector. The Federal government has done an exemplary job
in creating a model program which emphasizes, above all, the well being of our employees,
public confidence in our Government, and reducing any health or safety threats to the members
of the public.
Drug testing is only one component of the Federal program, which also includes training
for managers and supervisors on illegal drug use, intensive drug awareness programs, and
employee assistance programs.
Only those employees in national security, safety-sensitive, health, transportation, or
similar occupational areas are subject to random drug screening. Applicants for these positions
are subject to drug screening as well. Generally, this includes personnel who carry firearms,
such as law enforcement personnel, and some-but not all-transportation workers. Our drug
testing program in the military, which has been in operation for over ten years, has done an
excellent job in reducing drug problems in the Armed Forces. It includes pre-induction
screening for drug use.
•
Clinton Response: I support the idea of pre-employment drug testing for safety-sensitive
and security-related positions, such as certain law enforcement and military personnel. I
continue to believe, however, that drug tests are no substitute for expanded drug treatment and
education.
Question 10: When is random drug testing of Federal employees an appropriate
tool?
Bush Response: Federal Drug Free Workplace Programs are composed of several elements,
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�.
•
-7of which drug testing, including random testing, is a necessary and effective component.
Randomdrug testing for Federal employees is appropriate for employees who carry firearms,
for motor vehicle operators who carry passengers, for pilots and flight crew members, for air
traffic controllers, for those having access to national security information, and for others who
hold similar positions. These are just a few examples of the types of positions where employees
are in sensitive posts. The Federal program has been carefully designed and tailored to be as
minimally intrusive as possible, and to protect the privacy of Federal employees.
Clinton Response: While I am concerned that random drug testing, without a reasonable
suspicion of an employee having engaged in illegal drug use, can be administered in an unfair and
arbitrary manner, I do believe drug and alcohol testing is justified for employees in safetysensitive positions. Any such testing mechanism, however, should include strict standards to
insure accurate results and equitable implementation.
Question 11 : Do you favor legislation that would hold tobacco companies liable
for diseases caused by the use of tobacco?
Bush Response: According to a recent United States Supreme Court decision, tobacco users
who claim to have become ill from using tobacco products already have the right to sue the
tobacco companies.
._
In Cipollone v. Liggett Groups. Inc.; the Court held that, while claims by tobacco users
against tobacco companies for failure to warn of the risks of tobacco are preempted by the
Federal Cigarette Labeling and Advertising Act of 1965, tobacco users who have become ill may
sue the tobacco company on other grounds-breach of express warranties, intentional fraud, or
conspiracy to misrepresent or conceal material facts concerning the health hazards of smoking.
Clinton ·Response: I have not had the opportunity to study this particular legislation and the
extensive related case law and, therefore, cannot comment on it.
Question 1 2: Should the.· U.S. government promote the sale of U.S. cigarettes
abroad as a means of reducing our trade deficit?
Bush Response: The United States Trade Representative's (USTR) policy is to challenge
discriminatory barriers to U.S. exports that violate international law. Nevertheless, it is also
USTR's policy not to challenge nondiscriminatory measures that have been legitimately adopted
by foreign governments to protect public health and safety. The GATT recognizes that
governments have a legal right to implement such measures, so long as they do not operate as
disguised barriers to trade. The U.S. supports efforts by all governments to protect their
populations from drug, alcohol, or tobacco abuse, but also strongly opposes misuse of this
rationale for protectionist reasons.
Clinton Response: The only way for the U.S. to reduce its trade deficit is to win in the global
economy. We need to fundamentally change our trade policy, and that means we need a trade
policy that puts people first by investing in ourselves. My national economic strategy will
invest in the ongoing education of American people, in the productive equipment that gives our
workers the tools to compete, and in the economic infrastructure that binds our markets and our
businesses together. And instead of focusing on tobacco exports to help reduce the trade deficit,
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�..
-8my trade policy will recognize that we need companies that invest in the future-and that profit
from change.
Question
1 3: Do you favor requiring that all cigarettes exported by U.S.
tobacco companies be required to carry warning labels in the language of the
country to which they are exported?
