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��- N Aa^LON A.L,. AiiEAJJtai
A New Generation
White House: What
Clinton's budget and
health-care plan could
mean for our kids
Bv H O W A R D F I N E M A N
AND RICH THOMAS
T IS BILL CLINTON S DESTIM TO PLAY
the role ot Babv-Boomer-in-Chiet.
Bom in 1946. the postwar generation's
inaugural year, he discovered politics
on his living-room television and
j found his heroes in Kennedy and King.
I Now he and his wife live a busy two-career
' life in the capital. He complains about
i Washingtons cynical culture, worries
about his daughter's schoolwork and battles his inflatable waistline.
But last week an array of numbers —in
his new budget and in a study of his healthcare plan —underscored somethiniz more
important about his generational role. He
needs to talk bluntly to the American family
about its finances: to tell seniors —and his
fellow boomers—that they must stop shifting fiscal burdens onto children and the
unborn. Ending generational selfishness
would redeem a watchword of his administration: responsibility. But it's not an agenda that presidents (or Congress) have seriously pursued.
So far Clinton has also shown signs of
squeamishness. Far from talking tough to
seniors when he unveiled a commission last
week to study entitlement spending, he
pledged to protect them. He is expected to
do the same at a seniors center in New
Jersey this week. Advisers have even suggested he assume the mantle ofthe late Tip
O'Neill as defender ofthe elderly. "They're
ready for a new champion." concludes adviser I'aul Beeala. In thr political season
now starting. Clinton will have to square
feel-good politics with long-term trends.
Yet Clinton has at least made a start.
€ven if he was prodded by President
George Bush's 1990 budget deal and by
Democratic " deficit hawks" in 1993. Last
year's budget agreement, though anathema
to Republicans, helped reassure the markets and keep interest rates low. It reduced
|
I
;
Thinking about tomorrow? C/mfon
m
1!
I
u ithyoungpatients. Hillury w ith seniors • i
90
�result. Clinton has room to maneuver. It's
easier for him to oppose a constitutional
amendment that would require a balanced
liederal budget. Debate on the measure begins in the Senate this week. Sen. Paul Simon of Illinois, its sponspr. thinks he mayhave the votes: polls show overwhelming
public support. But with "short term" defi1995's likely federal deficit to $165 bil- cits seemingly under control, opposition
lion—the smallest (when compared with won"! damage Clinton
the size oi the economy) since 1979. ClinStill, the president and his aides know
ton's new budget shows a Democratic pres- the deeper theme of generational fairness is
ident proposing remarkable austerity: elim- potent. In tact, they are making bold to
ination of 100 programs, cutbacks in 300 adopt it. The new budget asserts that the
others. Even the RepubLcan staff of the Sen- Clinton health-care reform plan would save
ate Budget Committee was forced to con- $58 billion over the next five years alone.
cede that Clinton had "shown courage."
Such numbers enabled budget director
That " courage' is paying otV politically. Leon Panetta to send Congress a 10-page
The economy is rolling along: the populari- essay in which the administration touts its
ty of Ross Perot, who ran as champion skin- intergenerational statesmanship. "We're
flint in 1992. is in decline. Few Americans reducing the burden on future generanow cite the debt as a leading concern. As a tions.'' Panetta declares.
But raising that claim is risky.
^^^™"
The burden on future generations remains scary even by the
administration's
own reckonThe Congressional Budget Office said that the White
ing.
According
to
White House
House had underestimated the cost of Clinton's
calculations,
the
accumulated
health-care plan. But a NEWSWEEK analysis found
federal
debt
is
expected
to pass
that both the CBO and Clinton ignored two new
$6
fn'llion
in
1999-and
interest
health-care entitlements that could swell the deficit.
payments on that debt will reEstimated Defldt
main an onerous 14 percent of
IN BILLIONS OF DOLLARS
the budget. Using a new branch
1999
1995 1996 1997 199b
of econometrics called generaClinton budget
sies S170 $188 S I M S181
tional accounting, the White
CBO
House estimated that kids in 13171
167
aoa 212 226
year-old Chelsea Clinton's genIM
235
286 270
NEWSWEEK estimate
181
eration will have to fork over
wiRcn: CLIKIOK i •utx.iT.coscamiuv.u. •uncrr orrict AND K r o w m MJUICU
the equivalent of 38 percent of
The Cost Keeps Climbing
their lifetime income to government - up
from 32 percent for those in her dad's cohort. Theoretically, the unborn will be
forced to contribute 66 percent of their lifetime income. "The grown-ups are still fiddling while their kids'-and their kids'
kids —future bums." declares Ion Cowan
ofthe lobby group Lead . . . or Leave. "It s
fiscal child abuse."
Reftl crisis: Clinton's budget is largely
mute about therealcrisis: entitlements. It is
brutal in holding down "discretionary"
spending on itemsfromweapons systems to
public housing. But the intergenerational
problem is the continued growth of existing
entitlement programs—not to mention the
eventual cost of new ones Clinton wants to
create. Entitlements-automatic, mandated payments to qualifying citizens for everythingfromsocial security to disability insurance—have risen steadily. They now
account for about half the budget.
Clinton has spoken eloquently about the
ruinous effects of soaring health-care
spending on both public and private budgets. But the claim that his plan would produce immediate savings to the government
was dismissed last week by the most credible of sources—the Congressional Budget
Office. In the long run. concluded CBO
Director Robert Reischauer. Clinton's plan
would indeed cover everyone and slow the
rise of health-care spending. But over the
next five years it would add some »70 billion in federal debt. That change alone
nearly wipes out Panetta's alleged "improvement" in generational accounting.
More important was Reischauer s overall characterization of the plan. White
�N-A-T: I O N - A L. A^ F F A L R»S«.House officials were relieved that he hadn't
used the "T word " — taxes —to describe its
mandated insurance premiums. But he did
use the "E word.'' The whole SI.2 trillion-ayear program, he said, was a new • entitlement": not really a private insurance
scheme but an exercise ol sovereien power' that must be listed in the budget, like
social security.
Vet according to NFWSWEF.K estimates,
even Reischauer was too kind to Clinton s
proposal tchart i. In addition to the sweeping
guarantee ol adequate health care lor all —
subsidized by taxes where necessan —
there are specific new entitlements: one to
subsidize 60 percent ot the health-care costs
of workers covered by early-retirement
health-care programs: another to prov ide
home health care for the elderly and disabled. The CBO didn't question White
House cost estimates for either. But together
the programs could show annual overruns
of S50 billion to S60 billion bv the year 2000.
Feu insiders believe Congress will pass
the early-retiree subsidy as it stands: it's too
naked a payotf to auto, steel and airline
companies that are stuck providing such
costly coverage under existing labor-union
contracts. But Congress might well pass
some lesser subsidy for all eariy retirees
— whether they have generous programs
now or not. Any such program would be
expensive. Clinton's idea, careful private
estimates show, would cost S13 billion a
year right away—and S25 billion annually
in a lew years.
Fiscal risk: Clinton s planners believe
they can shorten costly hospital stays and
save money by providing living assistance
and nursing help to the homebound. It's an
honest belief—but a huge fiscal risk. To
limit abuse, the Clinton plan would require
a doctor to certify that a patient met strict
standards of impairment. But such stand-
ards teno to be subjective. "It boils down to
A warrrj^eanednes^ test." says Susan Tanaka of ir.e Committee for a Responsible Federal B-jdcet. " The wanner the doctor v
heart, the more who pass the test." She anc
other? believe that such a program will cos:
doubie Clinton's estimate of S20 billion ;i
year by the year 2000.
The Clinton plan rests on a deeper faith:
that the government can somehow be both
warmheaned and hardheaded. The fiscal
track record to date isn't encouraging. Take
Medicare. Government experts first predicted that Medicare, enacted in 1965.
would cost SIO billion a year by 1990. The
real number turned out to be S107 billion.
Such numbers should make the president
and Congress cautious as they move ahead
on heaim-care reform. They might do well
to remember the theme song Bill Clinton
chose for his last campaign: ""Don't Slop
iThinkme About Tomorrowj."
•
j underwritten by the Health Ini curance Association of America. Theyfretabout beEWT GINGRICH
ing "forced" to buy
wanted to show
insurancefrom"gova group of senior
ernment monopocitizens how scary
lies." But under the
govemment-run
Clinton plan, health
health care can be. So
alliances would offer
he cued up a news clip
three choices, more
about Canada's systhan most people have
tem on a VCR and
today. The HIAA repwatched the audience,
resents hundreds of
members of the Amersmaller insurers,
ican Association for
which would be drivRetired Persons, reen out of business in
HUA's earnest Hanr He just
The DNCs usual suspects: 'They
coil in horror. Except
Clipton's plan. HIAA
don't need government monopolies to
said there was no recession. Now they
for intensive care and
has already spent $14
get health coverage for everyone'
say there is no health-care crisis.'
emergencies, the Tomillion on ads, and it's
ronto broadcaster exonly February.
life to an M.D. or an M.B.A.?"
plained, all hospitals would be style system. Health-care ads.
Democrats arefightingback
closed for several weeks. Chil- most designed tofrightenmore asks the American Medical As- with one ofthe most overthan enlighten, have been pro- sociadon. The message here is workedrebukesofthe Ws:
dren 4 and older with high feliferating. Last fall NEWSWEEK that medical care will be
ver should not be brought in
"They just don't get it." A new
usurped by government buunless they were convulsive or dissected some early spots
ad paid for by the Democratic
(Oct. 11, page 44): a sampling of reaucrats who care more about National Committee captures
lethargic. The reason for the
the latest scare tactics:
cost control than good care. The four Republican presidential
shutdown was budgetary.
Gingrich calls it "the most chill- • "Everything is at risk" is the AMA is running a series of print hopefuls (Bob Dole. Jack Kemp.
ads in major publications under Carroll Campbell and Dick
ing 30 seconds I have seen al- tag for a spot produced by the
Project for the Repubbcan Fu- the heading THIS IS THE MOmost since the nuclear-war
Cheney! declaring that there is
ture, a Washington think tank. MENT OF TRUTH. Doctors are
movies ofthe early '80s."
no health-care crisis. Dole and
The ad strings together quotes encouraged to hand out copies Campbell have backed off from
Gingrich, the House GOP
to tbeir patients. What the
for maximum shock: There
whip, ponders how effective
that claim, and many Republiads don't say is that medical
those seconds could be in an ad will be rationing"—The Wall
cans support some kind of
decisions are already often
Street Journal. "A giant social
opposing the president's
health-care reform. But that
made by insuren and hospital
experiment"—NEWSWEEK.
health-care bill. "Just say. 'Let
hasn't stopped the DNC from
admnustrators.
The ad was aimed at opinion
us show you government
labeling the opposition as out of
leaders inside the Beltway. "It • "We couldn't choose a plan
health care in the North'."
touch. Scare tactics are a lot
would take 520 million to take it that's not on their list" is LouNever mind that neither the
more etiective than droning
to the people," says media ad- ise's plaintive cry. She and
Clinton plan nor its major
recitations about the pros and
Harry are the gratingly Middle cons of managed competition.
viser Alex Castellanos. .
Democratic rival, the Cooper
plan, proposes a Canadian• "Would vou rather trust vour America couole featured in ad>
F l F ANOK C l . l F T
Scare Tactics and Sound Bites
NiI
22
N F M' « W F F K
r
^
FFBFUARVSI.ipq^
' >• « « '" * * v 5 t. i nn ,
• 1.
ft
�E. J. Dionne Jr.
decisions, in private hands. This would
come as no surprise but for all the exaggerated rhetoric about how the Democrats
favor "big government" and the Republicans "small government."
See Through
That Patter \J
When people complain about politics,
their grumpiness usually falls into one of
two categories. Either the angry voter will
assert that there are no differences between Republicans and Democrats and
that it doesn't matter whom we elect. Or
the cntic will denounce both parties for
being too "extreme" and "partisan" and
wonder why they can't get together to
solve common problems.
Occasionally, the same person will make
both of these critiques simultaneously,
which is not as irrational as it seems.
Those who say that the parlies are both
too similar and too extreme are usually
asserting that the public fights between
them are largely contrived as both sides
exaggerate their differences for shortterm gain at election time.
Once in office, the parties never behave
as differently from each other as they
promised they would. Thus did George
Bush run as a fiercely anti-government
candidate and then preside over a large
increase in government spending as a
share of the nation's economic output. Bill
Clinton promised all sorts of new programs and now finds himself cutting away
at federal spending simply to keep the
deficit below $200 billion.
It's rare that a government document
throws light on this sort of debate, but
there was much enlightenment in the annual Economic Report of the President
issued last week. The report is mostly the
work of the president's Council of Economic Advisers, chaired by Laura D'Anorea Tyson.
The report demonstrates that there are
real differences in the way Democrats and
Republicans .look at the economy and government's role in shaping it. Democrats
worry more than Republicans do about
growing economic inequality, which the
report calls "a threat to the social fabric
that has long bound Americans together."
Democrats see government as fostering,
not retarding, economic growth and as
improving, not limiting, the average person's standard of living. Whereas the Economic Reports issued by Republican presidents included detailed analyses of the
costs of government regulation, this one
includes a section on the urgency of government-led health care reform and praises government's efforts to clean up the
environment.
