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DOCUMENT NO.
AND TYPE
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SUBJECTffiTLE
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08/31/1994
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Phone No. (Partial) (I page)
08/31/1994
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003. memo
P~one
08/31/1994
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No. (Partial) (I page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Speechwriting
OA/Box Number: 8169
FOLDER TITLE:
Ira/APSA [American Political Science Association] 9/94 [911/94] [2]
2012-1 004-S
ms517
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Presidential Records Act- [44 U.S.C. 2204(a)l
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P2 Relating to the appointment to Federal office [(a)(2) of the PRAl
P3 Release would violate a Federal statute [(a)(3) of the PRAI
P4 Release would disclose trade secrets or confidential commercial or
financial information [(a)(4) of the PRAI
PS Release would disclose confidential advice between the President
and his advisors, or between such advisors [a)(S) of the PRAI
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRAI
b(l) National security classified information [(b)(l) of the FOIAI
b(2) Release would disclose internal personnel rules and practices of
an agency [(b)(2) of the FOIAI
b(3) Release would violate a Federal statute [(b)(3) of the FOIAI
b(4) Release would disclose 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 FOIAI
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 [(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.
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DOCUMENT NO.
AND TYPE
001. memo
SUBJECTffiTLE
DATE
Phone No. (Partial) (I page)
08/3111994
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Speechwriting
ONBox Number: 8169
FOLDER TITLE:
Ira!APSA [American Political Science Association] 9/94 [911/94] [2)
2012-1004-S
ms517
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Presidential Records Act- )44 U.S.C. 2204(a))
Freedom of Information Act- )5 U.S.C. 552(b))
Pl National Security Classified Information l(a)(l) of the PRA)
P2 Relating to the appointment to Federal office l(a)(2) of the PRA)
P3 Release would violate a Federal statute [(a)(3) of the PRA)
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and his advisors, or between such advisors [a)(S) of the PRA)
P6 Release would constitute a clearly unwarranted invasion of
personal privacy l(a)(6) of the PRA)
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b(2) Release would disclose internal personnel rules and practices of
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b(4) Release would disclose trade secrets or confidential or financial
information l(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 FOIAI
b(8) Release would disclose information concerning the regulation of
financial institutions )(b)(8) of the FOlA)
b(9) Release would disclose geological or geophysical information
concerning wells l(b)(9) of the FOlAI
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.
�AtiGUST 31, 1994
8 pm
T.O: Maggie Williams
Yftelanne Verveer
Harold Ickes
Ira. Magaziner
Li·sa caputo
Greg Lawler
Lorrie McHugh
Chris Jennings
Jack Le:w
Lynn. Margherio
Christine Heenan
~ROl{:
Liss.a Muscatine
RE: Tra's remarks to the APSA
Here .i.s a first take oh. the speech for Ira. It may n~ecl some
fleshing out and some more loftiness and history, b:ut .I wanted to
c.ircula te some thin
t that you could look at. "I 'it be
reachable at· horne.
until abo.ut 8':30 a.Jn. Thursday.
otherw.ise I' 11 see you
a. rn. rneet_i~ng. T::tlank.? foJ' your
suggestions and ideas. Ahy thoughts will b_e a b:ig help!
tvl~
. ·. ··. . J;·. ·.
l/1- (LA.)~
4~~ -~·),·.· . '/·. -~I
'11!>
�LM DRAFT 8/31/94
8 pm
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished - chapter of American political and social history. Great because
for the first time in decades we have set in motion a process for
dealing with one of the most intractable social and economic
problems of our time -- a health care system that is out of reach
for millions of Americans and too costly for our nation.
Unfinished because Congress has not yet written the final words
of this chapter.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
vs~kl pi!.:<Sfe:ch'.x:.
Analyzing health ca
re!orm is all the more difficult right
now because the process is far from over. So my perspective, like
that of other insider and journalists and political
commentators, is bas d on current and fluid events that can
change from one da , or one month, to the next. But hopefully I
can offer you a
·
of the health care reform process that
has engaged the Clinton Administration and Congress for much of
~
this year.
iV'Isv"
committ~ ~~
When Bill Clinton ran for the Presidency, he was
to solving the health care crisis for two principal reason~~ ~~
First, because the health of tens of millions of Americans was at
risk in the current system. And second, because there was no way
to restore our economy without doing something about rising
health care costs.
When he took office last year, the picture was only getting
worse. On any given day, close to 40 million Americans --most of
them working people -- lacked insurance. Millions were locked in
jobs they couldn't leave for fear of losing their insurance.
Families couldn't get coverage because of "pre-existing
conditions" and other forms of insurance discrimination. Small
businesses faced health care premiums 35 percent ~igher than
those of large corporations
and projected to grow at doubledigit rates.
And there was little hope of reducing the deficit when
health care expenditures consumed about 14 percent of our
1
�fi'·t-~~
wr1\.. ed.9..ef. d..e{;0.+ - c.ou1.ct,.. ·~ s;olv-c.
~ ti:.(J(r1 ~
rM
Wl'CQ.A.e
~
71,A•c..
~~
~ eA.~
-
national income. By the year 2000, the figure would be closer to
20 percent. Month after month, year after year, health care costs
were further eroding our savings, our investment capital, our
ability to create new jobs in the private sector and the public
treasury.
So the question the new President faced 20 months ago was
this: How do you solve a problem of this magnitude, of this
complexity, of this urgency, when no President, Republican or
Democrat, has managed to do it in 60 years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and Carter before him.
Bu:L.Presi dent Clinton felt he had no choice bat ""'to go
forwara \;ith health CdLe reform. The American people demanded it.
The economy demanded it. And -- to use a football metaphor, since
football season is now upon us -- h~ knew he eeula no~ punt on
such a crucial issue.
'P~ c:...L, t..J,I~ ~"-'~> ~ o..l,;ov- \- fc;l
Health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health care
costs.
~ ~ go \.u:r.....-l ~ l..t:...-D . LA~v t...o-- '+ S'o.....e ~ uA-I..e..f? -<. c::... ~ _
()...e. },?v.,rLc,...,
c,n..
~$I ~
r:-\1+•
- ,.
~ 1\.,.;c C..C~-
Universal coverage was his bottom line because, unless
f~ru:~
everybody is covered, we can't fully control inflation. Why?
Because people who don't have insurance still get health care,
but they get it when it's too late, too expensive, and often and
from most expensive place in all, the emergency room. The rest of
us end up footing the bill through higher hospital bills and
higher insurance premiums.
When the President's plan was first presented last year,
virtually all Democrats and moderate Republicans supported the
goal of universal coverage. And virtually all the comprehensive
health care bills subsequently submitted by Democrats and
moderate Republicans included cost containment.
3 cfhoM ~ goo "-"f"o'-";1'-.
ei ck..., f""\.-0' ~ ~ ~There was a general consensus that the most efficient, most
feasible option for achieving universal coverage was an employer
mandate. This was the system that 90 percent of insured Americans
wS
2
�~
disrupt~,
~
'8...-f~ ~ 1~~
.v
:::.-
~~~
already used. It was the least
most conservative
option available. And, once again, i~~~ an option embraced by ~-Ul
groups across the political spectrum: the American Medical
~~
Association, the Health Insurance Industry Association of
American, many labor unions, the Jackson Hole group, the Chamber l}
of Commerce and other business groups, and a national coalition
~~
on health care reform co-chaired by former Presidents Carter and~,
Ford.
~,-A-
vr
f\)t'f'-
Cost containment was an equally important part of the
equation. Cost.containment is essential if you want families and
businesses to be able to afford health care, and if you want to
control federal spending.
But as with universal coverage, there are only a few ways to
get costs under control.
One option is price controls -- directly setting the price
for goods and services delivered in the health care sector, or
setting ceilings on the total amount the nation would spend on
health care.
Managed competition advocates· supported the idea of "tax
caps" to contain health care spending -- limits on the tax
deductibility of health spending by companies. The President
rejected that approach because it would raise taxes on middleclass families.
The President's plan proposed premium caps, limiting the
amount insurance premiums could be raised each year. This
approach was borrowed directly from Republican Senators
Danforth's and Kassebaum's bill.
,AAJIOA--(;.(...A - -
Pl~~
~!l.e.A.. l~ ~~/rev--- 11-...~.s..A~or-. - ~)- r~
How were these decisions reached?
v~
The formation of the President's health reform policy was
among the most open processes ever conducted in an
Administration, despite perceptions to the contrary.
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
in a short time frame. We cast a wide net for participants.
There were serious consultations with hundreds of Americans
from all walks of life: Physicians, nurses, social workers,
hospital administrators, benefits consultants and managers,
consumers, businesspeople, actuaries and accountants, health
lawyers, and many others.