Bush Response: The GATI recognizes that governments have a right to protect the health of
their populations through legitimate public health and safety measures, such as warning labels
and nondiscriminatory restrictions on tobacco advertising. Uke all U.S. firms, tobacco
producers have a legal obligation to comply with the public health and safety requirements of
the nations in which their products are sold.
·
Clinton Response: I certainly believe all governments should encourage their businesses to
·translate warning labels that· are affixed to their exports, particularly where health concerns
exist.
Question ·1 4: Do you favor tougher warning labels on alcohol?
Bush Response: Warning labels on the risk of alcohol use for pregnant women and the
danger of drinking and driving are already on many alcoholic beverages. A Federal Interagency
Task Force is currently working to determine how best to represent the alcohol content of
beverages for consumers. Recommendations from the Task Force are expected soon.
Clinton Response: I support the current warning label requirements and will consider any
appropriate changes that need to be made. I believe warning label messages should be based on
the most current medical and scientific information, so that consumers can be fully aware of the
possible effects of alcohol use.
###
�THE WHITE HOUSE
March 29, 1993
Sarah F. Hays, M.D.
Batesville Neuropsychiatry
1695 Harrison Street
Batesville, Arkansas 72501
Dear Dr. Hays:
Thank you for your letter of concern about the disparity of
insurance coverage for those with physical illness and those with
mental illness. I will direct your views and suggestions to the Task
Force.
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Again thank you for sharing your thoughts and for your
support in this tremendous undertaking.
Sincerely yours,
�---..
Batesville Neuropsychiatry
Sarah F. Hays, M.D.
1695 Harri soo Street
Batesville, Ark. 72501
(501 ) 793-0017
March 16, 1993
Hi 11 i ary Cl i ntoo
The W'lite 1-buse
Washington, DC 20500
Dear Ms. Clintoo,
I am writing yoo this 1etter in regard to yoor hea1th care reform p1anni ng. I am a 40 year o1d white
femle physician, W1o graduated fran the University of Arkansas ~ical Scie"'Ces Carrpus in 1900. I
did an internship in internal ITEdicine, which was then folla-.ed by a neurology residency. I becarre a
OOard certified neurologist in 1985. That sarre year I \'h1t into privBte· practice of neurology in
Batesville, Arkansas. I ranained in practice here in Batesville until May of 1990. At that tine I
returned to little Rock to do a oo year residency training program. in psychiatry, which I subsequently
CXlJ1)leted in June of 1992. Since that tine, I have returned to Batesville tO the private practice of
neuropsychiatry.
I:U'ing ·rrrf .psychiatry residency, I was eJqX>Sed to the Arkansas Divisioo of r-BTtal 1-ealth and spent
several rrmths of training at the Arkansas State ~spital, as well as· \\Orking in the Greater Little
~ Ccmrunity t-ealth Center. I witnessed, first hand, the plight of the chronically nentally i 11.
b that. i have returned to private practice, I am roti ng the disparity between insurance reirrtxJrserent
for "jjlysical 'illness" as CQ'Il)ared to that of ''nmtal ill~ss~" I· think with the advaramrt of ITEdical
science, it· has becare increasingly clear that the necharnsms underlying rmntal illness invariably involve
pathophysiologic processes involving the brain.· Therefore, there i's no differt:n:e between physical and
nenta1 ill ness.
In additiorl'; ·there are a nl.ll'ber of people 'IA'lO are 11 solid citizens" that \'0'1< hard in our society and
care for their families. Yet rmny of these people suffer .frtm rrental illnesses, such as depression,
\rttlich ·ill1)airs their capacity for a full and enriched life. It seens ·an unreasonable discrirninatioo ·
oo the part of insurance CQ'Il)anies, to reirrDllrse less for these peoples• illnesses than for sareone
\b) has hypertensioo or diabetes, for exarrple. These "walking \OJI'lded" rreke up a large portioo of oor
society •s \\OI"k force and taxpayers.
·
It is rrrf plea that you will stroogly coosider the issues to 'fklich I have ·alluded in this letter, as you
make plans for health care reform. Furthernore, I \\Ollld be happy to talk· with you about· these issUes ·
at anytineorcamunicate in any fashion, in regard to these matters.