On the other hand, anybody who thinks
of Democrats as closet "socialists" ought
to read all the material in here about the
importance of free markets, competition,
"capital formation," business investment
and free trade. Offering an argument dear
to the hearts of those who see a global free
market as a good thing for the United
States, the report explicitly questions
whether freer world trade has driven
down American wages.
So, yes, it matters whether you elect
Democrats or Republicans. Democrats are
more willing than Republicans to put floors
under people's incomes and health care
sUndards. Where both sides favor "safety
nets," Democrats tend to favor bigger
ones. Democrats think government spending for job training and education will help
more people than cuts in the top tax rates
that Republicans championed. Democrats
think that government investment in new
roads or research can help the economy at
least as much as private investment in,
say, new office buildings. Republicans are
skeptical.
But Democrats and Republicans are operating within broadly similar world views
when it comes to the merits of keeping
mnsr nf rhp prnnnmv and most investmenL
The truth is that both parties are operating at the margins. The margins are
important, as anybody making more than
$250,000 a year will notice next April 15.
But the similarities are more important.
No matter how much small government
rhetoric they deploy, the Republicans
won't abolish Social Security, Medicare,
Medicaid or the defense budget, which
together account for most of federal
spending. No matter how much they wax
populist in their occasional rebukes to "big
business" or "the rich," the Democrats
aren't proposing confiscatory taxes or a
government takeover of GM, GE or IBM.
All this needs to be borne in mind during
the coming health care debate. The Republicans have been at sea in that debate
because their anti-government rhetoric
doesn't match what they are already for.
Through Medicare and other health programs, the government pays over 40 percent of the nation's health bills. That share
will grow as the population gets older. By
supporting Medicare, Republicans concede
upfront that government will play a huge
role in the health system. But only rarely
do you hear talk about "big government"
Republicans.
Moreover, almost everyone in the debate says the government should prohibit
insurance companies from turning people
down for health coverage just because
they have a "preexisting" medical condition. That's a good idea, and also more
"big government." Many who knock the
Clinton bill praise private insurance companies for doing better recently at holding
down medical costs—by using some of the
very techniques they attack Clinton for
proposing m his plan.
So beware of all the "big government"
and "free market" patter you'll be hearing
in the coming months. Almost nobody in
the debate is proposing a real free market
m health care. And nobody is suggesting
we go tht- Soviet route. As the Council of
Economu Advisers would tell you, that's
true on almost every' other political question, too.
�Deceptions Hinder Waste-Dump Debat^
1
THE
NEW YORK
TIMES,
TUESDAY. FE
BRUARY" "
4
To the Editor:
In "Not a Federal Repon'' (letier,
Feb. 1), on California's proposed
Ward Valley nuclear-waste dump,
Robert M. Hirsch, acting director of
the United States Geological Survey,
attempts to discredit three of his own
agency's most senior scientists.
The detailed report, prepared at
my request by Geological Survey experts with more than 40 years of
experience in the Ward Valley area,
identified numerous paths by which
Health Tinkering Is Not Reform
Representative Pete Stark, the California Democrat who heads a House subcommittee on health
policy, says that Congress ought to scrap the purchasing cooperatives, or alliances, that lie at the
core of the Administration's health care bill. The
Senate minority leader, Bob Dole, and another
Republican Senator, Phil Gramm of Texas, say that
Congress ought to gut the other institutional reforms proposed by the President as well — and
stick to small fixes. In the next few weeks Congress
will decide whether it will overhaul or merely tinker
with health care.
Tinkering is not enough. To see why, Imagine
that Congress takes the go-slow approach and does
little more than require insurance companies to
make their policies portable (workers can keep the
policy when they leave their current employer),
communiO' raled (the chronically ill pay the same
premiums as the healthy) and guaranteed (insurers are required to sell to applicants regardless of
preexisting medical conditions).
These small-fix insurance reforms are not enforceable if Congress leaves the current unregulated — and uncompetitive — market largely in place.
The Government would find it difficult, for example,
to check whether insurance companies were serving all potential applicants. Did the insurer recruit
only in Scarsdale? Did the insurer answer phone
calis from potential applicants in Harlem? Did the
insurer tailor its benefits package so that AIDS
patients would not apply?
Congress could, of course, enact 13 trillion
pages of rules to stop these practices. But a more
effective, less regulatory answer is to require most
individuals or their employers to buy coverage
through a cooperative, or alliance. The alliance, not
the insurers, would then make every policy equally
accessible to everyone in the region. The alliance is
also positioned to transfer money from insurers
who, through trickery or happenstance, do not enroll many AIDS patients to insurers who do; that is
the only effective way to force insurers to serve the
chronically ill.
Even the power of the alliances will probably
?
not stop insurers from all discrimination. So Congress will need to insist that insurers provide an
identical set of health benefits — known as a
standard benefits package — to every enrollee.
That way policies cannot be crafted to attract only
healthy applicants.
Minimal fixes would leave too many loopholes.
If each of us is guaranteed the chance to buy
coverage whenever we want at community rates,
none of us who have a choice about coverage — who
are not automatically insured through work — will
buy until we get sick. That would leave only the sick
to buy coverage — at what would have to be
prohibitively high premiums. Under such rules, 20something-year-old couples would wait till the wife
becomes pregnant before purchasing insurance.
Advocates of small-fix reform would almost
certainly have to allow insurers to exclude coverage for preexisting conditions for at least, say, nine
months. But that provision would leave millions of
Americans temporarily unable to get insurance and
would not stop many others from gambling that
they could do without insurance — knowing they
could always flee to the nearest emergency room
largely at public expense. The solution is to make
insurance mandatory, as President Clinton proposes, so that no one, when well, can skip paying
premiums.
Real portability is another fix that takes more
than a flick of the legislative pen. Congress may
promise workers that they can continue to buy their
old policy after they change jobs; but what good is
that promise if their new employer doesn't include
the old plan among available health-care options?
Again alliances are an answer. If people get coverage through alliances, rather than employers, they
would retain access to their old plans as long as they
continued to work in the same region.
Every American ought to have coverage that is
portable, community-rated and guaranteed — operating through a system that is fair, dependable and
free of loopholes. Alliances and a standard benefits
package look like the best road to those goals.
Anything less does not deserve to be called reform.
The Boat People: A Chapter Closes \/
They first floated into the world's consciousness in 1977, fishing boats crammed with desperate
men, women and children fleeing the hardships and
persecutions of a newly united Communist Vietnam They encountered pirate attacks at sea and
hostile receptions on nearby Asian shores. Still,
nearly a million of these "boat people" eventually
set sail, most in the late 1970's and early 1980's.
That chapter of history has now been officially
closed by the United Nations High Commissioner on
Refugees. The U.N.'s refugee arm declared last
week that fleeing Vietnamese would no longer be
automatically eligible for consideration as political
refugees; they will be judged on an individual basis
like other applicants. Most of the 60,000 boat people
remaining in Asian refugee camps can now be
legally sent back home.
That is unwelcome news to the affected Vietnamese. But sending them home is no more cruel
than leaving them to rot in refugee camps — if they
can be assured of freedom from reprisals on their
return. Asian countries, fearing unemployment and
ethnic conflict, will not admit them as residents.
And Western countries other than the United States
have been almost equally unwelcoming.
Though the world likes to pretend otherwise,
the treatment refugees receive always has a lot to
do with international politics and the current standing of their homeland. The Vietnamese exodus of
the late 1970's shocked a world that had been lulled
by Hanoi's rosy — and false — postwar picture of
liberation, peace and national recuperation. Vietnam is still a poor country and remains arbitrary in
its treatment of those suspected of political nonconformity. Yet It offers more hopeful economic prospects and less systematic repression.
It is also being officially welcomed back into
the community of nations that isolated it during the
long Indochina wars. Only this month, the U.S.
finally dropped its 19-year economic embargo. The
Association of Southeast Asian Nations, once virtually an anti-Vietnamese alliance, now weighs accepting Hanoi as an associate member.
International law defines a refugee fairly
strictly. Most people trying to escape poverty and
dictatorship do not qualify, only those who can
demonstrate a "well-founded fear of persecution "
International agencies like the U.N. High Commissioner on Refugees have a dual mandate: to protect
legitimate refugees and to organize their return
home after it becomes safe to go back. For Vietnam,
that moment now seems to have arrived.
radioactive materials could migrad
to the Colorado River, the principa
drinking water source for Southen
California, Arizona and Baja Califor
nia The repon also shows seriou>
inadequacies in the analyses per
formed by project proponents:
Mr. Hirsch attempts to diminish
the findings of the survey's specialists by arguing that their study was
not an official study and was not peerreviewed by the Geological Survey.
Mr. Hirsch does not mention lhal It
was he who forbade the experts from
performing the work as an official
Geological Survey study and he who
first agreed to, and then forbade, Geological Survey peer review.
He also states thai the findings by
ih Ward Valley experts are at odds
with a Geological Survey study in the
1980's. Thai study, however, a mapping exercise of the southwestern
United Stales, was q broad effort that
did not conclude that the Ward Valley
site, or any other, was safe It merely
identified broad areas requiring further site-specific investigation. Indeed, the Geological Survey has written that it "has not conducted any
studies in Ward Valley, California,"
regarding suitability for low-level radioactive waste disposal.
Mr. Hirsch seems committed to
squelching an objective analysis of
the proposed Ward Valley dump. This
issue will not be resolved until decision makers engage in an open, honest process that both insiills public
confidence and insures ihe safety of
Ihis generation and future generalions.
BARBARA BOXER
U.S. Senator from California
Washington. Feb. 16, 1994
�Why the cost savings from
managed care will never materialize
By Doug Bandow
president's centrally-planned system of command-and-control regulation will succeed where a series
of presidential campaigns against
government waste, fraud, and
abuse have failed? CEA member
Alan Blinder points to existing managed care systems: "The savings
we project are perfectly reasonable
when you recognize that health
care provided by HMOs is 15 percent cheaper than regular fee-forservice."
Alas, Mr. Blinder's optimism is
belied by more than just the latest
federal review of Medicare, fbr
more than a decade, employers,
private insurers, and the federal
government have been trying, with
Uttle success, to limit costs by
he Clinton administration
continues to press forward
with a health care program
that seems to offer everything for
everyone: quality medical attention
for more people at less cost, insurance policies with lower
deductibles and copayments, and
money — at least $58 billion at latest count — fbr deficit reduction.
These claims "are not debatable," at
least that's what Council of Economic Advisers chairwoman Laura
D'Andrea Tyson said before the
administration adjusted its original estimates. Now the revised forecasts, promises White House aide
Ira Magaziner, are accurate: "We've
discussed this thoroughly, and I
dont think there is disagreement
now on what the numbers should
be." Except by the Congressional
Budget Office, but that's another
story.
Alas, the administration's
announcement that it will no longer
press Medicare recipients to join
Health Maintenance Organizations
because doing so doesn't save
money suggests that even it may
have to again readjust its numbers.
After all, if the Reagan and Bush
administrations were wrong in
thinking that they could cut costs
by pushing the elderly into managed care, then the Clinton administration is likely to be no more
effective even if it succeeds in forcing the rest of us into similar organizations.
Yet administration officials claim
that their program will perfonn the
medical equivalent of cold fusion
precisely because they expect it to
sharply reduce medical costs that
have heretofore been sprinting
ahead at double digit rates. The
scheme is to simultaneously reduce
federal medical expenditures, particularly for Medicaid and "managing" care through a panoply
Medicare; generate higher federal of programs: HMOs, Preferredtax revenues, by cutting corporate Provider Organizations (PPOs),
insurance premiums, allowing professional standards review orgacompanies to pay higher salaries nizations, utilization review and
that, in turn, will result in increased more. In fact, according to the Conincome tax collections; allow Wash- gressional Budget Office, by 1990
ington to spend less on retiree the percentage of employees in one
health care benefits than do private form of managed care or another,
firms today; and make better off, in
the long-run, most of the 40 percent including fee-for-service plans with
of Americans who will be paying Utilization Review, was 95 percent,
upfrom59 percent just three years
higher premiums.
before. Yet a study released by the
In short, the presidenrt entire General Accounting Office in Octoprogram hinges on its ability to ber found "little empirical evicurb tbe growth in health care dence" that managed care cuts
expenditures. If such cuts do not costs, lb the contrary, despite all of
materialize, the result will be some these efforts, reports Dr. Joshua
combination of higher taxes, Wiener of the Brookings Instituincreased insurance premiums, tion, "costs are still going up at very
lower quality of care and explicit high rates.'*
rationing. And we will be worse off
Overall, managed care appears
than before we started.
to have lowered base costs, though
What evidence is there that the the amount is in dispute. Consider
HMOs, which benefit from the fact
that their members tend to be
Doug Bandow is a senior fellow at healthier than average. While
the Cato Institute. He is the author of HMOs are, in general, cheaper than
"Dangerous Medicine: A Critical other plans, they are by no means
Analysis of Clinton's Health Plan," uniformly less expensive Two
•published by the John Locke Foun-recent business surveys, one by
dation.