The task force met with more than 1,100 interest groups,
held daily meeting with members of Congress, and involved more
~-
�than 120 Congressional staffers from both parties in the working
groups. During the 14 months between February of 1993 and this
past April, the First Lady held 23 public hearings and town
meetings across the country.
By May, review groups composed of health care providers,
consumers, auditors, actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of time.
Has it been a flawless operation? Of course not. We see that
even more clearly in hindsight.
·~
uf
UO~~tY
VV-v~~
~ .~
o- 'if'
.:r y;r
/
/
Early on, we should have done a better job of educating the
press about the process. Early on, we should have done a better
job of anticipating and responding to one of the most expensive
and intense advertising campaigns ever mounted against us. And we
wish, in retrospect, that we somehow could have ~verc~me --very
early -- the huge obstacles presented by the leg1slat1ve
calendar .
~ . ~.~.
Let me just digress for one mome~t to talk about the single
b1ggest obstacle we faced then and st1ll face now. Several
~~((\ studies have now documented the amount of money spent on
~g)~L
advertising and lobbying to influence the outcome of the health
~
care debate. Every major legislative battle -- from the New Deal
~ ;-~~ to Social Security to Civil Rights-- has met with opposition.
J' ~ / t
But never in the history of this country has there been the same
_J~ v
degree of misinformation spread as has been spread during this
~ ~
health care debate. And never has there been such an
~~ ~
extraordinary amount of money spent on disseminating that
~~
misinformation.
~~~~
~~~I
J
~ ~·
l~v~·
~.I
~~
~.j
The Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
Over $100 million has been spent overall to influence the
outcome. One study found that $50 million largely to influence
reporters and legislators rather than the public as a whole. And
these figures don't capture direct mail and phone bank efforts
financed by opponents.
Whatever your view of health care reform, if you've seen the
6:~~now famous --or infamous -- ads you know that they are not only
~ ~.J negative, they're downright scary. Health care is an extremely
/
~
.
personal issue, one people connect with more deeply and directly
~·~than somethi~like;l~~ ~;:y or
4
d:;;c;t r:du;:ion. And the
,.~~/ ,tl~~}<"~\>~~~>-''XI(;.'_; l
/1 J
.t~oo IJ))' if(~Q~~) J" ~lf.;;//y
�Withdrawal/Redaction Marker
Clinton Library
DATE
SUBJECT!TITLE
DOCUMENT NO.
AND TYPE
08/31/1994
Phone No. (Partial) (I page)
002. memo
RESTRICTION
P6/b( 6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Speechwriting
OA/Box Number: 8169
FOLDER TITLE:
Ira!APSA [American Political Science Association] 9/94 [9/1/94] [2]
2012-1 004-S
ms517
RESTRICTION CODES
Presidential Records Act- [44 U.S.C. 2204(a)]
Freedom of Information Act- [5 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 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(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) 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 misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
J.<~
" ,._ '
~·,j.,J,~"
'
•"
• •' r~
~
'
•
'
'
,
<"' ·•
:,
'•
v
~
•
'
'~
1-
•
~
•
•
1
'
•
•
'
•
�AUG0ST 31, 1994
8 pm
T.O: Maggie Williams
Melanne Verveer
/Harold J:.ckE:!s
Ira Magaziner
Lisa Caputo
Greg Lawler
Lorrie Mc:::Hugh
Chris Jennings
Jack Lew
Lynn Margherio
Chrfstih• Heenah
FROM: Lis.sa Muscatine
~E:
Ira's
r~marks
to the APSA
Here is a f{r,st take on the speech for Ira .. t t may need some
fleshing out and some more loftiness and history, but I want~d to
cirqulate someth±n
that you could lo.ok at.. T' 11 be
reachable at. home
unti.l about 8:30 a.m. Thursday.
Otherwise 1:1 ll s.ee you
a· ..m. ll\~~t~ng ~ Tha}:\ks .f.o:t:" your
suggestions and ideas.
th6ughts will :Qe a big help!
�campaign against health care reform continues to play on people's
fears.
I point out the degree of misinformation because these
advertising campaigns succeeded in distorting the President's
plan into some radical, wild-eyed attempt to revamp our health
system. In fact, as I mentioned earlier, the main elements of he
proposed were culled from Republicans and Democrats alike -- most
of whom could be described as political moderates. Universal
coverage, employer mandates, and premium caps are about as
mainstream and conservative an approach to health care as you can
get.
It's also easy to forget that the President never suggested
that his plan should be the final word adopted by Congress. As
soon as he outlined it, he stated very clearly that his bottom
line was universal coverage but that he was open to suggestions,
ideas, criticisms on how to achieve his principal goals. He
welcomed and encouraged bipartisanship. That has always been his
position, and remains so now.
So where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy and fulfilling
the President's broader agenda.
The President has set in motion a process for dealing with a
health care problem that is not going to vanish on its own. And
we are further along than we have ever been in our history in
getting Congress to act on reform.
Are we as far along the path as we had hoped? Not yet. Have
we given up hope? Not at all. Are we more realistic about how to
accomplish reform? Definitely.
,From a social science perspective, I hope this period will
be viewed as one of great ferment, energy, and momentum that
launched us toward solving the most difficult social problem of
our time, if not of this century.
Thank you very much.
###
5
�~
~-------------------------------
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Clinton Library
DOCUMENT NO.
AND TYPE
003. memo
DATE
SUBJECTffiTLE
08/31/1994
Phone No. (Partial) (1 page)
RESTRICTION
P6/b(6)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Speechwriting
ONBox Number: 8169
FOLDER TITLE:
Ira/APSA [American Political Science Association] 9/94 [9/1/94] [2]
2012-1 004-S
ms517
RESTRICTION CODES
Presidential Records Act- (44 U.S.C. 2204(a))
Pl
P2
P3
P4
National Security Classified Information ((a)(l) of the PRA)
Relating to the appointment to Federal office [(a)(2) of the PRA)
Release would violate a Federal statute ((a)(3) of the PRAI
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 misfile defined in accordance with 44 U.S.C.
2201(3).
RR. Document will be reviewed upon request.
Freedom of Information Act- (5 U.S. C. 552(b))
b(l) National security classified information [(b)(l) of the FOIA)
b(2) Release would disclose internal personnel rules and practices of
an agency l(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 FOIAI
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 FOIAI
�APGUST 31, 1994
8 pm
TO:Mo~aggie
Williams
Melanne Verveer
Harold Ickes
Ira. Magaziner
Lisa Caputo
Greg Lawler
Lorrie McHugh
Chris orennings
Jack Lew
Lynn Margherio
Chri~tine Heeha~
FROM: Lissa
Muscatin~
RE: Ira's remarks. to the APSA
Here is a first take on the speech for Ira. .Tt may need some
fleshing out and some more. lof:t-iness and history, but I wanted to
clr~l1late someth
you couid look at. "I r11 be
reachable at nome
until about 8': 30 a.m. Thursday.
Qtherwise I'll
a.m. :meetipg. Thanks for your
sugg'eS,tions and ideas. Any thoughts will be a bi.g }1elp!
�LM DRAFT 8/31/94
8 pm
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished - chapter of American political and social history. Great because
for the first time in decades we have set in motion a process for
dealing with one of the most intractable social and economic
problems of our time -- a health care system that is out of reach
for millions of Americans and too costly for our nation.
Unfinished because Congress has not yet written the final words
of this chapter.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective, like
that of other insiders and journalists and political
commentators, is based on current and fluid events that can
change from one day, or one month, to the next. But hopefully I
can offer you a fresh view of the health care reform process that
has engaged the Clinton Administration and Congress for much of
this year.
When Bill Clinton ran for the Presidency, he was committed
to solving the health care crisis for two principal reasons:
First, because the health of tens of millions of Americans was at
risk in the current system. And second, because there was no way
to restore our economy without doing something about rising
health care costs.
When he took office last year, the picture was only getting
worse. On any given day, close to 40 million Americans -- most of
them working people -- lacked insurance. Millions were locked in
jobs they couldn't leave for fear of losing their insurance.
Families couldn't get coverage because of "pre-existing
conditions" and other forms of insurance discrimination. Small
businesses faced health care premiums 35 percent higher than
those of large corporations -- and projected to grow at doubledigit rates.
And there was little hope of reducing the deficit when
health care expenditures consumed about 14 percent of our
1
�national income. By the year 2000, the figure would be closer to
20 percent. Month after month, year after year, health care costs
were further eroding our savings, our investment capital, our
ability to create new jobs in the private sector and the public
treasury.