.. .. ~:;
. :
•'.·i-·
p~q-;
Sarah F. Hays, M.D.
D-03-16-93
T-Q3-18-93
...
-~.'
-~ .
;-~~.
t.·
..·,
�THE WHITE HOUSE
March 29, 1993
Ms. Eleanor Butler
President, Board of Directors
Hospice of Burke County
P. 0. Box 1579
Morganton, North Carolina 28655
Dear Ms. Butler:
Thank you for writing and sharing your views regarding the
_,...
/
/
./
benefits of hospice programs. Certainly, caring for terminally ill
patients at home has definite advantages when it is at all feasible.
/
President Clinton is committed to reforming our nation's
health care system -- controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your ideas and for your support in this
tremendou.s undertaking.
Sincerely yours,
�. ....
HCSPICE
0
F
B U R K E
C 0 U N T Y
Post Office Box 1579
Morganton, North Carolina 28680
004) 879-1601
Hillary Rodham Clinton
100 Pennsylvania Ave.
Washington, D.C.
March 19, 1993
Dear Mrs. Clinton:
I am writing on behalf ofthe Board ofDirectors ofHospice ofBurke County. We are very interested in and
concerned with national health care reform and the impact that the various proposals currently being
discussed might have on the families being served by hospice programs throughout the country..
It has been shown in the past that home care is frequently a less costly and equally effective alternative to
hospital- or clinic-based care. For more than twenty years hospices in the U.S. have provided a readily
available alternative to often non-effective treatment for the terminally ill.
It is our hope that any basic benefit package proposed by the Health Care Reform Task Force will include
a hospice benefit. This will encourage patients to take advantage of palliative care when appropriate and
allow for the support services necessary to care for terminally ill persons at home, or in other palliative care
settings when indicated.
We would appreciate your continued awareness ofhospice services as progress is made in health care reform
and also would appreciate being kept informed of legislative action regarding this issue.
Sincerely,
£~4~
Eleanor Butler, President
Hospice of Burke County Board of Directors
�THE WHITE HOUSE
March 29, 1993
Ms. Betty Ervin
104 Woodside Place
Morganton, North Carolina 28655
Dear Betty:
Thank you for writing and sharing your views regarding the
benefits of hospice programs. Certainly, caring for terminally ill
patients at home has definite advantages when it is at all feasible.
President Clinton is committed to reforming our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your ideas and for your support in this
tremendous undertaking.
Sincerely yours,
�-~~--
-
-------
104 Woodside Place
Morganton, NC 28655
March 19, 1993
Mrs. Hillary Rodham Clinton
The White House
Washington, DC 20500-2000
Dear Hillary:
I am writing t? ask that you and your Health
Care Task Force g~ve in depth and (hopefully)
favorable attention to the Hospice concept.
currently I am vice-chair of our local Hospice
board, and I have been an interested observer and
volunteer for a number of years.
To me, Hospice
exemplifies the innovative and cost effective
approaches to health care that our country needs.
It is certainly less costly and more humane than
the extreme pointless measures often taken to keep
terminally ill patients technically alive in
hospitals.
The most important factor to me is the human
element.
Patients can remain in their own homes,
be surrounded and cared for by their family members
and
loved
ones,
receive
medical
and
other
supportive help, be kept relatively pain free, and
have a quality of life that is hard if not
impossible to achieve in a hospital.
It is my hope that Hospice will be an
important facet of our new health system and will
· have the resources it needs to keep up the high
quality of care.
Anything you and your group can
do will be deeply appreciated.
Sam and I are so very proud of you and the
President. We are always ready to help you in any
way possible. Please call on us when you need us.