KPMG Peat Marwick in 1992, the
T
other a 1991 review published in
Health Affairs, found little difference in premiums and similar rates
of premium increaseforHMOs and
indemnity plans. And HMOs can be
more expensive. According to the
GAO, "Some firms havefoundthat
their total health care costs have
increased after implementing network-based managed care." The
consulting firm FosterHiggins
reports that 35 percent of corporations surveyed stated that their
HMO rates were higher than those
for traditionalfee-for-serviceplans.
Moreover, the cost advantage
begins to melt away when HMOs
are transformed into Point of Service (POS) plans, which offer more
physician choice; the latter generate barely half the savings, 7.9 percent compared to 14.7 percent (in
1991) over indemnity coverage. Yet
one of the administration's amendments to its original proposal was to
require that health alliances offer
POSs rather than simple HMOs.
Professional standards review
organizations, PPOs, utilization
review, and similar attempts to
restrict medical use have proved to
be of uncertain value as well. Studies of the former, for instance,
which are applied to Medicare and
Medicaid, have found anywhere
between zero and 18 percent reductions in different hospital services.
Some researchers believe that
PPOs, provider networks which
tend to impose lower copayments
on patients — just as the administration intends — may actually
raise utilization and therefore costs.
Study results have been equally
equivocal for utilization review,
with cost savings limited largely to
hospital inpatient care, particularly surgical services. At the same
time, costs often rise elsewhere.
Fbr instance, a 1989 repon by the
National Academy's Institute of
Medicine said, "savings on inpatient care have been partially offset
by increased spending for outpatient care and program administration."
Anyway, to the extent that managed care has reduced costs, it is
largely a one-time phenomenon.
While the expansion of managed
care may have cut the costs of some
individual plans immediately after
implementation, it has done little to
reduce system-wide costs and has
not halted medical cost inflation.
Stanley Wallack of Brandeis University's Bigel InstituteforHealth
Policy points to "the inability of :
managed care to control system '
costs, as health care expenditures
have continued toriserapidly with
the widespread adoption of managed care." A1988 studyfoundthat
utilization review had "a one-time
effect of reducing use and expenditures" that did not increase in the
future, a conclusion reaffirmed by
other researchers a year later. FbsterHigginsreportsthat the avenge
employee cost for HMOs jumped
13-5 percent in 1991 (and 15.7 percent in 1990); PPOs were 13.7 percent more expensive in 1991. Con-
For more than a
decade, employers,
private insurers, and
thefederal government
have been trying, with
Uttle success, to limit
costs by 'managing'
care through a panoply
ofprograms. Yet a
study released by the
General Accounting
Office in October
found 'little empirical
evidence' that managed
care cuts costs.
]
cluded the Institute of Medicine
"Although it probably has reducec
the level of expendirures for som
purchasers, uuhzation manage
ment — like most other cost con
tainment strategies — does no
appear to have altered the long
term rate of increase in health-can
costs. Employers who saw a short
term moderation in benefit expen
ditures are seeing a re mm to pre
vious trends." The GAO and CBC
have both come to a similar conclusion.
Why is this the case? One reasor.
is that most of the easy cost-cuttinf
was done long ago Warns the CBO,
for instance, "in the past managec
care succeeded largely in reducing
hospital use, but similar drops in tht
future are now less likely" because
admission rates and lengths of sta>
have already dropped substantially
Nor does managed care change tht
underlying incentive stnicture created by pervasive third-party pay
ment, the fact that three-fourths o:
medical bills are directly paid b}
someone other than the patient
Observes Dr Thomas Rice o:
UCLA's School of Public Health
HMOs' "record of accomplishmeni
[in curbing medical inflation] is nc
better than that of fee for-service
medicine, probably because HMOs
are not insulated from any of the
underlying causes of health care
cost inflation"
These many, often arbitrary,
attempts to control costs have, however, adversely affected care,
resulting in premature discharges,
unperformed procedures, and
inadequate attention The result is
not a good model for the administration's promise to further cut
costs without harming medical
quality. Warns a group of
researchers at the Johns Hopkins
University, "It is difficult to be sanguine, however, about the potential
for future savings to come without
any loss in quality of care."
The
administration
has
promised much wiih its health care
program. But everything depends
on the assumption that federalizing
medicine will cut costs. If costs do
not fall, the Clinton program will
collapse. Unforrunately, our experience with managed care suggests
that there would be little, if any savings from more managed care
through the administration's
Health Alliances Past cost savings
have been less than commonly .
thought, and most of what can be
easily saved already has been
saved with 95 percent of people
now covered by managed care. In
short. President Clinton is asking
the American people to take a
riverboat gamble on their medical
futures, with the odds lengthening^
everyday.
Oje Bfagfrington Cfangg MONMY. FEBRUARY 21,1994
�LARRY KING (RADIO)
Date:
Time:
Location:
WH Press Contact:
I.
February 7, 1994
5:00 PM -6:00 PM
10 minute discussion and then phone calls
415 OEOB
Dawn 66740
BACKGROUND
Organizations putting on ads King will open the show with
roughly 10 minutes of discussion with you about the
advertisement campaigns ofthe AMA, HIAA, and the PMA
(with the Coalition for Health Insurance Choices-serving as a
loose coalition), after which you will take phone calls. The
campaign has already been extensive and expensive; HIAA has
started a second round of infamous "Harry and Louise" 30
second radio and tv ads, produced by Goddard and 14 states.
The cost for this two month campaign is $3.5 million; last year,
HIAA spent $10.5 million on ads. Of note is that Prudential
and Aetna dropped their membership in the HIAA as a result of
the ads.
Your statements In speech at the VA, you said that the
accusation that the plan would limit choice was
"unconscionable...They are raising the choice issue when it is
really the health insurance practices ...that have limited the
choices of millions of Americans." [Reuters 11/2/93]
HRC involvement As you know, the First Lady attacked HIAA
and their head Bill Gradison in November for running
"misleading" spots. Watch out for a question that Mrs.
Clinton's $100,000 investment in Valuepartners I Fund, which
"has a stake in the dechne of health care stocks" [Orange County
Register 11/3/93]
The DNC campaign under Celeste is running a $3 million
campaign on health care with TV, a 15 minute video and other
paid media. The Kaiser Family Foundation and the League of
Women Voters have launched a $4.1 million print and television
campaign (generally favorable to us) to provide "basic
information" on health care issues.
�As you know, their ads focus on :
Limiting consumer choice
Limiting drug R&D
Setting physician fees
II.
ATTACHMENTS
-- "A Few Points to Remember about the HIAA"
-- HIAA Attack Ads "An Objective Analysis" (5 pages)
-- NYT "Ads are Potent Weapon in Health Care Struggle" 2/1/94
-- W. Post "Those Health Care Ads" 11/3/93
Key quotes:
"The health insurance industry has been cbnducting a
demagogic campaign against the administration's health
care plan..."
Newsweek "Go Ahead, Bust Some Chops"
Key quotes
"Hillary was right to rip their heads o f f .
"...She's right substantively: the industry has brought us
back from the brink of bankruptcy."
-- Transcripts of HIAA ads
- "Partners I F (30 Second TV)
» "Thanks - Better Way" (30 second TV)
-- "Harry and Louise Part I I F (30 second TV)
"Yes, But IT'(30 second TV)
-- "Better Way" (60 second radio)
-- Washington Times "The First Lady's Invective Against Our
Ads is Misplaced" by Bill Gradison
-- Rhetoric vs Reality response to CHIC ad [9/9/93]
-- Orange County Register Editorial on Mrs. Clinton's health
related investment. [11/3/93]
2
Paul W. Jamieson 2/7/94
1
This article included a box that accused HIAA of "Highlighting Fears About the Clinton
Health Plan".
War room rhetoric vs realitv attached.
2
1
�Political Memo
Ads Are Potent Weapon
In Health Care Struggle
By ROBIN TONER
trirm ie Ttm Htm Yort Timm
WASHINGTON. Jaa 31 - Do you
want your next life-or-death decision
to be made by "an M.D. or an
M.B.A.?"
Are you ready to put your family's
health insurance into the hands of
"these new, mandatory government
health alliances run by tens of thousands of new bureaucrats?" Are you
aware that research by the oftencnucized pharmaceutical companies
"provides the best hope for conquering diseases like cancer and dramatically reducing health costs?"
A burst of new adverusing from
insurers, doctors and other interest
groups is posing all these questions
and more as the struggle intensifies
to influence the course of health care
restructuring — primarily, so far.
raising questions and doubts about
parts of President Clinton's plan.
Already, the subject of these ads —
on radio, television and in publications — is down to the emotional
basics, dealing with illness ang death
and the aching vulnerability of the
patient And some politicians and political profeuionals are predicting
that the groups behind this campaign
will push the limits of modern political advertising in both cost and technique.
A Rough Campaign
" I think there will be a barrage of
cynical advertising like we have never seen," said Mandy Grunwald. the
media consultant for Mr. Clinton, who
is advising the Democratic National
Committee on us forthcoming health
care campaign. " I think it will be
tideous."
Kathleen Hall Jamieson, dean of
the Annenberg School of Communications at the University of Pennsylvania, said, "Public pobcy is now being
conducted the way we conduct campaigns for elective office — with all
the flaws."
At work in many of these ads. political professionals say. is the basic
imperative of election advertising:
The one who defines a candidate first
— in this case a health plan — wins.
And while the Administration has the
formidable communications advantage of the White House, its allies
complain there is no way ihey will be
able to match the volume and intensiiy of advertising by interest groups in
tre campaign to come.
The Health Insurance Association
of Amenta, which spent $10.5 million
advertising is trying to break that
last year on advertising and has a S3.3
link between change and greater semillion campaign under way this
curity, arguing that the cnanges un
month in more than a dozen cities,
der consideration could, in faci. jeophas drawn the most fire in recent
ardize the quality of health care, not
weeks from friends and allies of Mr.
improve it.
Clinton and his wife, Hillary.
This is put most starkly by the
Tw* Major DtaagrMmeau
television spot broadcast this week in
BUI Gradison, president of the assofive cities and on Cable News Nei
ciation, counters that the group enwork by the Project for the Republidorses the AdministraUon's goals but
can Future. This ad casts the Clinton
disagree with two major aspects of health plan as the true health care
its approach: requiring most people
crisis, concluding, "Ever.-ttv.nn Rood
to buy insurance through state health
about your health care is a risk.''
alliances, which will be quasi-governcennda Lake, a Democratic poll
mental en ti ties acting as middlemen
taker who has worked extensively on
between consumers and Insurance
the health care issue, savs opoonems
companies; and putting caps on the
have already won onv rjur.d in the
cost ol premiums.
early struggle to delme the issue.
"We got absolutely nowhere tn
"The first thing that was accom
meeting with the Administrauon."
Mr. Gradison said. "So our view is '. plished by the opposition was, 'You're
that the issue is now up to the Amerigoing to pay more,' " she said.
can people and their representatives
"We've jealty lost that ftaht."
in Congress, and that's who we're
Another theme of much of this ad
trying to reach with these ads."
vemsmg is that an army of bureauDespite polls showing a broad con- crats will intrude on the inumate
sensus (or some kind of change in the ,relationship of doctor and pauent.
country's health care system, there | "Government and insurance compaare many openings tor group* seek- ny administrators could end up detering to raise doubts, change key provi- mining which types of treatment are
sions of the various plans or general- appropriate for patients like you."
ly try to slow the momentum for a says the Amencan Medical Associacomprehensive overhaul. Bob Blen- tion ad running in newspapers.
don. an expert on public opinion and
Amid all this campaigning are
health at Harvard University, notes groups trying to talk about the posithat people are still divided over just
tive side of health care restructunng
what kind of plan is best. As a result,
The National Health Care Reform
they are open to a campaign like that
Project, a Washington coalition o(
run by the Health Insurance Associa- i consumers, labor, business, civic, eld
tion of Amenca, which Mr. Blendon erly and health professional groups.
summanzed as, "Clinton's got the
nght idea, but the wrong plan."
is running a radio and pnnt campaign
in M cities.
The insurance association's ads
often feature people talking sympaAdvising the Administration on the
thetically about the need for reform,
health care campaign is much of the
then reviewing the Clinton plan with
same core of advisers who were Dealarm and building to a closing plea:
hind Mr. Clinton's Presidential bid
"There's got to oe a better way."
Ms. Grunwald. Paul Begala. James
Ms Jamieson notes that the health
Carville and Stan Greenberg.
^
issue is like iew others in the anxiety
it engenders even without the spur of
And the Henry J. Kaiser Family
advertising "You have so little inforFoundation has announced that
mation about something you care so
along with the League of Women vot
deeply about." she said.
ers Education Fund, it was beginning
Not surprisinitly. a pnncipal theme
a UA million campaign — featuring
in the campaigns n a yearning for
securuy which the Clinton forces i television and print advertising and
about 60 town meetings — to try to
have incd to make the centerpiece of
provide "basic information rn the
their campaign, as in the slogans.
health care issue, like who the unin"Health care that's always there"
sured really are.
and "Health care that cjn never be
taken away ••
But some of the interest groups'
�THE AO CAMPAIGN
Highlighting Fears About the Clinton Health Plan
ON THE KNONi Two women are in an office
diecuesing Preetdertt Orton'a neetth cere plaa
They talk about thetr desire for reform but qiricWy
move on to tneir reservations and fears. The rising
muaic undereooreattteiralarm, and tteir deelre to
take action by *8«n(lng a meeaage* to Congress.