So the question the new President faced 20 months ago was
this: How do you solve a problem of this magnitude, of this
complexity, of this urgency, when no President, Republican or
Democrat, has managed to do it in 60 years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions' and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and carter before him.
But President Clinton felt he had no choice but to go
forward with health care reform. The American people demanded it.
The economy demanded it. And -- to use a football metaphor, since
football season is now upon us -- he knew he could not punt on
such a crucial issue.
Health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health care
costs.
Universal coverage was his bottom line because, unless
everybody is covered, we can't fully control inflation. Why?
Because people who don't have insurance still get health care,
but they get it when it's too late, too expensive, and often and
from most expensive place in all, the emergency room. The rest of
us end up footing the bill through higher hospital bills and
higher insurance premiums.
When the President's plan was first presented last year,
virtually all Democrats and moderate Republicans supported the
goal of universal coverage. And virtually all the comprehensive
health care bills subsequently submitted by Democrats and
moderate Republicans included cost containment.
There was a general consensus that the most efficient, most
feasible option for achieving universal coverage was an employer
mandate. This was the system that 90 percent of insured Americans
2
�already used. It was the least disruptive, most conservative
option available. And, once again, it was an option embraced by
groups across the political spectrum: the American Medical
Association, the Health Insurance Industry Association of
American, many labor unions, the Jackson Hole group, the Chamber
of Commerce and other business groups, and a national coalition
on health care reform co-chaired by former Presidents Carter and
Ford.
Cost containment was an equally important part of the
equation. Cost containment is essential if you want families and
businesses to be able to afford health care, and if you want to
control federal spending.
But as with universal coverage, there are only a few ways to
get costs under control.
One option is price controls -- directly setting the price
for goods and services delivered in the health care sector, or
setting ceilings on the total amount the nation would spend on
health care.
Managed competition advocates supported the idea of "tax
caps" to contain health care spending -- limits on the tax
deductibility of health spending by companies. The President
rejected that approach because it would raise taxes on middleclass families.
The President's plan proposed premium caps, limiting the
amount insurance premiums could be raised each year. This
approach was borrowed directly from Republican Senators
Danforth's and Kassebaum's bill.
How were these decisions reached?
The formation of the President's health reform policy was
among the most open processes ever conducted in an
Administration, despite perceptions to the contrary.
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
in a short time frame. We cast a wide net for participants.
There were serious consultations with hundreds of Americans
from all walks of life: Physicians, nurses, social workers,
hospital administrators, benefits consultants and managers,
consumers, businesspeople, actuaries and accountants, health
lawyers, and many others.
The task force met with more than 1,100 interest groups,
held daily meeting with members of Congress, and involved more
3
�than 120 Congressional staffers from both parties in the working
groups. During the 14 months between February of 1993 and this
past April, the First Lady held 23 public hearings and town
meetings across the country.
By May, review groups composed of health care providers,
consumers, auditors, actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of time.
Has it been a flawless operation? Of course not. We see that
even more clearly in hindsight.
Early on, we should have done a better job of educating the
press about the process. Early on, we should have done a better
job of anticipating and responding to one of the most expensive
and intense advertising campaigns ever mounted against us. And we
wish, in retrospect, that we somehow could have overcome -- very
early -- the huge obstacles presented by the legislative
calendar.
Let me just digress for one moment to talk about the single
biggest obstacle we faced then and still face now. Several
studies have now documented the amount of money spent on
advertising and lobbying to influence the outcome of the health
care debate. Every major legislative battle -- from the New Deal
to Social Security to Civil Rights -- has met with opposition.
But never in the history of this country has there been the same
degree of misinformation spread as has been spread during this
health care debate. And never has there been such an
extraordinary amount of money spent on disseminating that
misinformation.
The Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
Over $100 million has been spent overall to influence the
outcome. One study found that $50 million largely to influence
reporters and legislators rather than the public as a whole. And
these figures don't capture direct mail and phone bank efforts
financed by opponents.
Whatever your view of health care reform, if you've seen the
now famous -- or infamous -- ads you know that they are not only
negative, they're downright scary. Health care is an extremely
personal issue, one people connect with more deeply and directly
than something like trade policy or deficit reduction. And the
4
�campaign against health care reform continues to play on people's
fears.
I point out the degree of misinformation because these
advertising campaigns succeeded in distorting the President's
plan into some radical, wild-eyed attempt to revamp our health
system. In fact, as I mentioned earlier, the main elements of he
proposed were culled from Republicans and Democrats alike -- most
of whom could be described as political moderates. Universal
coverage, employer mandates, and premium caps are about as
mainstream and conservative an approach to health care as you can
get.
It's also easy to forget that the President never suggested
that his plan should be the final word adopted by Congress. As
soon as he outlined it, he stated very clearly that his bottom
line was universal coverage but that he was open to suggestions,
ideas, criticisms on how to achieve his principal goals. He
welcomed and encouraged bipartisanship. That has always been his
position, and remains so now.
So where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy and fulfilling
the President's broader agenda.
The President has set in motion a process for dealing with a
health care problem that is not going to vanish on its own. And
we are further along than we have ever been in our history in
getting Congress to act on reform.
Are we as far along the path as we had hoped? Not yet. Have
we given up hope? Not at all. Are we more realistic about how to
accomplish reform? Definitely.
From a social science perspective, I hope this period will
be viewed as one of great ferment, energy, and momentum that
launched us toward solving the most difficult social problem of
our time, if not of this century.
Thank you very much.
###
5
�LM DRAFT 8/31/94
8 pm
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished - chapter of American political and social history. Great because
for the first time in decades we have set in motion a process for
dealing with one of the most intractable social and economic
problems of our time -- a health care system that is out of reach
for millions of Americans and too costly for our nation.
Unfinished because Congress has not yet written the final words
of this chapter.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective, like
that of other insiders and journalists and political
commentators, is based on current and fluid events that can
change from one day, or one month, to the next. But hopefully I
can offer you a fresh view of the health care reform process that
has engaged the Clinton Administration and Congress for much of
this year.
When Bill Clinton ran for the Presidency, he was committed
to solving the health care crisis for two principal reasons:
First, because the health of tens of millions of Americans was at
risk in the current system. And second, because there was no way
to restore our economy without doing something about rising
health care costs.
When he took office last year, the picture was only getting
worse. On any given day, close to 40 million Americans -- most of
them working people -- lacked insurance. Millions were locked in
jobs they couldn't leave for fear of losing their insurance.
Families couldn't get coverage because of "pre-existing
conditions" and other forms of insurance discrimination. Small
businesses faced health care premiums 35 percent higher than
those of large corporations
and projected to grow at doubledigit rates.
And there was little hope of reducing the deficit when
health care expenditures consumed about 14 percent of our
1
�national income. By the year 2000, the figure would be closer to
20 percent. Month after month, year after year, health care costs
were further eroding our savings, our investment capital, our
ability to create new jobs in the private sector and the public
treasury.
So the question the new President faced 20 months ago was
this: How do you solve a problem of this magnitude, of this
complexity, of this urgency, when no President, Republican or
Democrat, has managed to do it in 60 years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and Carter before him.
But President Clinton felt he had no choice but to go
forward with health care reform. The American people demanded it.
The economy demanded it. And -- to use a football metaphor, since
football season is now upon us -- he knew he could not punt on
such a crucial issue.
Health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health care
costs.
Universal coverage was his bottom line because, unless
everybody is covered, we can't fully control inflation. Why?
Because people who don't have insurance still get health care,
but they get it when it's too late, too expensive, and often and
from most expensive place in all, the emergency room. The rest of
us end up footing the bill through higher hospital bills and
higher insurance premiums.
When the President's plan was first presented last year,
virtually all Democrats and moderate Republicans supported the
goal of universal coverage. And virtually all the comprehensive
health care bills subsequently ,submitted by Democrats and
moderate Republicans included cost containment.
There was a general consensus that the most efficient, most
feasible option for achieving universal coverage was an employer
mandate. This was the system that 90 percent of insured Americans
2
�already used. It was the least disruptive, most conservative
option available. And, once again, it was an option embraced by
groups across the political spectrum: the American Medical
Association, the Health Insurance Industry Association of
American, many labor unions, the Jackson Hole group, the Chamber
of ,Commerce and other business groups, and a national coalition
on health care reform co-chaired by former Presidents Carter and
Ford.
Cost containment was an equally important part of the
equation. Cost containment is essential if you want families and
businesses to be able to afford health care, and if you want to
control federal spending.
But as with universal coverage, there are only a few ways to
get costs under control.
One option is price controls -- directly setting the price
for goods and services delivered in the health care sector, or
setting ceilings on the total amount the nation would spend on
health care.