Affectionately yours,
r&dlj
Betty Ervin
: jcc
~.(0
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009a. letter
DATE
SUBJECTfi'ITLE
Hillary Rodham Clinton to June Kozak Kane, M.S., RD [partial] (1
page)
03/24/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
ONBox Number: I 0813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. ll04(a))
Freedom of Information Act- (S U.S.C. SSl(b))
Pl National Security Classified Information ((a)(l) of the PRA)
Pl Relating to the appointment to Federal office ((a)(l) of the PRA)
P3 Release would violate a Federal statute ((a)(3) of the PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted Invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(l) Release would diselose internal personnel rules and practices of
an agency ((h)(l) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would diselose trade secrets or confidential or financial
Information ((h)(4) of the FOIA)
b(6) Release would constitute a clearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA)
b(7) Release would diselose information compiled for law enforcement
purposes ((b)(7) of the FOIA)
b(8) Release would disclose information concerning the regulation of
financial institutions ((h)(8) ofthe FOIA)
b(9) Release would disclose geological or geophysical information
concerning weDs ((h)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in accordance with 44 U.S.C.
ll01(3).
RR. Document will be reviewed upon request.
�-- - - - - - - ·
-
·:--::.:o."'::."',-.-...:::e- .-::-:... ....~~=:--..><:-~=~--~--•
{'
I
THE WHITE HOUSE
March 24, 1993
Dear Ms. Kane:
Thank you for writing and sharing your views on health care
refonn and other human services which relate so closely to it.
Certainly, wellness programs, good nutrition and prevention of
diseases enter clearly into the total picture.
-----·- -
President Clinton is committed to refonning our nation's
health care system - controlling runaway costs and providing
security to every American family. It won't be easy and it won't
happen overnight, but we can bring costs under control while
maintaining quality medical care and preserving the choice so
important to us all.
Thank you again for your views and for your support.
Sincerely yours,
---
�Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
AND TYPE
009b. letter
DATE
SUBJECTffiTLE
June Kozak Kane, M.S., RD to Hillary Rodham Clinton [partial] (1
page)
03/10/1993
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Maggie Williams
OA/Box Number:
l 0813
FOLDER TITLE:
HRC Healthcare Correspondence [3]
2006-0223-F
ab618
RESTRICTION CODES
Presidential Records Aet - (44 U.S.C. 2204(a))
Freedom of Information Aet -(5 U.S.C. 552(b))
PI National Security Classified Information ((a)(l) of the PRA)
P2 Relating to the appointment to Federal office ((a)(2) of the PRA)
P3 Release would violate a Federal statute ((a)(3) ofthe PRA)
P4 Release would disclose trade secrets or confidential commercial or
financial information ((a)(4) ofthe PRA)
P5 Release would disclose confidential advice between the President
and his advisors, or between such advisors (a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy ((a)(6) of the PRA)
b(l) National security classified information ((b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency ((b)(2) of the FOIA)
b(3) Release would violate a Federal statute ((b)(3) of the FOIA)
b(4) Release would disclose trade secrets or confidential or financial
information ((b)(4) of the FOIA)
b(6) Release would constitute a elearly unwarranted invasion of
personal privacy ((b)(6) of the FOIA]
b(7) Release would disclose information compiled for law enforcement
purposes ((b)(7) of the FOIA]
b(8) Release would disclose information concerning the regulation of
financial institutions ((b)(8) of the FOIA]
b(9) Release would disclose geological or geophysical information
concerning weDs ((b)(9) of the FOIA)
C. Closed in accordance with restrictions contained in donor's deed
of gift.
PRM. Personal record misf"de defined in aeeordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
�-- r
,.
March 10, 1993
Ms. Hillary Rodham Clinton
CLINTON HEALTH CARE TEAM
THE WHITE HOUSE
1600 Pennsylvania Avenue
Washington, DC 20006
RE: HUMAN SERVICES REFORMS AND COORDINATED COMMUNITY MODELS ("HEALTH AND
HUMAN SERVICES CENTERS") IN RE HEALTH CARE REFORMS.
Dear Mrs. Clinton:
-··----· ··-:c-
< .......~-
""
rs--~Thomases'-motheJ_stiggested that I forward my enclosed views. to you. I hope these comments may be of
~the administration's disease prevention and health care/human services refonns.