The graphic at the end says: 'For facts you need to
know — 1-800-285-HEALTH.
Twsacrr
Ubby: *l want Congress to pass health care
reform . . . "
Louise: "Make sure everyone is covered.*
Ubby: * . . . but not torca us to buy our insurance
from these mandatory Government 'health
alliances.' •
Louise: 'So we couldn't choose a plan that's not on
Iheir list even if if we think It's better for our
employees and their families."
Ubby: "Not according to this." (Holds up President's
health plan.)
Louise: "But Congress canfixthat — cover
everyone and let us pick the plan we want."
Ubby: "And they will, II we send them that
message*
Announcer "For the facts you need to send
Congress a message, call today.'
ACCURACY: The ad focuses on one of the most
confusing pans of the Clinton plan, the health
alliance, a quasi-govemmental entity intended to
pool the purchasing power offconsumersand small
companies ana thus !o::s health plans to compete
for their business. The ad is correct in saying that
most Americans would be required to enroll in an •
alliance and purchase their nealth insurance through
it; major exceptions mciude Ihe elderly covered by
Medicare and those who work for companies with
more than 5.000 employees.
But Admintstnalton officials emphasize, the
alliance is simply a middleman and people will still
l-rvi'-uxy Cbc.xirv. For.
be buying private insurance. And they reject the
implication of the ad that the alliance will restrict the
average person's ability to choose a health plan.
Administration officials assert that just the opposite
is true: the alliance will give more choices in health
coverage to people who now have decisions made
for them by their employers.
SCORECARD: The ad focuses on two political
vulnerabinties of the Clinton plan: the fear thatttwM
lead to huge new bureaucracies and ths fear that It
will limit consumers' choice. At the same time, the
ad is careful to present itself as favoring health ear*
change — just not the Clinton plan.
The Health Insurance Association of Amenca
wants alliances to be voluntary, enabling people to
continue to buy health coverage directty from
insurance companies. Analysts say many smaller
insurance companies In the insurance association
(ear they will lose out to the biggest companies in
tne new marketplace run by alliances.
Administration allies also assert that the insurance
industry simply wants to retain control of health care
— deciding whom to cover, how much to charge
and so on
ROBIN TONER
PRESIDENT SEEKING
MORE (ME RELIEF
Acknowledging Need
In authorizing the new exoenduures.'
Mr Clinton conceded that Gov Pete;
Wilson of California was right in argu- •
ing mat the Federal aid (or the earthqu.ne would fall (ar short o( me need
LiPi week. Mr. Clinton said he would
ask Congress for $6.6 billion in emergencv money, a request thai would
make ine earthquake the cosiliest nai-.
ural disaster ever (or Federal taxpay-.
eri Ine earthquake, which measured ,
6 6 in' ihe Richter scale o( ground mono:: Miieu -il people and miured 8.00u
Leon L. Fanetta. the director of the ,
Office of Management and Budget. <
saic; .v '.ne time that he expected the
ncuTt io grow and has said since that i
ine Federal Governmem should re-ex-;
amine the way u pavs (or disasier aid.
Wants to Add $1.5 Billion for'
Total of $9 Billion in Aid
By GWEN IFILL
:
S t w o i n o T V N p . Yorn r i m n
WASHINGTON. Jan j I - President
Clinion will ask lor at least $1.5 billion
m additional Federal aid for victims of
the Los Angeles earthquake. Admimsirauon officials said todav. raising the .
proposed Federal commitment
to!
earthquake relief to more than S9 bil- i
1
1
lion.
i
A.i l e a n SS billion ot ihai would be I
sought in a supplememal budget re1
Somehow, we've got io do a belter
tob m terms of preparing for disasters,
either bv setting aside some kind of
tunu io aeai wnn anaxers or loomne
Coneress must specifically waive
budget limits when it approves new
disaster assistance, and the white
House has acknowledged that the
eanhouake relief will add at least 13
nilliun to ihe deficit.
Although states must normally
match at least 25 percent of the Federal commumenr, the Clinton Admimst IMI ion has relaxed that commitment
ior eronomically distressed California,
reou'nng onlv a 10 percent match.
In
Midwest floods last summer
h;i- • ; "st the Government $4.6 billion
so :.. and hurricane damage aid in
I9^i surpassed $8 billion, but that figure takes into account both Hurricane
Anaicw. which struck Florida and Louisiana, and Hurricane Iniki. which
sirucl: the Hawaiian island of K a u a i
The T i m e s B o o k
fleWew.
every Sunday
�A FEW POINTS TO REMEMBER ABOUT...
HEALTH INSURANCE ASSOCIATION OF AMERICA
THF HIAA OFPOSED CREATIOS Ot- SfENCARE:
•
The HIAA opposed die creaiic-n ot Nfcdicne in th« ftuJ 1960s.
•
HIAA spokesman H. f rwis Rietz (representing HIAA anti the I.-.fr. Insurance
Association ot America) tesiifieil io rcgistev our opposition to H.R. WO fMedicnl
Tan? for rhe Ased] and aU simitar proposals ' (Rieu sutemcnt to Himse Ways and
Means Comnnltee on Mrdical Caro for the Aged. November 22, 1963)
•
I HAA. *po)cesman J. Hcnt) Smith entered a atateneni into the Congressional Record
t'rv die House Committee <>n Ways and Means thai.
"[The HIAA] has 'xrrn opposed tc this t>|w of legislation on the grounds that it
is jrmecesaary anrl undesirable m the Uglii MI the existing magnimile and
growth of voluntaiv health insurance, ciiuplnl with the evolution and potemiul
of govemmcai programs for those who nccrl help.* iSmith statement on
MedicafUirc for th?. Ayeit H.R. 1. House Cummlttee Ways and Means,
February 1. 1965)
THE HIAA IS FIGH77SG HEALTH CARE RtfORM TO PROTECT ITS OWS
PROHTS:
•
The HTAA is a trade association for coromercul hcaltii insurance coinpanies wliiL-h
write mote -ian 85% of the anion's health care and dixabiliry i»hcies that are
provided bv private insurance ujmpanies. HIAA has VtO corporate members
• Alnniui- of Federal FACi. 1W-1993)
HIAA-LED COALITION SPtNDISG MILLIOSS AUAlNST THE PRESIDENT'S
HEALTH CARF. PLAS:
•
According iu Adi-emmg Age (Ai)iil 26. 1993). Hl\.\ is the 'principal member" ol
the Coalitinti for Health Care Chmcej, which recently begau airing a $1.7 million ad
campaign m anack the President's r - ^
^ campaign rhf coalinonranin the
spring—cosiniu some $4 million—vas entirely tii^nccd" hy HIAA. {Advertising Age,
liU1
l a f l t
4.-26:'93)
HIU OPPOSET) BILL TO PROTECT SEMORS FROM 1NSURASCE ABUSES:
•
When Congress set out to protect wiiurs in 1979 by creatiug a natlowide sumdard
£Q:8T
£6/81-63
�foi supplemental Medicare insur.ince (Kilififs and providmi; piniilties for inMjr.nxr
^ilfs abuses of jeniorj. the HIAA oppi").<ctl ii. saying "We feel the iolutioc ;an
rcaclieO ai rhe state level...We ask you to help u*. allow the Sutes time to do the joh
(U.S. Congress House Committee on bitcrstate nnd Foreijn Commerce.
Subcommitice mi Health and the Envircnmcnt. Seium Citizens Health Insurance
Kcform Aa H.R ?n02 96ih Cong., is-, vesa.. 19791
HI4,1 IS CLOSELY TIED TO THE REPUBUCW PARTY:
•
HIA-A'i political action coniuiitufe <KIPAC) contributed 61
of ilic,S23I.OOO it
contributed to federal v-.audulauis in the 1992 eiectkra cycle to Republicans. (Federal
Election Commission dau, 1091-92;.
•
HIAA President Willis D. Ondiscn Is a former Republican memhr.r of Congress from
Ohio.
•
According to labile Citireivs Congress Watch publication. Govtinmrm Sen-ice for
Sate; How the Revolving Door hii\ been Spinning, Gradison "brought «f lea»i three
[CongressionatJ staffers wiJi him to work at HIAA." (W'atrman, Nancy. Gvwmment
Senicetor Sale: Her* ih* Reuilvmx Door has teen Spinning. Wasliington. DC:
Public Citizen Scptcmhei. 1993. Page li.)
HIA.A HAH AS ARMY OF LOBBYISTS READY TO DEFEAT REFORM:
•
HIAA has nineteen lobbyists, .uvurding to Washington Kepresemati\t's. 1993
�HIAA ATTACH ADS:
AN OBJECTIVE ANAL YSIS
BACKGROUND
"HIAA hardly represents the insurance industry as a whole. The group's
members control 35% ofthe health insurance market." [Los Angeles Times.
11/9/93]
"Virtually unopposed, the Health Insurance Association of America has
spent a staggering $10.5 million since April to air six ads attacking
President Clinton's plan." [Los .Angeles Times. 11/9/93]
HIAA's ADS PLAY FAST AND LOOSE WITH THE TRUTH
•
"The purpose of the ads showing Harry and Louise sitting at their kitchen
table bemoaning the Clinton proposal is not to foster factual discussion
about health-care reform. Instead, their goal is to make the public
anxious about Clinton's plan. [USA Today. 11/10/93]
•
"In general, the ads do not espouse a new plan. They simply raise vague
doubts about Clinton's -- and occasionally imply dire consequences not
f u l l y backed by fact." [Los Angeles Times. 11/9/93]
•
"In September, it [HIAA] began introducing the first of four Harry and
Louise ads. (One ran for only two days before being pulled because of
inaccuracies.)" [Los Angeles Times, 11/9/93]
•
"The opinion that the insurance industry is greedy is pretty common.
...Hold it right there, Louise. The Clinton plan doesn't limit health care; it
limits premium increases. This would not keep you from the care you
need. ...The HIAA is playing fast and loose..." fUSA Today. 11/3/93]
•
"The first [HIAA] ad asserts that the Clinton plan would require people 'to
pick from a few health care plans designed by government bureaucrats.'
That claim is not true -- the Clinton plan would allow private companies
to design health care plans and would give all workers the choice of a
traditional 'fee for service' plan." [Los .Angeles Times, 11/2/93]
•
"For most Americans the implication that under the Clinton plan, they
wiD face more red tape, receive fewer benefits and will have to pay for
services for their current plan is not true." [Newsday National Desk. 11/1/93]
�"The ads [contain] some inaccuracies." [Los Angeles Times. 11/9/93]
"It's [HIAA's] newest ad, for example, cites a provision in the Clinton plan
that would put a ceiling on insurance premium increases and vaguely
suggests that as a consequence, the plan could run out of money -- an
implication generally viewed as improbable." [Los Angeles Times. 11/9/93]
"The ads aren't really about anything at all,' said [Douglas] Bailey, the
former Republican political consultant." [Los Angeles Times. 11/9/93]
"While the veracity ofthe ads is debated, there is widespread agreement
among health experts and lawmakers that past practices of insurers have
fueled the current health care crisis. Insurers, especially the small and
medium-sized companies represented by HIAA, often deny coverage of
existing health problems, charge older consumers higher rates and drop
policies for small businesses whose employees run up high health costs."
[Washington Post. 11/4/93]
"A new insurance industry ad attacks the Clinton plan, saying that it
would limit choices of health insurance plans. That argument is true -the Clinton plan would, for example, prevent insurers from offering highdeductible plans that cover only 'catastrophic' illness. ...The Clinton plan
gives people at least three options to choose from an increase in choice
for most workers." [Los Angeles Times, 11/2/93]
"The Administration proposal provides that in most states everyone would
be offered the choice of at least three health care plans, including one of
traditional fee-for-service plans with no restrictions on choice of doctor."
[New York Times. 11/2/93]
"The Clinton proposal provides that a health alliance may borrow, on a
short term basis, from the Treasury if it meets a cash flow problem, and
then would raise its rates the next year. If a particular insurance plan, or
a cooperative plan run by doctors, went broke, the state authorities would
see that its bills are paid through reserves they establish, much as they
now require insurance companies to maintain reserves." [New York Times.
11/2/93]
"Its [HIAA's] advertisements raise broad and non-specific concerns about
the Clinton program." [Los Angeles Times, 11/10/93]
"Mrs. Clinton [shot] down the insidious message being bankrolled by the
Health Insurance Association of America...Mrs. Clinton focused on the
dishonest implication at the heart ofthe insurance association's televised
ads...The very concept of universal coverage constitutes a threat to the
�discretionary system that has been so profitable for the insurance
industry." [St. Petersburg Times. 11/3/93]
OTHER INSURERS ARE DISTANCING THEMSELVES FROM HIAA
•
"Four of the country's largest insurance companies -- Aetna, Cigna,
Travelers, and Metropolitan -- recently dropped out ofthe group [HIAA]
because they preferred not to participate in such aggressive opposition to
the Clinton plan. Blue Cross - Blue Shield is also not a member." [Los
Angeles Times, 11/9/93]
•
"Several insurers, meanwhile, are trying to distance themselves from the
controversial ads. A coalition made up ofthe nation's five largest insurers
is actively pointing out that its group had nothing to do with the ads. And
the president ofthe Blue Cross-Blue Shield Association wrote to Mrs.