Managed competition advocates supported the idea of "tax
caps" to contain health care spending -- limits on the tax
deductibility of health spending by companies. The President
rejected that approach because it would raise taxes on middleclass families.
The President's plan proposed premium caps, limiting the
amount insurance premiums could be raised each year. This
approach was borrowed directly from Republican Senators
Danforth's and Kassebaum's bill.
How were these decisions reached?
The formation of the President's health reform policy was
among the most open processes ever conducted in an
Administration, despite perceptions to the contrary.
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
in a short time frame. We cast a wide net for participants.
There were serious consultations with hundreds of Americans
from all walks of life: Physicians, nurses, social workers,
hospital administrators, benefits consultants and managers,
consumers, businesspeople, actuaries and accountants, health'·
lawyers, and many others.
The task force met with more than 1,100 interest groups,
held daily meeting with members of Congress, and involved more
3
�than 120 Congressional staffers from both parties in the working
groups. During the 14 months between February of 1993 and this
past April, the First Lady held 23 public hearings and town
meetings across the country.
By May, review groups composed of health care providers,
consumers, auditors, actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of time.
Has it been a flawless operation? Of course not. We see that
even more clearly in hindsight.
Early on, we should have done a better job of educating the
press about the process. Early on, we should have done a better
job of anticipating and responding to one of the most expensive
and intense advertising campaigns ever mounted against us. And we
wish, in retrospect, that we somehow could have overcome -- very
early -- the huge obstacles presented by the legislative
calendar.
Let me just digress for one moment to talk about the single
biggest obstacle we faced then and still face now. Several
studies have now documented the amount of money spent on
advertising and lobbying to influence the outcome of the health
care debate. Every major legislative battle -- from the New Deal
to Social Security to Civil Rights -- has met with opposition.
But never in the history of this country has there been the same
degree of misinformation spread as has been spread during this
health care debate. And never has there been such an
extraordinary amount of money spent on disseminating that
misinformation.
The Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
Over $100 million has been spent overall to influence the
outcome. One study found that $50 million largely to influence
reporters and legislators rather than the public as a whole. And
these figures don't capture direct mail and phone bank efforts·
financed by opponents.
Whatever your view of health care reform, if you've seen the
now famous -- or infamous -- ads you know that they are not only
negative, they're downright scary. Health care is an extremely
personal issue, one people connect with more deeply and directly
than something like trade policy or deficit reduction. And the
4
�campaign against health care reform continues to play on people's
fears.
I point out the degree of misinformation because these
advertising campaigns succeeded in distorting the President's
plan into some radical, wild-eyed attempt to revamp our health
system. In fact, as I mentioned earlier, the main elements of he
proposed were culled from Republicans and Democrats alike -- most
of whom could be described as political moderates. Universal
coverage, employer mandates, and premium caps are about as
mainstream and conservative an approach to health care as you can
get.
It's also easy to forget that the President never suggested
that his plan should be the final word adopted by Congress. As
soon as he outlined it, he stated very clearly that his bottom
line was universal coverage but that he was open to suggestions,
ideas, criticisms on how to achieve his principal goals. He
welcomed and encouraged bipartisanship. That has always been his
position, and remains so now.
So where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy and fulfilling
the President's broader agenda.
The President has set in motion a process for dealing with a
health care problem that is not going to vanish on its own. And
we are further along than we have ever been in our history in
getting Congress to act on reform.
'Are we as far along the path as we had hoped? Not yet. Have
we given up hope? Not at all. Are we more realistic about how to
accomplish reform? Definitely.
From a social science perspective, I hope this period will
be viewed as one of great ferment, energy, and momentum that
launched us toward solving the most difficult social problem of
our time, if not of this century.
Thank you very much.
###
5
�7
j
i
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished chapter of American political and social history. Great because
for the first time in decades we are addressing one of the most
intractable social and economic problems of our time -- a health
care system that is out of reach for millions of Americans and
too costly for our nation. Unfinished because Congress has not
yet written the final words of the text.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective, like
the perspectives of other insiders and journalists and political
commentators, is based on current and fluid events that can
change from day to day and month to month. But hopefully I can
offer some useful insights into the health care reform process
that has engaged the Clinton Administration and Congress for much
of the last year.
President Clinton continues to press for health care reform
for the same two reasons he outlined when he ran for the
Presidency: First, because the health of tens of millions of
Americans -- both uninsured and insured -- was at risk and is at
risk in the current system. And second, because there is no way
to fully restore our economy over the long-term without doing
something about rising health care costs.
Every day, the health care picture gets worse. On any given
day, close to 40 million Americans -- most of them working people
-- lack insurance. Millions are locked in jobs they couldn't
leave for fear of losing their insurance. Families can't get
coverage because of "pre-existing conditions" and other forms of
insurance discrimination. Small businesses face health care
premiums 35 percent higher than those of large corporations -and those premiums are projected to grow at double-digit rates.
And there is little hope of further reducing the deficit
when health care expenditures consume 14 percent of our national
income, and a decade from now, the figure will be closer to 20
percent. Month after month, year after year, health care costs
1
�are further eroding our savings, our investment capital, our
public treasury, our ability to create new jobs in the private
sector. And we cannot take full advantage of the progress this
President is making in restoring the economy if we attempt to
reduce health care costs simply by chipping away at Medicare and
Medicaid.
So the question President Clinton faced upon his
inauguration 20 months ago was this: How do you solve a problem
of this magnitude, of this complexity, of this urgency, when no
President, Republican or Democrat, has managed to do it in 60
years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and Carter before him.
But health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health care
costs while still preserving quality. Universal coverage and cost
containment sometimes are viewed as contradictory, when in fact
they go hand-in-hand. Counter-intuitive as it may seem, you can't
reduce the burdens on business and government and individual
families until everyone is insured.
The reality is that
pay but still get health
late, too expensive, and
all, the emergency room.
footing the bill through
insurance premiums.
people who don't have insurance can't
care. They just get it when it's too
often from the most expensive source of
The result is that the rest of us end up
higher hospital bills and higher
The President beat the historical odds by putting health
care reform on the national agenda and presenting a plan last
year. Furthermore, virtually all Democrats and moderate
Republicans supported the goal of universal coverage. And
virtually all the comprehensive health care bills subsequently
submitted by Democrats and moderate Republicans included cost
containment.
There are only three ways to achieve universal coverage, all
of which have been debated by politicians, economists, and policy
2
�experts for years. one is a single payer approach that would
replace today's employer-based system with a broad-based income,
payroll or value-added tax. It would require about three to four
hundred billion dollars of new federal taxes each year, a
political implausibility.
A second approach is to require all individuals to buy
health insurance, the same method many states use with auto
insurance today. The down side of that method is that employers
might be inclined to stop covering their workers, that more and
more individuals would need government subsidies to help pay for
their premiums, and new taxes and a new administrative
bureaucracy would result. More important, the public opposes it.
The third option -- the approach the President chose
is
to extend the system that 90 percent of insured Americans already
use. The employer mandate is the least disruptive, most
conservative option available. It was an option embraced by
groups across the political spectrum: the American Medical
Association, the Health Insurance Association of America, many
labor unions, the Jackson Hole group, the Chamber of Commerce and
other business groups, and the National coalition on Health Care
Reform co-chaired by former Presidents Carter and Ford.
In fact, the President's proposal for achieving universal
coverage through an employer mandate was first proposed by
President Nixon more ~han two decades ago in a bill introduced by
Senator Packwood, the ranking Republican member of the Senate
Finance Committee.
Cost containment is an equally important part of the
President's equation. Cost containment is essential if you want
families and businesses to be able to afford health care, and if
you want to control federal spending.
But as with universal coverage, there are only a few ways to
get costs under control.
One option is to have the government directly set the price
for goods and services delivered in the health care sector, or
set ceilings on the total amount the nation would spend on health
care. But having the government involved in every health care
transaction is way too bureaucratic.
Some advocates support the idea of "tax caps" to contain
health care spending -- limits on the tax deductibility of health
spending by companies. The President rejected that approach
because it would raise taxes on middle-class families.
The President's plan relied on creating a more competitive
market and a more cost-conscious consumer to control costs. As a
back-up, the President proposed premium caps to limit the amount
3
�insurance premiums could be raised if market forces did not
succeed in keeping prices down. This approach was borrowed
directly from a bill put forth by Republican Senators Danforth
and Kassebaum and moderate Democratic Representatives McCurdy and
Glickman.