From 1978 to 1981, as developer of an immensely successful nutrition segment for a Robert Wood Johnson-funded
wellness program in Milwaukee, and later as Chief Nutritionist for that city's health department, I was directly
involved in community based wellness programs and· community health centers that included WIC facilities. We
routinely coordinated nutrition education and wellness programs with clinical and food assistance systems. And
eventually, we were asked by the County to take over several WIC sites and bring them into our comprehensive
wellness and community health care system.
During those years, I testified before state and federal committees on food assistance programs, giving oral and
written suggestions for their improvement and reform. I am sure I do not need to tell you how little reform
occorred in these areas during the last 12 years. despite passionate pleas. Therefore, I'd like to reiterate some of
my suggestions now, in case they might be of assistance to new policies being developed by the Clinton
administration. These suggestions may also have bearing upon healthcare reforms now under construction.
After observing several food-and nutrition assistance programs, and speaking to people who lived through the
"dole" of the 30's depression, I feel strongly that we need a new format for food assistance, based on the WIC
specific voucher model, coordinated with clinical and learning segments - but streamlined, with needed
modifications (a modular 'credit card' or punch card system?) and attention to current sensibiijties.
Few in the U.S. begrudge giving necessary food to those in need. Most anti food-stamp feelings arise only when
taxpayers observe food stamp shoppers purchasing either perceived "luxury" items or "junky" non-nutritious (and
therefore "non-necessary") foods which the taxpayers feel they themselves cannot afford on a budget already asked
to subsidize the food stamp purchase in question. As a nutritionist, I have concerns about food stamp choices that
will not help build optimal health in an already at-risk population. And too often, I have witnessed homes which
simply do not have enough food at the end of the month for family members. either through poor planning or
inadequate scrip. But current food assistance programs can be altered to alleviate concerns such as these.
•
Rather than providing food stamp scrip in too limited amounts usable for a wide variety of discretionaiY purchases.
I believe the program would be more successful if it were administered much like the successful WIC model:
Hungry people could be provided vouchers good for ample amounts of healthful products such as milks,cheeses,
yogurt and eggs; dried/canned beans and peas; oatmeal and other nutritious cereals; brown and enriched rice and
other whole grains and enriched breads and flours; healthful fat sources; juices, apples. oranges and bananas;
green.yellow and orange vegetables; and minimally processed fish, poultry and other healthful protein sources such
as natural (non-hydrogenated ) peanut butter. Other vouchers could be used for generic or house brand paper
products such as diapers, toilet tissue. and personaVsanitary products. If the country can afford it, there could also
be a minimal amount of unspecified scrip or special vouchers issued monthly to cover "extras" such as generic
chocolate syrup, coffee, tea, etc., which most people might agree to be actual necessities; but the clinician
approving the packet might specify "decaffeinated" types only, for example, depending upon health conditions.
The use orspedfic vouchers would automatically tend to provide consumers with more healthful food
products while eliminating most empty calorie (or especially expensive) food items. Such specific vouchers
would also eUminate many resentments voiced in the plllt by taxpayers., and conld close gaps of inadequate
WIC funding until a seamless melding of the two systems might be effected.
�KOZAK KANE I HEALTH & HUMAN SERVICE REFORMS
MARCH lO, 1993
Pagel
Food assistance programs could also be broadened to include a participant-run meals-on-wheels option for new
mothers or others who might temporarily be unable to shop and/or cook. H able-bodied food stamp program
participants can be given the opportunity to staff such programs. peer pressure may help deter abuses,
while new and valuable job skills may be learned. These programs could be broadened, as well, to include food
kitchens which could exchange cooked meals for special food stamp vouchers issued to those who are unable to
cook their own meals. Such communal kitchens would be ideal placements for high school students exercising
their community service requirement. Food service management trainees could provide additional staffing, with
professional supervision provided by those with professional training (perhaps training financed by the proposed
government grant/work payoff system). Hospitals or community schools with cafeterias could be considered for
sites offering social services, classes, meals,day care,extended day, and auxilliary clinic services. If such
comprehensive community health and human services centers were coordinated with HUD, available buildings
. could be found and renovated, and new jobs could be created in the renovation and upkeep of such programs.