Clinton yesterday, saying that while, 'it's unfortunate that the Health
Insurance Association of America has chosen to aggressively challenge
your health care reform initiative through national advertising...It is also
unfortunate that you have chosen to paint all insurers with the same
brush." [Wall Street Journal. 11/4/931
•
"A fifth member of that alliance, Prudential Insurance, is still in the
HIAA but refused to help pay for the ads. 'We thought they were far too
negative,' said Prudential spokesman Kevin Heine." [The Washington Times.
11/4/93]
•
"Now, a dramatically improved health care system is within our reach.
President and Mrs. Clinton are making a remarkable effort, and as new
legislation goes to Congress, we at Blue Cross and Blue Shield will work
hard for Its enactment."
Shield, 10/27/93]
["An Open Letter to the American People," Blue Cross/Blue
HIAA IS CLEARLY MOTIVATED BY PROFIT AND GREED
•
"The insurance industry TV ads seem to us to be aimed much more at
preserving the industry's own revenues." [Washington Post, 11/3/93]
•
"The $6.5-million the insurance industry is paying for its current
campaign is just a taste ofwhat the health care system's various special
interests will spend on advertising and lobbying in an effort to protect
their profits." [St. Petersburg Times, 11/3/93]
�"The ads, part of a multimedia blitz in 10 states, are intended to raise
doubts about sections of Clinton's plan considered most damaging to
insurers. The latest focus is on premium caps, or limits on annual
premium increases to hold down health care costs in the private sector.
The industry sees them as a threat to profits." (Washington Post. 11/4/93]
"If Clinton's plan becomes law, many HIAA members are expected to go
out of business because they are too small to be able to lower their costs
far enough to meet government-imposed standards." [Los Angeles Times
11/9/93]
"The association represents small and medium-size insurance firms that
many believe would be driven out ofthe health care underwriting
business by Clinton's proposal. Although it contends that it agrees with
many of Clinton's goals, it objects to his plan to impose limits on increases
in premium growth and to require people to purchase health coverage
from state-run alliances." [Los Angeles Times. 11/10/93]
"The health insurance industry has been conducting a demagogic
campaign against the administration's health care plan, and Mrs. Clinton
was right to fire back. She gave at least as good as the administration has
been getting. Maybe now the debate can revert to substance. The
insurers are like every other groups now living off the overstuffed health
care system - absolutely in favor of'reform' but not at their own expense.
Months ago they'tame out in favor ofhealth insurance for everyone, a
system in which 'all employers and individuals' would be required to buy
'an essential package,' and the government would subsidize those who
could not afford it. You bet their for that -- a guaranteed market. They
get less enthusiastic as the conversation moves toward regulating the
system to control Its COStS." [The Washington Post. 11/3/93]
"The current firestorm of controversy concerning consumer choice under
managed competition has been initiated by those who either fear change
or are genuinely opposed to managed competition. On the issue of choice;
case closed. Let's move on in a bipartisan effort to achieve health care
reform." [News Release. The Alliance for Managed Competition, 11/3/93]
MEMBERS OF CONGRESS DOUBT THE VERACITY OF THE ADS
•
'"Do you think you are bringing light or do you think you are bringing
heat to this issue?' [Senator] Kennedy demanded of Charles N. Kahn, III,
executive vice president ofthe Health Insurance Assn. of America." [Los
Angeles Times. 11/10/93]
�THE ASSOCIATION
•
ITSELF IS BACKING OFF
"Kahn said the current set of ads will run only through Thanksgiving.
After that, he said, 'we are going to reassess their usefulness.'" fLos Angeles
Times. 11/10/93]
�A26 TED<iESDOr. NOVEWEK 3.1993
THI f ASHIICTW POST
Sl)c asljinqton |Jo5t
AN
INDEPENDENT
NEWSPAPER
Those Health Care Ads
T
HE HEALTH insurance industry has been tbe amount that plans could raise their premiums
conducting a demagogic campaign against each year.
Members of the Heahh Insurance Association of
the administration's health care plan, and
Mrs. Clinton was right to fire back. She gave at America want to be free .to continue to sell
least as good as the administration has been insuranpe .outside Jhia regulatory apparatus, and
getting. Maybe now the debate can revert to they don't like the idea of premium caps. To begin
to win over public opinion, the association haa been
substance.
The insurers are like every other group now running a series of TV ads suggesting the Clinton
living off the overstuffed health care system—- .plan would limit "choice" to "a few health plans
absolutely in favor of "reform," but not at their designed by government bureaucrats" and possibly
own expense. Months ago they came out in favor create shortages' of health care as well Mrs?
of health insurance for everyone, a system "in' Clinton denounced thefintof these suggestxns as
which "all employers and individgals" would be'. "one of the great bes . . . 'ctattotly afoo( jn the
required to buy "an essential package," and the ""dbontry." She accused • the •todiistryof' having
government would subsidize those who could notTlffought us to the brink of tankruptcy because of
afford it. You bet they're for that—a guarantee^ .the way thaUhey havefinancedheahh care," said
market. They get less enthusiastic as the conver- -th* insu/Bttr companies "bke what is happening
sation moves toward regulating the system to today . . . like being able to exclude people from
coverage" and much more. . . .
control its costs.
In fact, a lot of people today don't have much
The administration would do the regulating choice in the health care they get. They're bound
mostly through state and local health alliances. in no small part by rules aet by the insurance
It's through these that most citizens would pick compaaiefi. Some would have a lot more choice
their health care plans. To get on the list of under the Clinton plan; it seems to ua few would
approved plans, an insurer or provider would have less. There could indeed come a time under
have to offer a generous standard bene6t pack- the plan when cosu bumped up against premium
age and couldn't turn people away because they and spending limits. That, of coune. is the whole
were already sick or likely to become so, as idea of having limits. The alternatives that the
insurers often do now. No ducking of risks and critics offer, including the insurance industry, are
insuring only the healthy. The ooty way plus pretty badly worn. There are plenty of legitimate
would have left to compete would be through wayi to cnfcdze and perhaps improve the Clinton
higher quality or lower cost; that's the theory. If plan. The insurance industry TV ads seem to us
the ^competition failed to hold down costs, the to be aimed much more at preserving the mdusadmiaistration would have in reserve limits on try'a own revenues.
<
-
c
�/
N A T I O N A L
A» » \ I Us
BETWEEN THE LINES
JONATHAN ALTER
Go Ahead, Bust Some Chops
HV\ I f Ul>^ H(H »SK"\K
' 1_T » \1 81 STISI. TRrVt'V HF cal wtea behind the Clinion plan was to divide the big healthdevcnliecl rapt.iin> ot industn a«. malflacton insurance companies trom the smaller ones The halt-do^en big
ol aveM vvejlth Tum-ol-ihe-^fniun Amencans bovs would back the plan because they stand to win one oi ihe
didni h.n r to I on I. up malftactors in thf die- sweetest shared monopolies ever: the smaller companies, which
lion;in ui know thji n me.Tns fnmmali." The wreak havoc on the system with mounds ot paperw ork and chern
presidenl \\ a>. cjllina thr countn s rich men a bunrh ol'crooks. picking (insuring only healthy people without pre-existing condiSince then nm-i presidenl - h>n e defined themselve> in pan bv the tions"!, would be driven out. But instead of backing the Clinion
enemie> they've mnde And ihe\ should be ludced lhal way. too. plan wholeheartedly, several ol the big insuren hav e w eighed in
1FK look on ereedv fieel e\erutne«: Georae Ru>h demoni/ed .
with the rest ot the industn by attacking premium caps and other
tljL burner* Bill Clinion. <o n.minl a polmcun in other respects, cost controls. A lew even helped undenxTite Ham- and Louise.
kiii-m »the mtport-.int e ot m.ikmc the ncht enemies onh abstractlv.
Clearer enemies might have also meant cleaner legislation The
noi instmctn ely. Hill.in Rodh.im Clinion undersiandf it betier. mad complexity of the Clinton bill sometimes seems like nothing
Her atuck
week on the heahh-msurance industn shatters yet more than an elaborate eflon to avoid the late the White House
another sill* tradition —the one resays would hav e aw aited anv smglequinnc Firsi Ladies lo speak onl\ in
pa>fr. Canadian-style plan II it
soothinc platiiude> It also «.en es as
were called a Big Government plan,
a model lor how her husbond should
it would tail, the Clintons reasoned
sharpen his rhetomBut that s exactly what it's being
Ihe attack was prompted by
called anyway So why not use this
Hiirn and Louise characters in a
i period ol compromise to throw some
" i milluMi .id camp.ucn sponsored
! obbyttts out of work by moving back
by the Health Insurance Association
toward simplicity One powerful
oi Amend I H I A . \ I . which repre, senator joked last week that the
scnt* .1 large chunk ol the nation's
^
l.)UO-page bill could be reduced to
JOIHI health insurers Harn is glad
^^^Hr
one sentence that simpiv deletes the
the presidenl is 'doina something
^^^^^^ ^1
words over 65 trom Medicare
jlx'ut he.iltli-eare relorm." but Lou^ ^ ^ ^ S ^ H
Ammo tax: Clinton
in the
isi- keep- complaining ihnt •'there's
sand' on health care is universal coveoi ic be H hetier uav " The Clinton
erage. That s good. But by sav ing so
IOITP* \Mjrked up an anihcial huthclearly that everything else is negoni-«« o\ei the-e ads Although one
tiable, he sends a message ot w eakroinmercial wroneh claimed that the Bluting htalth imurtrs: Are antmo makers next
ness One way to look strong again Clinion pLm limits choice, it wasn't
as well as do the nght thing - w ould
an> more misleadingthan the average election-year spot. Inlact.the
be to embrace Sen. Daniel Patnck Moynihan s efforts to tax ammuinaiMrv - openine saKoi were rather mild, considenng that H I . \ . \
nition to help pay lor health care. The revenue raised « ould be
member are literallv struggling lor survival.
small, but the payurt in political-courage points is potentiallv huge
But Hillarv « as sman to np their heads off. Although it earned Far from being a distraction from the Clinton health plan it's a
her .i bnel rebuke Irom Bob Dole iwho is he to talk about "enemie* chance to harness some ofthe passion surrounding crime to help it
list>"•'> and the new nickname 'Shnllary." her aura on Capitol Hill
This is one ot those issues that appear more nsky than thev realh
remains mostlv intact Alter all. she srightsubstantively: the induv are When House Speaker Tom Foley u i d last week that Muym
try /io brouchi u> to the brink ot bankruptcy." it does "like being han s bullet -rontroi proposal is remote trom the health-care de
able in exclude people trom coverage. because the more the* can bate, it was Foley who lnuked remote. Emerge no-room phv siriar
exclude the more moncv they can make." No other indu-tnali/c-d aero— the countn are enraged about new kinds of ammumtioi
conntry piit>. up w ith useless paper shulflers taking such u l.iixe i ui especially the Olm Corp.'s M-mm Black Talon, that not unlv r
oi their hdlth Imdcet- She - al-u ncht politicalls: he.ilth-inMir.inii- tliruuiih ti—ne . i - never Ixlore hut endanger surgeons liiugir
i'onip.inir» I'.nik v\( n l.m cr m polU thrtn mrmlvr- ol Conere*' or sticking vour tingers inio the wiuint) made hy the- hnllr ,irepurtor- Thev 're (low n there with ii>>rd-ear dcali-r» .ii-i-urrinK to exp.ind- anil lorm- r.i/or-sharp proiectiuns Cut- will cxpo-c uM..II Civenlion;. And h i n c h t i.K tic.il111 p i C - K H I l l - p o l l t . i k i NoodlKiriK mleclion- carru-d In the sliimtin^ victim iniimii
•
i. • In i I In c i >iii|>;iiiic- li.n kiii'_ H.ii'i * .iini ln i
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�CHIC23464
0 SECOND TV
"PARTNERS IT VERSION BR
TRANSdUFT
11/2/93
FADS UP FROM BLACK
1.
EXT. CAR- HARRY * LOUISE.
HARRY ii dropping LOUISE zt the office ia tbeir hmQy car, tn Americanmade gedan. LOUISE leam over to lightly Ion him goodbye end exits the car.
HARRY:
On Saturday?
LOUISE:
O*.
HARRY:
Have a great day.
LOUISE:
Bye.
HARRY:
Bye, Honey.
DISSOLVE TO
i
�CHIC.23444
50 SECOND TV
"PARTNERS IT
TRANSCRIPT
11A03
2.
INT OITICE.
A ilgfi on « wi&dow Hides by as we move into t lotll, seat offiee lohe. Tbt
sign read* LOUISE & UBBY COMPUTER CONSULTANTS. Loaiie perts
t YOUNG MAN woridng tt i computer termfnii u she ptitei ha deik.
UBBY, t bUek veaan eboat Louise'i age speaks to her pert&cr.
UBBY,SYNCi
Louise, Can we talk for e moment.,?