As you examine the main elements of the President's plan you
will find that the bulk of ideas he proposed were gleaned from
members of both parties, from liberals and conservatives and
moderates alike. And in many cases, the proposals already had
been tested successfully at the state level. Employer mandates
are working effectively in Hawaii, Washington, and Oregon;
premium caps in Washington and Minnesota.
Perhaps no idea occasioned as much debate initially as
mandatory alliances. The first barrage of negative ads came from
the insurance industry, which misrepresented alliances as
government take-overs of health plans that would reduce consumer
choice, when in fact the opposite was true.
The idea behind alliances was to give people more choice of
plans and to reduce the administrative burdens that now exist for
businesses.
As someone who ran a successful small business, I can tell
you that today, cost and complexity make it nearly impossible for
small businesses to offer their employees a choice of plans.
Alliances would have made this choice possible.
The idea for mandatory alliances came from the Jackson Hole
group and from legislation sponsored in 1992 by Representatives
Cooper and Andrews and Senators Boren and Breaux.
Other provisions such as the long-term care benefit, a
focus on primary care, funding for academic health centers,
improvements in rural and urban health care infrastructures, and
some public health initiatives were also included in Republican
health reform proposals.
So if you compare the President's approach to some of the
options at hand, you will see that -- in case after case -- his
plan was fundamentally reasonable, moderate, and in line with
what most Americans wanted then and still want now.
Yet while the bill's provisions reflected the conventional
solution, the size and detail of the document generated criticism
from opponents that it was a bureaucratic form of social
engineering and an example of "big government."
Health care reform is a very complex subject. A bill to
reform the health care system is never going to make for light
beach reading. Our goal in writing the legislation was to offer
4
�--------------
the American people a realistic description of how the proposed
changes would work.
It's worth noting that many pieces of major legislation are
as long or longer than our bill. Health care reform measures
circulating on Capitol Hill range from 650 to 1,400 pages. The
crime bill that passed last month was almost as long as health
care legislation, and NAFTA was literally thousands of pages.
Yet the length of the President's health care reform bill
became a metaphor for the complexity people would supposedly face
under a reformed system. The number of pages became a symbol of
the amount of government involvement people would see in their
health care.
How did we arrive at the provisions of the bill?
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
in a short time frame. We cast a wide net for participants.
To have a credible health care bill, one must address dozens
of specific issues such as long term care, mental health,
malpractice, and insurance reform. So we brought together experts
and practitioners in each of these areas -- both from Washington
and from around the country.
We held daily meetings with members of Congress, and
involved more than 120 Congressional staffers in the working
groups. The First Lady also held public hearings and town
meetings across the country.
By May of 1993, review groups composed of health care
providers, consumers, auditors, actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of time. We succeeded in meeting
a very tight deadline.
Has it been a flawless operation? Of course not. And while
some of the problems we encountered were avoidable, others were
not.
One that we couldn't avoid was the legislative calendar. We
were ready to move forward at the end of May of 1993, just as the
President had pledged we would do. During April and May of last
year, the task force met 21 times to finalize decisions, a number
of times with the President. But after the defeat of the economic
stimulus package, it became clear to everyone that the
5
�introduction of health care reform should be delayed until
passage of the economic package was assured. There was concern
that. introducing health care might compromise support for the
economic package. For example, when word leaked out -erroneously -- about a Treasury Department analysis of health
care financing that included a tax on wine and beer, the
California delegation immediately sent a letter of complaint to
the White House, and some members privately threatened to
withhold support for the economic package.
With the economic package stalled, the introduction of
health care was delayed from early June, to late June, to mid
July, to late July, and finally to late September. The
legislation finally was submitted in late October instead of in
late May. Attention was further diverted from health care because
of the debate over NAFTA and the crisis in Somalia, both of which
dominated the White House and Congress during the weeks after the
President's bill was introduced.
There wasn't much we could do about the calendar. But we
could have done things differently in terms of the press. From
the outset, we should have done a better job of informing the
press about the process. That way we could have avoided
perceptions that the deliberations were cloaked in secrecy, and
we could have helped the news media develop a better
understanding of reform as the debate evolved.
These problems notwithstanding, when the plan was introduced
in the fall it was greeted very enthusiastically, and in fact, it
became a baseline for other approaches. Representative Cooper
termed his plan "Clinton Lite," a "close cousin" of the Clinton
plan. Senator Chafee spoke on Sunday talk shows about "the
similarities in our approaches" and voiced optimism about
achieving a consensus. The President, meanwhile, was applauded
for offering a clear and persuasive enunciation of his goals to
Congress and the nation. Polls showed broad support for his plan.
The New York Times went as far as to term the President's bill
"alive on arrival."
As the President's plan generated excitement and support for
reform, interest groups who benefited from the status quo
mobilized their attacks.
Powerful special interests are perhaps the biggest single
obstacle we faced then and still face today as we try to move
forward with reform. Several recent studies have documented the
amount of money spent on advertising and lobbying to influence
the outcome of the health care debate. Every major legislative
battle -- from the New Deal to Social Security to Civil Rights
has met with opposition. But never in the history of this country
have modern technology and scare tactics combined to produce the
degree and tone of misinformation that was spewed out so quickly
6
�about health care reform. And never has there been such an
extraordinary amount of money spent on disseminating that
misinformation.
The_Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
Over $100 million has been spent overall to influence the
outcome. One study found that $50 million was spent largely to
influence reporters and legislators rather than the public as a
whole. And these figures don't capture direct mail _and phone bank
efforts financed by opponents.
Whatever your view of health care reform, if you've seen or
heard the now famous -- or infamous -- ads you know that they are
not only negative, they're downright scary.
In fact, they were so distorted that the Wall Street Journal
ran a story about the misinformation campaign under the headline
"Truth Lands In Intensive Care Unit."
The article began:
The baby's scream is anguished, the mother's voice
desperate. "Please," she pleads into the phone as she seeks help
for her sick child.
"We're sorry, the government health center is closed now,"
says the recording on the other end of the line. "However, if
this is an emergency, you may call 1-800-GOVERNMENT." Her baby
still wailing, she tries it, only to be greeted by another
recording: "We're sorry, all health care representatives are busy
now. Please stay on the line and our first ~vailable . . .
"
"Why did they let the government take over?" she asks
plaintively. "I need my family doctor back.
The story goes on to say: The only problem with the radio
spot, produced by a Washington-based group called Americans for
Tax Reform, is that it isn't true. [WSJ, 4/29/94]
/
Misconceptions about the President's plan were continually
fueled by this type of fearmongering. At town hall meetings I
attended, angry people would shout their opposition to the
Clinton plan. I'd ask why they were against it. They would talk
about the government taking over and running all the hospitals.
Or they would talk about how people wouldn't be allowed to see
their own doctor outside the health plan approved by the
government and that, if they did, the doctors could go to jail.
I'd explain that this just wasn't true. But the questioner
7
�- - - - - - -
invariably would shout back that I was lying and wave a mailing
he had received from some group asserting one or another of these
points as fact.
The Wall Street Journal said that "another of the big
canards about the Clinton plan is that people face '5 years in
jail if you buy extra health care.'" The story alluded to a
direct mail package sent to millions of Americans by the American
Council for Health Reform. The story explained that this penalty
referred to ari anti-bribery provision in the Clinton proposal
and, in fact, the President's bill explicitly stated that people
were free to purchase any health care services they wanted.
But these ads proved that it's always easier to make the
negative case rather than the positive, more complicated case.
I point out the degree of misinformation because these
advertising campaigns distorted the President's plan into some
radical, wild-eyed attempt to revamp our health system. In fact,
as I mentioned earlier, the main elements he proposed were drawn
from Republicans and Democrats alike -- most of whom could be
described as political moderates. Universal coverage, employer
mandates, and premium caps, while opposed by powerful interest
groups, are heavily favored by most Americans -- even though, as
a Wall Street Journal headline noted, "Many Don't Realize It's
the Clinton Plan They Like."
In spite of the barrage from special interests, the American
people have said what they want -- and they have said how they
want to pay for it. And they've been very consistent in their
views.
A recent Washington Post/ABC poll showed that 77 percent
favor universal coverage, 72 percent favor an employer mandate,
and 75 percent favor government cost controls. Even more, 80
percent, support a tobacco tax.
With that kind of support, these ideas and proposals are not
going to disappear and be forgotten by the public.
Another thing worth remembering about this process is that
the President never expected his plan to be the final version
adopted by Congress. He has always stated very clearly that his
bottom line was universal coverage but he knew his plan would be
rewritten. In fact, two House committees and one Senate committee
wrote their own bills, which were similar to the President's.
This was all part of the legislative process the President
envisioned.
So where are we today, nearly 20 months after the process
began?