This important broadening of the food stamp prognuh to include community food kitchens or available site meal
service (which could be contracted for) should ideally be coupled with a complete array of health. day care.
social senice and counseling or training senices. In urban/suburban community facilities, eligible participants
could take part in available (mandatory or incentive) classes to learn nutrition and wellness tips, healthy food
preparation techniques, and other skills. Providing meals, day care, homework assistance and other incentives to
learning, centers might prove popular and gain necessary community support. If such programs were held in
association with community medical centers, it would enable these programs to be further coordinated with
medical attention, WIC exams, classes in parenting, breast feeding, wellness and stress management, home safety,
Headstart, HIPPY,etc. Rural models, of course, would need to be planned with travel modifications.
Existing urban models around the country currently provide several facets of the above. Several large city health
centers provide a wide variety of health facilities that incorporate wellness classes along with medical/dental clinic
opportunities. And, of course, most WIC centers provide, as well, nutrition classes on various topics, including
breast feeding, maternal and infant nutrition, etc., which are an integral part of that program. Coordinated centers
could provide all of these options. A different example of such programs is The Floating Hospital model
(operating out of NYC). The Floating Hospital is a non-profit ship that sails around Manhattan during the summer
months and provides a free day-long outing plus lunch to eligible participants who then utilize on-board medical
and dental screening services, and attend nutrition, parenting and wellness lectures, films, etc. Each model offers
workable aspects which can be incorporated into comprehensive health and human services centers.
Obviously, I concur with the Clinton administration's belief that it is critical to address the total health and welfare
issues of the economically disadvantaged -which I believe can best be done dealing concurrently with food
assistance. While a totally reformed medical system with universal access will eventually provide medical
attention for all, it will better serve taxpayers and beneficiaries if we can also improve the quality of foods and quality of life - for those on financial assistance. Rather than providing only crisis -oriented food and
medical assistance, a community-based comprehensive wellness model could provide access to a totally
healthier lifestyle.
Additionally, since medical costs of the indigent are- and will be- borne by tax- payers, attention to
prevention of diseases and to social needs in a comprehensive health and human senices model should be
expected to provide cost benefits similar to that which the exemplary WIC program has so consistently
shown throughout its existence.
Please feel free to contact me if I may be of additional assistance in your endeavors.
Very truly yours.
,J~Mc-~~
June Kozak Kane M.s•• R.D.
cc. Ms. Shalala, Health and Human Senices
Mrs. Tbomases, Englewood, NJ.
�(
-·
CODER:_·_-_ -" -.,.
•.
HEALTH CARE TASK FORCE SORTING SHEET
INPUT DATE:_ _
GENERAL SORT:
_General mall
__Personal stories
__Other Health Providers
POSTCARD 1:
__Letter Campaign
POSTCARD 2:
_Offers to help/Employment
FORM LETrER:
_Letterhead
_Policy
REROUTE:
__Casework
_Scheduling _President
_J»hy&ici.ans
__Other
POLICY AND PERSONAL STORIES:
_ORGANIZATION (I)
_insurance premiums
_insurance reform
_insurance pools
_boards and oversight
_COVERAGE CID
_working families
_unemployed/low income
_benefits
__providers
_INFRASTRUCTURE/WORKFORCE (W)
_quality assurance (guidelines)
_administration, reimbursement
& information systems
_malpractice & tort reform
_manpower issues (training)
_unnecessary procedures
_GOVERNMENT PROGRAMS (IV)
_medicare
_medicaid
_veterans
_DoD
_Indian health
_COST ISSUES (VI)
_drug prices
__physician fees
_hospital fees
_medical equipment
_fraud & abuse
_FINANCING (VII)
_MENTAL HEALTH (IX)
_LONG-TERM CARE (X)
_PUBLIC HEALTH/
SPECIAL POPULATIONS (XII)
__prevention
_AIDS
_women's health
_immunizations/children
_rural
_urban
_OTHER~--------------------
··~
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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HRC - Health Care Correspondence [3]
Creator
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First Lady's Office
Maggie Williams
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
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Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Reproduction-Reference
Date Created
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1/8/2015
Source
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42-t-2194630-20060223F-005-001-2015
2194630