3.
Laoise ttepf Iato her ofBet Libhy moves to her desk.
UBBY, SYNC!
Fm with the Pnsident on health eve for
evNyoBc.Bot these details^.
UKbj ttU oo comer of hir dttL Louse xaorei la doee,
Thty both look it hook oa Preeldcari plan.
Lovise takti tht book aad open* to a corner tuned down.
SUPER:
Frtf idtftfi BUI Tltli VI-JL.
LOUISE, SVNO
like the national health care budget? The
government sets a ceiling on spending aad
1
teyt Muf t ft.
V
1
�CHIC-23460
30 SECOND TV
TARTNERSIT
TRANSCRIPT
ll/tflS
IJBBVSYNG
I
But, what if there'i not enough money...? I
mean, whit happens then?
LOUISE, SYNC
There's gotta be a better way, libby.
4.
GRAPHIC A BETTER WAY TO REFORM I-SOO-ISS-HEALTH
ANNOUNCER, VO:
There is a better way to reform. Call this toll
free munber for the facts.
FADE TO BLACK
�CHIC-2364
30 SZCOSDTV
L
^—
J2B5 ITP 7*Q>« *toCX
XS2. IttflTHl, cawBsaivDW
HJMg&i/ ww*--— -7
vita Ijouxsa » pcj.-^—r
s i t at a ^ ^ S ^ r ^ S S l S ; ^ sister, broth«r-in-l«v
ASTHOR AND O J K ^
plater* of food ar* being
and their S ^ S ^ ^ S S S t e d carving tte turkey
and i s caxrymg tte
^
^
at tte a««eabl«d faaxiy.
3
X^a JUHt tteiDdMl v ' r . a l l
2.
tealthy.
1SCLS OS DOftOTHX
DOBOSSXt
c a l l e d t h a t 800 mnober on TV.
3.
MUISB L00X8 *0 1 » » D »
«
BIM
LOTJZSBt
And?
^
X got
s
.
idaa. ^
r
M ^ a n m .
^
v o t t
J
ffl'*
"
jcacp «7«a if ytm
^
3ob.
^ « C A L
E^aryone'a covar^i?
gat
aide,
or
�Everyone7.
1SGLH OH LOUISE
LOTH SB I
Life* the Prasidcat v&nts.
3.
AHQLS OH UtTSUIt
ABSEUR:
And this plan i s baclced ty thousands of Aaaricams l i k e your
notter and aa... and onr insurance cospany.
9.
ANGLE ON DOSOTXT
OOXOSEZ:
Sounds IDca thara i s a b a t t e r way.
10.
AHOLS OH fflPPT
HAH2Z:
Sounds li3ce I ' a going to c a l l t h a t 800 tnnnber.
7222 TO BLACK
�10/27/93
*
i::C0
OT03 207 6313
HEALTH LIN'S
NXW HIAA AO: HARRY AND LOCTISB PART I I I
Vidfto op«n« with Harry coming inro kitcban and Louis*
leaning on countar. Disclalnar at bottoa of screen: "Paid Cor
by Coalition for Health Insurance Choices. Funding by Health
Insuranca Aaaociation of America". Harry kissing Louisa: "Find
mora you liXe in tha president's plan?" Louise reading "The
Prasident's Haalth Security Plan": "Yeah." Harry: "And?"
Louise shoving Harry tha book: "Wall, i t just doesn't hava th*
choice we want. Look at this — [chyronj "President's Plan Pag*
661 the government picks health plans, than va hava to pick a
plan <*rom their l i s t . That's t&e choice va get." Harry taking
the booJc: "*hat If va don't like their choices?" Louis*
throwing book on table: " I f i t ' s not on their l i s t . . . " Harry
folding his arms on his chest: "Wall, there's got to ba a better
way."
Fade to black scraan. Voice over: "Thera i s a batter way
to reform. Call this toll-free njaber for tha facts. Call
today."
Chyron: "A Batter Way To Refona" over "1-800-285HEALTH" over tha disclaimer.
2l
0 0 2
�HIAA.23464
30 SECOND TV
"YES BUT IT
10/04/93 1045h
FADE UP FROM BLACK
1.
INT. KITCHEN.
It is eariyraon&in*HARRY and LOUISE ere back as the kitchen
table. Breakfut diihee are ipread about and they are dressed tot work.
Harry ii reading the morning paper, Lodse il engrossed in the health
care reform book published by the New York Times.
HA&RY, SYNC:
I'm glad the President's doing
something about health care reform...
LOUISE, SYNC:
He'sright.We need it
HARRY, SYNC:
Some of tbeae details...
LouiM gesturea wtth the book.
LOUISE, SYNC:
Uk* a ntdooal limit on health care?
HARRY, SYNC:
Really.
2.
REVERSE ANGLE. OVERHEAD.
We see the book cover as Louise opens it to a page with a tuned down
comer, A Use hit been marked with a yelow high lighter.
�. ; SECOND TV
"'."SS BUT n"
10/04/93 104511
SUPER:
Rtfonn Plan Page 103.
LOUISE, OA*
The fovemme&t cape bow msch tbe
country can spend on all health care
i
and layt; "that's it!'
Barry looks ooaoerned.
HARRY, SYNC:
So what if our health plan runs out of
money?
Louise shrugs.
LOUISE, SYNC:
There's gotta be a better way.
3.
GRAPHIC. A BETTER WAY TO REFORM 1800 2&5-HEALTfL
ANNCR, V.O.
�iu,11.53
;5:.J
•BETTER WAY"
60 RADIO SPOT
WOMAN:
The Preiidem'j dfht. Amtrict wtatj hetltfa etre ccveraft that everyone hai and
everyone can keep,
ANNOUNCER:
But let'i be wre health care refonn jivw us the $ecurUy we want Thert'i a book
in the stores with all the details of tbe President^ proposal. There's a lot to
like, but also much to worry about Page 65 says everone in America would
choose from only those plans approved by the foversment.
WOMAN:
Wait, we can only choose one of the plans on their list?
ANNOUNCER:
And page 102 says the government will set a limit on what America can spend for
healthcare.
WOMAN:
So if my health care plan runs out of money I'm out of luck?
ANNOUNCER:
There is a better way to refonn. Insunnce everyone can get, everyone can aflbrd
and everyone can keep, even if they change jobs or lose their job. Por t better
way to health cart reform call 1400485-HEALTH. Call today. That's 1*800235-HBALTH. Oetthefhcts. 1.800-2«5-HEALTH. Sponsored by Coalition for
Health Insurance Choices. M^jor funding by Health Insurance Association of
America.
�COALITION FOR HEALTH INSURANCE CHOICES AD CAMPAIGN
More Facts - September 9, 1993
RHETORIC:
"This was covered under our old plan."
"Oh. yeah. Thar was a good one. wasn't it?" [Text From CHIC Ad)
REALITY:
The comprehensive benefits package is as good as those offered by many of the
Fonune 500 companies. And it includes some benefits that are rarely covered -particularly full coverage of over 70 preventive services, including Pap smears,
mammograms, and immunizations. .
No benefits that people have as of January 1. 1993 will be taken away or treated as
taxable income.
r
RHETORIC:
"The govemmenr may force us to pick from a few health plans designed by government
bureaucrats. " [Text from CHIC Ad]
REALITY:
The President's proposal builds on the employer-based system and remains rooted in
the private sector.
It will allow people to choose their own doctor and health plan - which, now. is more
and more being done by the employer. Today, only 28% of employers with fewer than
500 employees offer any choice ofhealth plan. (Foster Higgins 1992 benefits survey)
After reform. 100% of employees will have a choice ofhealth plan.
The health plans will be designed by people in the private sector, just as they are now.
Insurance companies, hospitals, and groups of doctors will likely run plans, as they do
today. And all qualified plans will be free to compete for patients in the marketplace.
�Thefirstlady's invective
against our ads is misplaced
ty Bill Oradtoon
O
n December 2.1992. tfc* bovd
of dirtcton of Ox Health
Iniurwict AiMCiition of
Ajnenct i HIAA) voted unuumoutly
to support p u u | ( of federtl Iefi5
Ution that would mike imivvntl
heilth cire coveri|e • reality.
Wiuun • dev. ranking memben of
ihe icon to-be-inaufurated Qui ton
tdministrttion. includuii Judith
Feder and Ceor|e Stephanopoulot.
pudbcly acknowledged the imporlance of the industry's in»ovau%«
nevi policies, and seemed uncondi•onail> pleased thai the industry
and the mcormng administration
had far mort in common or the subjec of health reform than anyone
nugh: hjvr previously thought
In the months that followed.
HIAA and the many companies for
wrucl: it carries the banner of responsible reform have not wavered
from the belief that every Amencan
should have affordable health insurance coverage that cannot be taken
awi> under any circumstances Yet.
in recen: ueefci several of the most
vijitle and vocal members of the
Cli.-.ior. »drr.in:s[riijons health care
reforrr. team hive attacked HIAA
ans ::s members, chiefly by eharacter.zir; .s — and frankly. 1 find this
ir.creeib.e — as opposed to reform,
i.- s-;?c::-.r.g the status quo. as
faN:'':'.i > system that permits
chern picking and the use of preex:s::.-.g cond::ion limitations to
i t - cevt-age None of these asser
:icr.t :s : r j e
F:rs: Lai Hillary Rodham Clmtor s facfja:!> groundless remarks
atjcu: heal:r. insurers.debwreddurir.; •'-t recen: annual meeting of the
AT.e::ia.- Academy of Pediatncs.
are :r.e :a!ts: manifestation of acornm-jr.ica::or.i strategy nfe with dis
icri.cr. a r ; inspired, at least in pan,
b> dales ?o:i results 1 know this because >»her, I met with senior White
Ho.st pohc;. advisor I n Magaziner
this past February, he candidly edmuted thai White House pollsters
had aJread> concluded that the ad
ministration s campaign to aell its
healtr care plan would be enhanced
b> attacks sn the insurance industry
Clean;, no ones position in the
debaie over health care refonn is in
am us* enhanced by scartershot accusations thai have no basis in fact.
The cynicism that underlies such
attacks is truK disturbing
The focus of the first lady's dia
tnbe against health insurers was a
teleMiion ad^enisement sponsored
B:: C'sd.-son is p ' t u d t m of l i e
He;.:': /rsyancr Association of
A r-:r-..-j
by the Coalition fer Health Imuran c« Choices and funded by HIAA
Thu ad (in fact, then have been two
•uch ads. and we apolofue for neithen focused on the question of per
aonal choice — in parecular choice
of health plan — under the Clinton
•dmimstnnon s approach to re
fenn.
A/ter a wortang draft of tbe Clwm plan began to circulate last August, it was clear to everyone that the
admimstnoon warned to drastically
limit the number ol haalth care
plans competing m the marketplace
Tbe limiting mechanism m queabon
was the monopotisoc (or "exclusive") health alliance, which would
alio* only a few plans to market
health inaurance products ie a given
region and unilaterally n r l u d e all
others We believed then, as w» be-
point-by-point niponae Ball of Mrs
Clinton's accuaauons against com
panics that market haalth insurance
products but one additional aspect
of her speech cannot be left un
addressed At one point, she slam. |
oted the use of utiluaoon review is :
as inaurance company -inspired con j
piracy ID keep docton from doing ,
their jobs And yet hter m her |
speech, she praised managed care. :
aayuig that "under a managed care :
fystem fer Medicaid. I had mothers :
•tiling me [that) b r the first nme
tbey had their ows doctor They had
a telephone number they could call j
They w e n ablate get good informa. ,
Don."
j
' The f i n t lady's ideologicalu contradictory stances puule me 1 think .
it s reasonable to say that Mrs Clm ;
ion knows what I and many others .
know about uulixauon review — that :
it's fundamental to managed care s
effectiveness Without it. what puts
the brakes on unneccssan care, on
the unnecessary costs from unwar
ranted tests and procedures'- Need- ,
less to say. it isnt tht insurance com
panics that denvt profits from
paying for unnceded care Instead
u s tht insurance companies that ire
called upon to pay for it
Real nform of the health care
system means that everyone — in
sunrs included — musi make seen
fices And everyone includes ever
those groups whose political anc
professional inclinations have/r.ir:
fested themselves time and again or
beve now. thai alliances are a good
Capitol Hill and in statehouset
idea but they shouldn't be monop
across the country, as opposed a:
olistic. and they shouldn't under any
en' turn to managed care and to ::s
circumstances have life-or-death
quality-enhancing and cost con
power over health plans Our two
taming elements Noi the I ear of
choice ' commercials reflected
which is utiliiauon review
these beliefs We wanted people to
Contrary to Mrs Clintons r-et
question the advisability of a system
one. the companies represeriec
under which govemmenial entities
HIAA support meanmgf ui reform, of
decided which plans consumers
tht nations health c a n system u
would haw access to.