8
�We are on the path to restoring the economy and fulfilling
the President's broader agenda. And ultimately history will show
that this was a time of great ferment and energy when a
courageous President didn't dodge a difficult issue, but instead
launched a process to solve the health care problem once and for
all.
We have made extraordinary progress in the fight for the
health security of the American people and the fight goes on. The
Congressional Leadership has made certain that health care will
be first on the agenda when they return to Washington. As was
proven with passage of the Crime Bill, special interests do not
always succeed in undermining the interests of the American
people. And we must continue to make sure that the voices of
reason are heard over the shouts of fear and confusion. That's
why we will not walk away from the fight to provide security for
the American people.
Thank you.
###
/
9
�'!
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished - chapter of American political and social history. Great because
for the first time in decades we are addressing one of the most
intractable social and economic problems of our time -- a health
care system that is out of reach for millions of Americans and
too costly for our nation. Unfinished because Congress has not
yet written the final words of the text.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective, like
the perspectives of other insiders and journalists and political
commentators, is based on current and fluid events that can
change from day to day and month to month. But hopefully I can
offer some useful insights into the health care reform process
that has engaged the Clinton Administration and Congress for much
of the last year.
~'Plot~
,~~tn.. c~ ~,.,. ~
~1 Clinton continues to press fo~the same two reasons he
outlined when he ran for the Presidency: First, because the
health of tens of millions of Americans -- both uninsured and
insured -- was at risk and is at risk in the current system. And
second, because there is no way to fully restore our economy over
the long-term without doing something about rising health care
costs.
Every day, the health care picture gets worse. On any given
day, close to 40 million Americans -- most of them working people
-- lack insurance. Millions are locked in jobs they couldn't
leave for fear of losing their insurance. Families can't get
coverage because of ''pre-existing conditions" and other forms of
insurance discrimination. Small businesses face health care
premiums 35 percent higher than those of large corporations -and projected to grow at double-digit rates.
~~~-~
~re is little hope of further reducing the deficit
when health care expenditures consume 14 percent of our national
income A decade from now, the figure will be closer to 20
percen~onth after month, year after year, health care costs
W-f>..
1
�are further eroding our savings, our investment capital, our
public trea_sury, our ability to create new jobs in the private
sector. And we cannot take full advantage of the progress this
Presiden·t is making in restoring the economy if we attempt to
reduce health care costs simply by chipping away at Medicare and
Medicaid.
So the question President Clinton faced upon his
inauguration 20 months ago was this: How do you solve a problem
of this magnitude, of this complexity, of this urgency, when no
President, Republican or Democrat, has managed to do it in 60
years?
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and Carter before him.
But health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage ~nd to control health care
costs while still preserving quality. Universal coverage and cost
containment sometimes are viewed as contradictory·,' whe.n in fact
they go hand-in-hand. counter-intuitiv~ as it may seem, you can't
reduce the burdens on business and government and individual
families until everyone is insured.
The reality is that
pay but still get health
late, too expensive, and
all, the emergency room.
footing the bill through
insurance premiums.
people who don't have insurance can't
care. They just get it when it's too
often from the most expensive source of
The result is that the rest of us end up
higher hospital bills and higher
The President beat the historical odds by putting health
care reform on the national agenda and presenting a plan last
year. Furthermore, virtually all Democrats and moderate
Republicans supported the goal of universal coverage. And
virtually all the comprehensive health care bills subsequently
submitted by Democrats and moderate Republicans included cost
containment.
There are only three ways to achieve universal coverage, all
of which have been debated by politicians, economists, and policy
2
�experts for years. One is a single payer approach that would
replace today's employer-based system with a broad-based income,
payroll or value-added tax. It would require about three to four
hundred billion dollars of new federal taxes each year, a
political implausibility.
A second approach is to require all individuals to buy
health insurance, the same method many states use with auto
insurance today. The down side of that method is that employers
might be inclined to stop covering their workers, that more and
more individuals would need government subsidies to help pay for
their premiums, and new taxes and a new administrative
~\
bureaucracy would result. More important, the public oppose~it. ~
The third option -- the approach the President chose -- is
to extend the system that 90 percent of insured Americans already
use. The employer mandate is the least disruptive, most
conservative option available. It was an option embraced by
groups across the political spectrum: the American Medical
Association, the Health Insurance Association of America, many
labor unions, the Jackson Hole group, the Chamber of Commerce and
other business groups, and the National Coalition on Health Care
Reform co-chaired by former Presidents Carter and Ford.
In fact, the President's proposal for achieving universal
coverage through an employer mandate was first proposed by
President Nixon more than two decades ago in a bill introduced by
Senator Packwood, the ranking Republican member of the Senate
Finance Committee.
Cost containment is an equally important part of the
President's equation. Cost containment is essential if you want
families and businesses to be able to afford health care, and if
you want to control federal spending.
But as with universal coverage,
to get costs under control.
there~ only
a few ways
One option is to have the government directly set the price
for goods and services delivered in the health care sector, or
set ceilings on the total amount the nation would spend on health
care. But having the government involved in every health care
transaction is way too bureaucratic.
Some advocates support the idea of ''tax caps" to contain
health care spending -- limits on the tax deductibility of health
spending by companies. The President rejected that approach
because it would raise taxes on middle-class families.
The President's plan relied on creating a more competitive
market and a more cost-conscious consumer to control costs. As a
back-up, the President proposed premium caps to limit the amount
3
�--------
insurance premiums could be raised if market forces did not
succeed in keeping prices down. This approach was borrowed
directly from a bill put forth by Republican Senators Danforth
and Kassebaum and moderate Democratic Representatives McCurdy and
Glickman.
As you examine the main elements of the President's plan you
will find that the bulk of ideas he proposed were gleaned from
members of both parties, from liberals and conservatives and
moderates alike. And in many cases, the proposals already had
been tested successfully at the state level. Employer mandates
are working effectively in Hawaii, Washington, and Oregon;
premium caps in Washington and Minnesota.
Perhaps no idea occasioned as much debate initially as
mandatory alliances. The first barrage of negative ads carne from
the insurance industry, which misrepresented alliances as
government take-overs of health plans~?~n in fact the opposite
was true.
~~ 1\.Ad...c.u..a. ~~u..)
The idea behind alliances was to give people more choice of
plans and to reduce the administrative burdens that now exist for
businesses.
~
As someone who
a successful small business, I can tell
you that todayl~~~~t and complexity make it nearly impossible
for small businesses to offer their employees a choice of plans.
~
Alliances would have made this choice a.J.railable to all em~loyees. f'trJl.Jt
•
for~lliances
The idea
carne from the Jackson Hole
group, which advocated manageG eonrpetH:ioli;" and from legislation
sponsored in 1992 by Representatives Cooper and Andrews and
Senators Boren and Breaux.
Other provisions such as the long-term care benefit, a
focus on primary care, funding for academic health centers,
improvements in rural and urban health care infrastructures, and
some public health initiatives were also included in Republican
health reform proposals.
So if you compare the President's approach to some of the
options at hand, you will see that -- in case after case -- his
plan was fundamentally reasonable, moderate, and in line with
what main~}~~ Americans wanted then and still want now.
Yet while the bill's provisions reflected the ~slitical ~~ .
the size and detail of the document generated criticism ~U,...Jt)on_.,
from opponents that it was a bureaucratic form of social
engineering and an exarnp le of 11 big government. 11
1
llr 11-i/J. ft -tl(ol\.q.. IU · "-• r. , ~
'
'1.4 ~
. a very cornp l ex su b JeC
' t .A Our goa 1 1n
Hea lth care re f orm ~s
~ ~
writing the legislation was to offer the American people a
~
cefilil"EeF,
4
~&~-
-------------
------------------------------
�realistic description of how the proposed changes would work.
~M
It's worth~oing that many pieces of major legislation are
as long or longer han our bill. Health care reform measures
circulating on
Hill range from 650 to 1,400 pages. The crime
bill that passed last month was almost as long as health care
legislation,and NAFTA was literally thousands of pages.
Yet the length of the President's health care reform bill
became a metaphor for the complexity people would supposedly face
under a reformed system. The number of pages became a symbol of
the amount of government involvement people would see in their
health care.
How did we arrive at the provisions of the bill?
To meet an aggressive timetable, we established a process
for making policy that was unconventional for Washington,
borrowed from private sector models for conducting big projects
~ a short time frame. We cast a wide net for participants.
Jt
.
/
L
_
~ ~ ~~J!--tl>
-o
To have a credible health care bill' WID ua.nt€Hi credib~e
~~~specific issues such as long term care, mental
fiea t ~and insurance reform. So we brought together experts and
practitioners in each of these areas -- both from Washington and
from around the country.