•upponuniverial. continuous cover
It would seem that our ads were
agt for all Amenans under t pecs
even mort effective than «« might
age of comprehensix benef it •
have hoped. The administrauon
package tha: does include - in spue
blasted HIAA at every turn for proof M n . Clinton's comments to the
ducing them Yet ranking White
coeitnry — acroas the-board pre
House officials haw evidently taken
ventivt health c a n services
op
the ads simple but powerful mespose denial of coverage for presages to hean And 1 say this beexisting conditions Wc want even
cause the Clinton admuustntion r»
cently made last-minute changes u> body covered under the humane aus
ptces of a new n f o r m ed health cart
its health c a n reform bill, changes
system, one that will ulnmatetv pu:
thai would oblige alliances to accept
the health systems of all other mdus
even health plan that meets minitnalixed countnes to shame We car
mum federal standards, with some
do it. Wt Should do it But progress
limits As soor is we had the actual
toward the health care goals '-."•«'
legi station for the Clinton plan in our
HIAA shares with the edmjvu-a
hands, and saw that the White House
non
will only be promoted if political
had backed away from the idea of
rhetoric is abandoned in favor ol ar.
timiung choice by limiting the num
attitude of mutual respect 5u::
ber of plans that couid compete in a
upon a shared commitment to
given market. «« stopped running
together consiructiveh to mane
our "choice" ads Thev had clearly
A m e n d s health care system •ne
served their purpose
finest ui the worU
Space limitations don't permit a
:
Hilhry Rodham
Clinton^ factually
groundless remarks
are the latest
manifestation of a
communications
strategyrifewith
distortion.
(
�HIAA RADIO AD - OCTOBER 8, 1993
RHETORIC: "There's a book in the stores with all the details of the President's proposal "
REALITY:
This is an unauthorized publication of an early draft ofthe President's plan.
The plan has changed since that draft as a result of conversations with
members of Congress, outside groups, and the American people.
RHETORIC.
"Page 65 says everyone in A merica would choose from only those plans
approved by the government. "
REALITY:
Consumers can choose any plan that meets basic quality standards, offers a
comprehensive benefits package, and agrees to cover all who apply, regardless
of health status.
RHETORIC. "Page 102 say s the government will set a limit on what every one can spend for
health care "
REALITY:
There is no limit on how much people can spend on health care. It's not the
government's place to tell people what to do with their after-tax dollars.
There is a limit, however, on how much the insurance companies can raise
your premiums.
�BC-HEALTH-EDITORIAL op-ed editors
' •( •
Huckster H i l l a r y
Knight-Ridder/Tribune News Service
'c)l993, The Orange County Register
The following • d i t o r i a l appeared in The Orange County Register on
Wednesday, 11-3.
XXX
F i r s t Lady H i l l a r y Rodham Clinton's nostalgia-inducing attack on the
health-insurance industry ah, remember the v i s c e r a l l y a n t i - c a p i t a l i s t
rhetoric of the •60s radicals, back when Mrs. Clinton's p o l i t i c a l views were
formed and apparently set in stone? should remind us that when you
p o l i t i c i z e some aspect of l i f e , you set the stage for ill-tempered
confrontations and accusations. I f you want more finger-pointing and
ill-tempered accusations, you'll love the Cinton health plan.
But the accusation of greed and profiteering on the part of insurance
companies p a r t i c u l a r l y i s inappropriate coming from Mrs. Clinton. As Business
Weekpointed out in i t s Nov. 1 issue, the f i r s t lady has arranged her own
investment portfolio so as to profit, as the magazine put i t , "from the pain
her proposals are i n f l i c t i n g on health-care stocks, which have plummeted in
1993."
Mrs. Clinton has about $100,000 in Valuepartners I Fund, which has
a stake in the decline of health-care stocks. As Business Week put i t ,
*"Valuepartners i s a hedge fund, which means i t regularly shorts stocks. So
the more Clinton's proposals drive down health-care stock prices, the more
she prospers. And the fund was up 14 percent for the f i r s t eight months of
the year, says another investor in i t . This performance i s almost twice as
good as that of the S&P 500 index.••
Mrs. Clinton claims not to have known of the fund's health-care holdings
.1 the f i r s t couple f i l e d a financial disclosure. An aide said no conflict
c_ interest exists because she's a policy planner making broad proposals, not
a regulator with day-to-day power over individual firms.
That's disingenuous, at best. And Mrs. Clinton's attack on an industry
apparently provoked by some sectors of the industry having the effrontery to
pay for TV ads questioning the wisdom of a plan calculated to put many of them
out of business r a i s e s serious questions about her a b i l i t y to be
disinterested and dispassionate in shaping broad policy.
The f i r s t lady apparently has a v i s c e r a l , emotional d i s l i k e of insurance
companies. And she has positioned herself to profit when she uses her bully
pulpit to attack them.
A l l t h i s overheated rhetoric i s the predictable r e s u l t of any ambitious
attempt at further government control (and further p o l i t i c i z a t i o n ) of an
industry. The ads were sponsored by the Health Insurance Association of
America, which represents small- to medium-sized companies. Most analysts
believe that i f the Clinton plan i s adopted, the mandatory government
bargaining agents i t envisions w i l l favor a few large companies, forcing most
of the 1,500 smaller companies offering health insurance out of business;
indeed. President Clinton hinted that such a ^consolidation'* would be
desirable in h i s health-care speech. So these companies l i t e r a l l y are
fighting for their l i v e s .
And Mrs. Clinton i s fighting for her p o l i t i c a l l i f e , with polls showing
big declines in public support for the Clinton health-care mandates. So expect
more rhetorical o v e r k i l l .
Orange County Register
****
f i l e d by:KR-F(—)
on 11/03/93 at 08:05EST ****
**** printed by:WHPR(MMIL) on 11/03/93 at 09:15EST ****
�MICHAEL KINSLEY
DATE:
TIME:
PLACE:
PARTICIPANTS:
STAFF:
February 23, 1994
12:30 PM
3326 Treasury (Altman's office)
Roger Altman
Michael Kinsley
Paul and/or Christine
BACKGROUND
As you know, this is one of a series of meetings coming out of the First Lady's
office to influence and educate pundits who might be able to help our plan.
In this week's New Republic, Kinsley pretty much stays on our message,, beating
back the assertion that doctors will be thrown in jail for treating patients and
explaining the rationale behind the alliances. One point he raises that you might
want to take up with him is the supposed bureaucratic complexity involved in
community rating. He maintains that "the dirty secret of all those from Clinton on
right who oppose a Canadian-style single payer system is that insurance
'community rating'...essentially socializes health care costs and will require
tremendous new government involvement no matter how it is done." You could
make two points on this regard:
First: The Clinton plan involves minimal government intervention, alliances
have no regulatory powers, etc. Individual mandate bills would require a
much larger expansion of government powers.
Second: You might warn him against using the word "socialized" — the
President specifically rejected socialized medicine. Two thirds of health care
costs after reform will come from the private sector (businesses and
households) — just as they do today.
As you also know, Kinsley was one of our chief defenders on the McCaughey piece,
exploring the similarity of the utilization review requirement to current HMO's
(although I would not bring up the McCaughey situation unless asked). [By the
way, the unequivocal message from the war room is to do nothing on McCaughey
but have a surrogate, like Laura Quinn, challenge her.]
KEY MESSAGES
Lorrie M. suggested that you stick with the message of the Friday NY meetings:
Provide basic information about the plan and dispel the fears generated by the
opposition.
�It would be interesting to explore off the record how Kinsley thinks the fears and
misinformation about the plan have spread. Maybe throw a hypothetical question
at him: "If you were the White House health care communications director, what
would be the three things you would do to counter all of the fear and
misinformation on 1) choice of doctors and 2) bureaucracy?"
ATTACHMENTS
"Mad Social Scientists" by Kinsley in this weeks NR (2/28/94)
"Health Care Nonsense" by Kinsley in Post (1/27/94)
Response to McCaughey piece
Top 5 lies
�FROM WASHINGTON
it better than he did), the reason has to
do with the problem ofrisk-sharing.One
goal of every health reform plan, including the most conservative and "marketoriented," is to end the insurance industry practice of charging more to people
who are more likely to get sick, or are
already sick: older people and those with
"pre-existing conditions." Magaziner
calls this "discrimination," but it's really
just rational business practice unless forbidden by the government. The classic
purpose of private insurance of all sorts
is to insure against unknownrisks,not
against known ones. Absent government
regulation forcing all insurers to do the
same, charging bad risks the same as
goodrisksi* a recipe.for bankruptcy. .t But, "commuriitT' ratings as^it'i
callid^-jprdering insurance companies to charge everyone the
same for health insurance,
no matter what his or her
individualrisk—is&nbla^?|
simple matter,, though you
wouid'not know this from
some Republicans who
present it as a painless
cure-all. It requires not just
rules against price discrimination, which are fairly simple,
but rules to prevent insurance companies from discriminating against customers who are likely to prove expensive,
which are much more complex and hard
to enforce. Ordered by the government
to charge both of them the same, it will
be a remarkably saindy insurance company that is not tempted to make a
healthy potential customer feel more
welcome than a sick one.
his alliances are the best way to solve this
problem. But he isrightthat there is no
"simple" solution, and those who sav ihat
minor insurance reforms can straighten everything out are either ignorant
or dishonest. The.dirty secret of all.those^
from Clinton on nghrwho^ opgoje^,^
Canadian^tyie single-payer^ system^ is.
thatiftsurance^cq^
bouom-line .. reform newly^je^one/
Mwgpwurnmept involvement no nutter <
h«#Ttirdohe?
As for George Will's fifteen years in jail
for bribery, Magaziner savs this applies
only to outright insurance fraud. If a
Patient and a doctor collude to bill .in
insurance company for a procedure that
isn't covered, by purposely mislabeling it as one that is covere,d,^
aplicaced and intrusive:
they go to the slammer. F j f j ^
Why, for example, must virtually everytwp yearirseems a. bit, stiff
one join one of these "alliance" chingies?
but of ^course that's ^tlie
And what is this business George Will was
fashion these days.
going on about in S'rwsu/eek recendy? "It
would be illegal," Will wrote, "for doctors
It would not be "illegal
to accept money dirccdy from patients,
for doctors to accept monand there would be fifteen-year jail terms
ey dirccdy from patients.'
for people driven to bribery for care they
First, anyone would be free
feel they need but the government does
to go outside the system and
not deem necessary.'" Sounds scary.
pay any doctor any amount for
any service. Second, many insurAfter all, as the skeptics point out. a
ance plans would involve partial colarge majority of Americans currently
payments by patients, as they do now.
have health insurance thev're satisfied
What would be illegal is for docton to sav.
with. Without a clearer explanation than
"I'll treat you, but only if you pay me
has been supplied so far, it is perfecdy
more than the agreed-upon co-payment.
reasonable to wonder why this majority's
This is, fint of all. a matter once again of
current arrangements must be unsetded.
insurance fraud. If docton have agreed
Why isn't it enough simply to reform the
to accept a set fee schedule with a set coinsurance market so that people can't
payment, they should stick to it.
lose their coverage, and to create a much
smaller program to help the uninsured?
More generally, this rule addresses the
And even if insurance companies
Are the Clintons just mad social scien- don't discriminate, the luck of the draw problem of controlling costs in an industists, experimenting needlessly on the means that some of them will end up try where insurance coven all or most of
body politic?
with a worseriskpool than othen. That is the cost of individual services. For years
The answer is that the complications why "community rating" also requires Medicare paid 80 percent of a set docare inevitable. Perhaps not these exact complex procedures for assessing indi- tor's fee, but docton werefreeto charge
complications, but either these or others vidualrisks,and for redistributing funds patients more than just the remaining
among insurance companies to level the 20 percent Inevitably, the fact that fourthat would arguably be worse.
fifths of the basic charge was seemingly
Take those alliances. Their purpose is playing field.
twofold: to hold down health care costs
Magaziner maintains that if almost "free" enabled docton to charge a lot
through market compeution by giving everybody acquires insurance through more than they otherwise could if Medibuyers more leverage, and to help end these large regional alliances of his, the care weren't there. This becamtfjjfc±iuge
price discrimination against individuals task of equalizing insurance costs beand small businesses by putting them comes much simpler and requires less
into pools as large as the largest compa- intrusive regulation, not more. The gennies. But if the alliances are such a won- eral point is that largerriskpools equalderful idea, why must folks be forced ize costs automatically. If the alliances are
There are alternatives to managed
into them? Under the Clinton plan, only strictly voluntary, groups of low-risk competition, such as Senator Phil
companies with more than 5,000 employ- (younger, healthier) people will form Gramm's scheme to encourage people to
ees are exempt. Representative Jim outside of them and negotiate preferen- go without insurance for all but "catasCooper's plan exempts all companies tial rates. If there are hundreds of insur- trophic" medical expenses. But if you
with more than 100 employees. Most ance companies making separate ar- want basic medical insurance to survive,
rival plans simply allow companies and rangements with thousands of compa- and if you want more market discipline
other groups to form buying pools if they nies and millions of individuals, the task on cosu in the health care industry, rules
wish, and leave it at that. Why are Clin- of leveling the playingfieldamong cus- like this one are essential.
ton's mandatory?
tomers and companies becomes inNext question?
As explained by Clinton's health care finitely more complicated.
guru Ira Magaziner (and I'm explaining
Magaziner may berightor wrong that
Mad social scientists?