We also held daily meetings with members of Congress, and
involved more than 120 Congressional staffers in the working
groups. Du ·
uary o
his
p~
First Lady~held pi public hearings and town
meetings across the countr~~
By May of 1993, r£~oups composed of health care
providers, consumers,~~~actuaries, hospital and insurance
administrators, and lawyers responded to ideas that had been
proposed by different working groups.
The whole process resulted in an amazing amount of work
completed in a very short amount of t~me. We succeeded in meeting
a very tight deadline.
Has it been a flawless operation? Of course not. And while
some of the problems we encountered were avoidable, others were
not.
.
~~
One that we couldn't avoid was the legislat~e calendar. We
were ready to move forward at the end of May of /93, just as the
President had pledged we would do. During April and May of last
year, the task force met 21 times to finalize decisions 1 ~ a
number of ~with the President. But after the de~eat of
the economi }.~~~~~lus package, it became clear to everyone that
C..lL,;(d
~l....t/)
5
�the introduction of health care reform should be delayed until
passage of the conomic package was assured. There was concern
that introduci g health care might compromise support for the
economic
. For example, when word leaked out -erroneously -- about a Treasury Department analysis of health
care financing that included a tax on wine and beer, the
California delegation immediately sent a letter of complaint to
the White House,and some members privately threatened to withhold
support for the economic package.
With the economic package stalled, the introduction of
health care was delayed from early June, to late June, to mid
July, to late July, and finally to late September. The
legislation finally was submitted in late October instead of in
late May. Attention was further diverted from health care because
of the debate over NAFTA and the crisis in Somalia, both of which
dominated the White House and Congress during the weeks after the
President's bill was introduced.
There wasn't much we could do about the calendar. But we
could have done things differently in terms of the press. From
the outset, we should have done a better job of informing the
press about the process. That way we could have avoided
perceptions that the deliberations were cloaked in secrecy, and
we could have helped the news media develop a better
understanding of reform as the debate evolved.
These problems notwithstanding, when the plan was introduced
in the fall it was greeted very enthusiastically, and in fact, it
became a baseline for other approaches. Representative Cooper
termed his plan "Clinton Lite," a "close cousin" of the Clinton
plan. Senator Chafee spoke on Sunday talk shows about "the
similarities in our approaches" and voiced optimism about
achieving a consensus. The President, meanwhile, was applauded
for offering a clear and persuasive enunciation of his goals to
Congress and the nation. Polls showed broad support for his plan.
The New York Times went as far as to term the President's bill
"alive on arrival."
AJ£~~1
the President's plan generated excitement and
interest group~mobilized their attacks.
· ~~ f
'V~t..,. ~fui fro.-....Jlt K /t.l""" 'lJ-A>
Powerful special interests are pe~aps the biggest single
obstacle we faced then and still face today as we try to move
forward with reform. Several recent studies have documented the
amount of money spent on advertising and lobbying to influence
the outcome of the health care debate. Every major legislative
battle -- from the New Deal to Social Security to Civil Rights
has met with opposition. But never in the history of this country
have modern technology and scare tactics combined to produce the
degree and tone of misinformation that was spewed out so quickly
about health care reform. And never has there been such an
support~Ao~~sin9
6
�extraordinary amount of money spent on disseminating that
misinformation.
The Annenberg Public Policy Center studied this phenomenon
and concluded that the health care debate has generated "the
largest, most sustained advertising campaign to shape a public
policy decision in the history of the Republic."
over $100 million has been spent overall to influence the
outcome. One study found that $50 million was spent largely to
influence reporters and legislators rather than the public as a
whole. And these figures don't capture direct mail and phone bank
efforts financed by opponents.
Whatever your view of health care reform, if you've seen or
heard the now famous -- or infamous -- ads you know that they are
not only negative, they're downright scary.
In fact, they were so distorted that the Wall Street-Journal
ran a story about the misinformation campaign under the headline
"Truth Lands In Intensive Care Unit."
The article began:
The baby's scream is anguished, the mother~-~oice desperate.
"Please," she pleads into the phone as she seek¥'h~lp for her
sick child.
"We're sorry, the government health center is closed now,"
says the recording on the other end of the line. "However, if
this is an emergency, you may call 1-800-GOVERNMENT." Her baby
still wailing, she tries it, only to be greeted by another
recording: "We're sorry, all health care representatives are busy
now. Please stay on the line and our first available . . .
"
"Why did they let the government take over?" she asks
plaintively. "I need my family doctor back.
The story goes on to say: The only problem with the radio
spot, produced by a Washington-based group called Americans for
Tax Reform, is that it isn't true. [WSJ, 4/29/94)
Misconceptions about the President's plan were continually
fueled by this type of fearmongering. At town hall meetings I
ded, angry people would shout their opposition to the
n plan. I'd ask why they were against it. They would talk
about government taking over and running all the hospitals. Or
they would talk about how people wouldn't be allowed to see their
own doctor outside the health plan approved by the government and
that, if they did, the doctors could go to jail. I'd explain that
tll-e~e ~~e not "'1rtements of 'Eae p:J..sn. But the questioner
invariably would shout back that I was lying and wave a mailing
(..Y 1~.:,<:. ~L
vvY' · r \~
.
7
�he had received from some group asserting one or another of these
points as fact.
The Wall Street Journal said that "another of the big
canards about the Clinton plan is that people face '5 years in
jail if you buy extra health care.'" The story alluded to a
direct mail package sent to millions of Americans by the American
Council for Health Reform. The story explained that this penalty
referred to an anti-bribery provision in the Clinton proposal
and, in fact, the President's bill explicitly ?tated that people
were free to purchase any health care services they wanted.
~
But these~ds proved that it's always easier to make the
negative cas~than the positive, more complicated case.
I point out the degree of misinformation because these
advertising campaigns distorted the President's plan into some
radical, wild-eyed attempt to revamp our health system. In fact,
as I mentioned earlier, the main elements he proposed were drawn
from Republicans and Democrats alike -- most of whom could be
described as political moderates. Universal coverage, employer
mandates, and premium caps, while opposed by powerful interest
groups, are heavily favored by most Americans -- even though, as
a Wall Street Journal headline noted, "Many Don't Realize It's
the Clinton Plan They Like."
In spite of the barrage from special interests, the American
people have said what they want -- and they have said how they
want to pay for it. And they've been very consistent in their
views.
A r26ent Washington Post/ABC poll showed that 77 percent
favor~~iversal coverage, 72 percent favor an employer mandate,
and 75 percent favor government cost controls. Even more, 80
percent, support a tobacco tax.
With that kind of support, these ideas and proposals are not
going to disappear and be forgotten by t~~ public.
~o~WJ,~(~
Another thing wor
remember'ng about this process is that
the President never e ected his plan to be the final version
adopted by Congress.
e has al ys stated very clearly that his
bottom line was univ sal cov age but he knew his plan would be .
rewritten. In fact,
wo Hous and ~Senate committees wrote
{~
their own bills, w
e were similar to the President's. ~
all part of the legislative process the President envisioned.
So where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy and fulfilling
the President's broader agenda. And ultimately history will show
8
�that this was a time of great ferment and energy when a
courageous President didn't dodge a difficult issue, but instead
launched a process to solve the health care problem once and for
all.
We have made extraordinary progress in the fight for the
health security of the American people and the fight goes on. The
Congressional Leadership has made certain that health care will
be first on the agenda when they return to Washington. As was
proven with passage of the Crime Bill, special interests do not
always succeed in undermining the interest of the American
people. And we must continue to make sure that the voices of
reason are heard over the shouts of fear and confusion. That's
why we will not walk away from the fight to provide security for
the American people.
Thank you.
###
9
�LM DRAFT #3 -- 9/1/94
Noon
IRA C. MAGAZINER
REMARKS TO THE AMERICAN POLITICAL SCIENCE ASSOCIATION
NEW YORK CITY
SEPTEMBER 1, 1994
Today we find ourselves in a great -- yet still unfinished - chapter of American political and social history. Great because
for the first time in decades we have set in motion a process for
dealing with one of the most intractable social and economic
problems of our time -- a health care system that is out of reach
for millions of Americans and too costly for our nation.
Unfinished because Congress has not yet written the final words
of the text.
As you know, the daily accounts we read on issues like
health care reform are merely first drafts of history. Over time,
those interpretations are revisited by scholars like you, who
bring their own theoretical and historical perspectives to bear.
Analyzing health care reform is all the more difficult right
now because the process is far from over. So my perspective, like
the perspectives of other insiders and journalists and political
commentators, is based on current and fluid events that can
change from day to day and month to month. But hopefully I can
offer some useful insights into the health care reform process
that has engaged the Clinton Administration and Congress for much
of the last year.
Bill Clinton remains committed to reform today for the same
two reasons he outlined when he ran for the Presidency: First,
because the health of tens of millions of Americans -- both
uninsured and insured -- was at risk and is at risk in j:h..ea_,
current system. And second, because there is no way tof?eStore
our economy without doing something about rising health care
costs.
owcrne ~-~
Every day, the health care picture gets worse. On any given
day, close to 40 million Americans -- most of them working people
~- lack insurance. Millions are locked in jobs they couldn't
leave for fear of losing their insurance. Families can't get
coverage because of "pre-existing conditions" and other forms of
insurance discrimination. Small businesses face health care
premiums 35 percent higher than those of large corporations -and projected to grow at double-digit rates.
And there is little hope of reducing the deficit when health
care expenditures consum~about 14 percent of our national
1
�~~ -::'"~··.
~I ~.,.., M\... ,-~;~
I
w;t{.,
income. By the year 20
, the figure ~d be closer to 20
percent. Month after onth, year after year, health care costs
are further eroding
r savings, our investment capi~r
ability to create n
jobs in the private secto~~~u~_b~l~ihc:Jtreasury. And give the immensity of the deficit, there 1s no
)
hope of restoring conomic growth or reining in health care costs
simply by chipping away at Medicare and Medicaid.
.
'b
So the question the new President faced upon his
inauguration 20 months ago was this: How do you solve a problem
of this magnitude, of this complexity, of this urgency, when no
President, Republican or Democrat, has managed to do it in 60
years?
·
Many people advised President Clinton that it was too
politically risky to tackle health care reform. It couldn't be
done, they said, because of the array of special interests
positioned to stop it· -- special interests that had spent
millions and millions of dollars to stymie the efforts of
Presidents Truman and Kennedy and Nixon and Carter before him.
But the American people demanded reform. The economy
demanded it. And -- to use a football metaphor, since football
season is now upon us -- the President was not about to punt on
such a critical and momentous issue.
Health care reform was simply the right thing to do
socially, economically, and morally. That's why the President
took on this mammoth challenge, and set in motion this historic
process, regardless of the political risk. That's why he is
sticking to it, and why he will keep fighting for reform until it
is achieved.
Throughout the process the President's goal has been
twofold: to achieve universal coverage and to control health care
costs while still preserving quality. Universal coverage and cost
containment sometimes are viewed as contradictory, when in fact
they go hand-in-hand. Counter-intuitive as it may seem, you can't
reduce the burdens on business and government and individual
families until there is no more cost shifting to compensate for
the health care of millions who are un- or under-insured.
The reality is that people who don't have insurance still
get health care. They just get it when it's too late, too
.
expensive, and often from the most expensive source of all, the
emergency room. The result is that the rest of us end up footing
the bill through higher hospital bills and higher insurance
premiums.
When the President's plan was first presented last year,
virtually all Democrats and moderate Republicans supported the
goal of universal·coverage{ And virtually all the comprehensive
�health care bills subsequently submitted by Democrats and
moderate Republicans included cost containment.
There were only three ways to go about universal coverage,
all of which have been debated by politicians, economists, and
policy experts for years. One was a single payer approach that
would replace today's employer-based system with a broad-based
income, payroll or value-added tax. It would require about three
to four hundred billion dollars of new federal taxes each year, a
political implausibility.
A second approach was to require all individuals to buy
health insurance, the same method many states use with auto
insurance today. The down side of that method was that employers
might be inclined to stop covering their workers, that more and
more individuals would need government subsidies to help pay for
their premiums, and new taxes and a new administrative
bureaucracy would result. More important, the public opposed it.
The third option -- the approach the President chose -- was
to extend the system that 90 percent of insured Americans already
used. The employer mandate seemed to be the least disruptive,
most conservative option available., And, once again, it was an
option embraced by groups across the political spectrum -- ~9l:ii?S ~
that has-studied the issue more closely ~l:la:R a1w~me else 1•ecal!lse ~
they were the mest directly affected by 1t.: the American Medical ~
Association, the Health Insurance~lf"' Ail' Association of
n.z_ "#>
American, many labor unions, the Jackson Hole.~roup, the Chamber
of F~rnmerce and other business groups, and ~~tional ~alition
on ~alth4Care ~form co-chaired by former Presidents Carter and
Ford.
In fact, the President's proposal for achieving universal
coverage through an employer mandate was first proposed by
President Nixon more than two decades ago.
Cost containment was an equally important part of the
President's equation. Cost containment is essential if you want
families and businesses to be able to afford health care, and if
you want to control federal spending.
But as with universal coverage, there were only a few ways
to get costs under control.
One option was to have the government directly set the price
for goods and services delivered in the health care sector, or
set ceilings on the total amount the nation would spend on health
care. But having the government involved in every health care
transaction seemed way too bureaucratic.
Some advocates supported the idea of "tax caps" to contain
health care spending -- limits on the tax deductibility of health
3
�In another story, the Wall street Journal said that "another
of the big canards about the Clinton plan is that people face '5
years in jail if you buy extra health care.'" The story was
referring to a direct mail package sent to millions of Americans
by the American Council for Health Reform. The story explained
that there was an anti-bribery provision in the Clinton proposal
but that the bill explicitly stated people were free to purchase
any health care services they wanted.
I point out the degree of misinformation because these
advertising campaigns distorted the President's plan into some
radical, wild-eyed attempt to revamp our health system. In fact,
as I mentioned earlier, the main elements he proposed were ~b 1 ' 1 ,u.Q.
from Republicans and Democrats alike -- most of whom could be
~
described as political moderates. Universal coverage, employer
mandates, and premium caps are about as mainstream and
conservativ~ an approach to health care as you can get. And these
provisions were precisely the ones favored by most Americans even
though, as a Wall Street Journal·headline noted, "Many Don't
Realize It's the Clinton Plan They Like."
... ~~That's why I believe that, even though the interest·groups
~Ohes§: lle zif :J!biegessfad and remain our biggest obstacle as we move
forward, the process is going to succeed.
The American people have said what they want -- and they
have said how they want to pay for it. And they've been very
consistent in their views.
A recent Washington Post/ABC poll showed that 77 percent
favored universal coverage, 72 percent favor an employer mandate,
and 75 percent favor government cost controls. Even more, 80
percent, support a tobacco tax.
With that kind of support, these ideas and proposals are not
going to disappear and be forgotten by the public.
Another thing worth remembering about this process is that
the President never expected his plan to be the final version
adopted by Congress. He has always stated very clearly that his
bottom line was universal coverage but he knew his plan would be
rewritten. In fact, two House and two Senate committees wrote
their own billsl Wa~ ~:Q a f:i~~=~en Ehe part of the Pr~s~Qent?
Not at a 11 . rt afL ~
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.so where are we today, nearly 20 months after the process
began?
We are on the path to restoring the economy a~d fulfilling
the President's broader agenda. And ultimately history will show
that this was a time of great ferment and energy when this
8
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Presidentflaunched a process that led us to solve the health care
problem once and for all.
~' while we still have further to go, we will get there.
~e business of health care reform is not yet over.
Thank you very much.
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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
Speechwriting
Creator
An entity primarily responsible for making the resource
First Lady’s Office
Speechwriting
Date
A point or period of time associated with an event in the lifecycle of the resource
1994
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36105">Collection Finding Aid</a>
Identifier
An unambiguous reference to the resource within a given context
2012-1004-S
Description
An account of the resource
Within the First Lady’s Office, Speechwriting assisted with the writing and editing of the speeches given by the First Lady at various events and on various trips. This collection highlights topics relating to the arts and humanities, women’s issues and organizations, medical issues and organizations, health care, the economy, the military, and the efforts of the First Lady on behalf of candidates running in the 1994 midterm elections. It contains speeches given by the First Lady, and speeches given by President Clinton and Ira Magaziner, to a wide variety of organizations and audiences during 1994. The records include memos, notes, speech drafts, talking points, pamphlets, articles, correspondence, and newsletters.
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
Extent
The size or duration of the resource.
150 folders in 10 boxes
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
A name given to the resource
Ira/APSA [American Political Science Association] 9/94 [9/1/94] [2]
Creator
An entity primarily responsible for making the resource
First Lady’s Office
Speechwriting
Identifier
An unambiguous reference to the resource within a given context
2012-1004-S
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 5
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/Systematic/2012-1004-S-Speechwriting.pdf">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/1766805" 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
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
11/13/2014
Source
A related resource from which the described resource is derived
42-t-7763272-20121004s-005-005
1766805