8 THE NEW REPUBLIC FEBRUARY n, 19M
t
�George F. WW
Michael Kinsley
Gatekeeper Moyn
Health Care Nonse]
Like the Ronua god Janus from
whom this month gets iu name, the
Clinton administntion is looking in two
directions. One is represented by iu
suddenly intense concern with dime,
the other by iu bizarre health care
refonn bill. The former repteaenu a
tendency that could consolidate a Democratic presidential era. The Utter
could transform Clinton's presidency
into a reprise of Carter's presidency, a
brief interiude in a Republican en.
Clinton's administration has not
been nearly as liberal in iU results—iU
aspirations are another matter—as
Congress has
restricted Ointon to
a watery liberalism.
i
i
any conservatives feared and some secretfy hoped. However, the health care
plan, with iU gargantuan bureaucraaes
rabonag everything frocn medicine to
medical students, is a caricature ol
coerave snd hubrisbc liberalism, and it
can crysuUtxe a lethal perception of
this presidency. But one man can save
ClintonfromClinton's pet project: SCIL
Pat Moymhan, chairman of the Finance
Committee.
To fathom the importance of Cbnton't sesxure of tbe crime issue, consider some history. Tbe Democratic Party, advocate ol an energetic federal
government, surrendered the presidency m January 1969. The Demoaau
reacquired it far only four yean ia
January 1977, and did so with a man
who ran against Washington and was
the most conservative Democrat elected president smoe Grover OeveUod in
1892. So when, last Januuy. the liberal
partyreoccupiedthe presidency after,
effectively, 24 yean, many conservatives antidpated a government extravagant in both asptfatioos and expenditures.
But Congress, by imposing spending
limiu as a price of passing Clinton's
budget, has restricted Omton to a
watery liberalism. And now, by his
embrace ol the crime issue, be has
awakened echoes of an old argument in
the Deroocntjc Party.
In 1970 two "Jackson Democnu"—
the label then referred to Sen. Henry
"Scoop* Jackson, around whom moderate Democnu nlbrrt puMiihed a
book to warn thetr party of a precipice
ahead. In The Real Majority' Richard
Scammon and Ben Wattenberg warned
that "social issues* such as crane were
acqianng a sahenry comparable to ecomtnic concerns, and that the phrase
Taw and order" should not be disdained
by liberals aa racist "code words.*
In February 1968. at the beginning
of the Niaon campaign that began the
en ci Republican victoriea in Gve ol aa
preudentuj elections, a Gallup poO had
A screed against the Clinton health bought and often insurance paid, with
asked "Is there any area around
here—that is. within a mile—where care refonn plan in last week's New regard to price. These monopoly pre
you would be afraid to walk alone at Republic suggests that one of the hor- provided both the incentive and
night'" The "yes" response was: men ton awaiting us if Bill and Hillary get capital for lavish drug research,
their way ia something called "utiliation form—any refonn—will reduce this
19 percent, women 5^) percent
Scammon and Wattenberg saw the review." This is a system whereby doc- search.
ton must get
social dynamite: i
The Wall Street Journal editorial p
clearance from fires a shot at the Clinton plan abn
Half of America's
some central au- every day. One recent salvo, tit
husbands had
T» t »
thority before per- "Price al Managed Care." waa ab
wives afraid to go
11
fonrang a test or how healthroamtenanceorganizati
out at night In
l|
treatment on a p^ harm theff pstimta by skimping
1992—11 federal
|
,
bent
testa. The article died without iron
crime bills lath so happens "near-docen malpractice spedabsts,"
er—the "yes" reJ 91 »
that the New Re- ol whom warned that inadequate test
sponse to Gal_
public's own ia rife at HMOs.
lup's question " • ^ J ^ * ^ * *
besttb cuv pbfl
Why do I aay "without irony? I
was: Men 29 perlot which I am a cause the WaO Street Journal has bt
cent, women 59
jfaryean against excess
percent
tensive "iititiiarinn
of medal malpncticf
A genention
review." Along deed ns^nctioe nlorm is the cent
has passed since
with heakh main- piece of the JoureaTa own health a
Scammon and
Wattenberg explained that the avenge tenance mgauiotjons, generic drag rfr vision. It has been the Journal's poshi
voter was saying he did not expect quiremenu and so on. ^ttihuOQn re- that—thanks to "malpnctice sped
politicians to solve all such probiems, view" is one of the devdopmenu rapidly iati*—we give too many tests, th
"But I do expect that )ny politician I spreading—far good or iB—wder our drivmg up costs. 01 coune maipract
lawsuiu occur only when the failure
vote for will Ar ON IW sid*.' Today current health care system, h is one give a teat turns out badly—when
TCSSOO
hdttb
cost
lofls&oo
fass
sfaitcd
Clinton is using the crime issue to send
MRI far a headache would have cauj
to middle America an "I'm on your so druniUafly, iflowng Chttod't critside" signal, the sort of signal his cam- ia to amrt that tbere • oo "aim."
infer Jminial style heahh care refor
CJiutoo's bctltb C M piflQ is fo
paign sent by using two issues that
aiiwikiteafitetfaue wiD mease.
^u^pp^trftj wbco tbc cuopu^pi coded* perfect But it is pointless to
the Chntan plan with tome
The deasion not to perform an M
Those two issues we^e the middle- version of the daasic American lyatem. even when there ia a one-in-i-cailli
clasa tax cut and "ending welfare as we in which yon can go to any doctor you
cbSBGB otfiodhofA tSBOOtt
in c£ft
know it,* meanmg a maximum ol two want who can perform any treatment health care rationing. Any health a
yean on welfare and,then a work he want*, order any test she wants, ayitett dffinea an appiopt'iate stands
requirement The patent insincerity ol presoribe any drug he waoti and fhary at care, if only through the tort la*
his tax promise haa increaaed the polit- whatever she wants, aO pad far by and any such standard weighs a
ical importance of his promise of wei- msunnce. That system ii <haappHnD^ agaawt dbaace ol aurceaa What ia ma
£w refonn* Hcocc the yr^p^^^nc^ of whatever we do. The ssportant compar- any retem of Amenca's system • be
the Moymhan factor.
isons are of Clinton's system with
^naifartHMMUt<d" or otherwise—»
Moynihan'a chairmanship makes him system as it actually wtB wort with no take a more stringent view of the co
a gatekeeper for both health care re- reform, and as it wiD work under rifil betiHit tiade off than the never-oew
form and welfare reform. So he is in a refonn pbna.
tand system we have now.
position to impoae sobriety on the for- The Cbntontes insist that their reEven wtthotft leftam, market fore
mer while insisting that the latter pro- form would reduce, not un icaae, cum- are already driving Americans by t
ceed. That is why Moyilihan is some- benome "uTibonoQ leviev" reQuir^ nrifinriB nto managed care arran),
thing that almost no Democrat in menu. Could be. But it is daractenabc itifnti Tree-maiket" style reforms t
Washington haa been for a genentioa: ot Clinton's sales tednique that ba ing puafaed by cooaervatrve Republic
He is dangerous to Republican presi- would rather insist that his modet'a tires wifl only speed this development So
dential aspintkms. If he can make never goflatthan point out that rival bold out managed care as a great bnt
health care reform less grandiose and models getflattires toa
boo ot the Clinton refonn plan ia absu
threatening, and can make welfare reConsemtrves and Republicans into
Take another example. There
form a (act he will be as disorienting been much «gF»*«« on the T t r ^ n
that there ia "no health care a m
to, and disarming ci. Republicans re- bow Onton's plan will afiect
Meanwhile, their own "mminutat" i
garding domestic policy as the end of research, especially the
farm plans would constitute the bigg
the Cold War haa been to Republicans new drugs. High drag prices, hi^i |
new sodal welfare program since ti
regardingforeignpolicy.
charged by teaching hnsptfabfarordi- Great Society, and the biggeat gom
There is nice symmetry in this. In nary medical services and special Medi- meat intrusion into the workings
1976, when Moymhanfintran for the care payments afl sutMifas nwdiral
private industry since Nino's wage ai
Senate, be wu a "Jackson DemocnC search, and afl wS be squeeted under price cuntiuta.
supporting Scoop Jackson in that year's the Omton plan. But afl wt be aqueead
The coma* debate is not about
primaries. Eighteen yean later, that under any reform to oootnl mrdk'il free market" vs. "soaata&Tforheal
good man's influence ia still felt
exists. In fact, the more 'taartatarieflt- care, or about wikmited freedom
As for Ointon. there is this seasonal ed" i d leas "gwennnent-mwiaterf* a choose your own doctor and treatme
thought as his radical health care pro- reform is, the more lisdy it is to root vs. rrginwtitatiop and nooning. It
about (IdTnrnt degrees and styles
posal undermines his program to coo- out these axfireet aubaidiea.
vmc* the public that liberalism is palatUnder the old tyatesu, drag compa- gu¥enuttent uivolvemeot in heslth car
able. It is commonfara politician to be met were i m to IDMC WIB wonopaKj and about the best way to impose hmi
pulled in two directions at once, but to profit! hfynnd tte Ifjpfimtg inonop^ on our lieallh care appetites that a
move in opposite directions sonuftap^vfits thev pateBts eotided them nevttabte n any event
neoualy mvnes compariaon with the to—because urillwi price MBHirtiUuu
Are we capabie of having tuch
familiar maak ol Janus, which is two- nor gtwenanent cuwtiuia impueed any debate?
iraiiaa< Docton prescribed, petifKa
faced.
©ISKUrVTWMrrl
M
|
t
�NO TRUTH:
TALKING POINTS ON "NO E X I T THE NEW REPUBLIC ARTICLE
The New Republic should be ashamed of itself. This is one ofthe clearest examples of
irresponsible journalism seen so far in the health care debate. Elizabeth
McCaughey's February Tth "No Exit" cover story -- touted by The New Republic as
"What The Clinton Plan Will Do For You" •- was full of lies, factual inaccuracies, and
willful distortions of the President's Health Security Act.
McCaughey's article is factually incorrect and obviously diminishes her credibility as
a journalist and the integrity of The New Republic editors that were willing to
publish an article full of inaccuracies and distortions. It's clear that the publication
made no attempt - even cursory - to check the facts in this biased article. For
example, in the 9 sentences ofthe first paragraph, 5 are direct lies, and 2 are dear
misrepresentations. Ms. McCaughey and The New Republic were obviously more
intent on scaring the American public than providing the "straight story" they claim.
And that is the real problem with this kind of irresponsible journalism - its
consequences extend far beyond the pages of a single article in a single magazine.
From now on, Ms. McCaughey's article becomes a legitimate source for opponents of
reform to use in a critique of the President's plan. They've got cover for their
criticisms of the Health Security Act. These lies and distortions feed on each other
and, unfortunately for those interested in a substantive debate on health care reform,
they can have a serious impact on the future ofhealth care in America.
Case in point: millions of Americans watched Bob Dole on television after the State of
the Union, making a number of points very similar to the lies in this article. I f
anyone asks him about his sources, he's covered by Ms. McCaughey. An advance copy
of the article was obviously given to the "Project for the Republican Future" which is
already running a TV ad citing it. For the next year, you can expect to hear everyone
from insurance industry executives to members of Congress to pharmaceutical
manufacturers refer to this article to back up their attacks. All because 1 writer was
willing to write and 1 magazine was willing to print lies and distortions.
New Republic writer Michael Kinsley further criticized the article asserting that: "It
is pointless to compare the Clinton plan with some idealized version of the classic
American system... The important comparisons are of Clinton's system with the
system as it actually will work with no reform, and as it will work under rival reform
plans." ["Health Care Nonsense", The Washington Post. 1/27/94]
The New Republic should retract the article -- or, at the very least, issue a public
statement that their article contained many distortions of the Clinton plan.
�NEW REPUBLIC ARTICLE: TOP LIES
LIE:
"Escaping the system and paying out-of-pocket to see a specialist for the tests
and treatment you think you need will be almost impossible.'
TRUTH: Under the Act, you can pay "out-of-pocket" for anything you want at any time,
to any physician or hospital willing to treat you.
LIE:
"Under the bill, a National Health Board... will decide how much the nation
can spend on health care beginning in 1996.
TRUTH: The Health Security Act makes no attempt to "decide how much the nation can
spend on health care" and specifically rejected the idea of global budgets or
price controls.
LIE:
"What most of us call fee-for-service (choose your own doctor) will be difficult to
buy."
TRUTH: To the contrary, the Act preserves fee-for-service arrangements by requiring
all alliances to offer at least 1 fee-for-service plan.
LIE:
"Price controls on doctors' fees and other regulations will push doctors.."
TRUTH: There are no price controls in the President's plan.
LIE:
The Act "... expressly includes futilization review] as a requirement for
doctors treating patients with fee for service insurance as well."
TRUTH: Utilization review is but one option they are expressly permitted, not required,
to do.
LIE:
"Doctors in training will be assigned to the coveted specialty programs based
partially on race and ethnicity...."
TRUTH: This is ridiculous. No physician or medical student is "assigned" to any
specialty or told what type of medicine they can practice.
LIE:
If a producer balks at paying the rebate, the Secretary can ^blacklist' the drug,
striking it from the list of medications eligible for Medicare reimbursement."
TRUTH: There's no blacklist. Contrary to the implication deliberately spread by
using quotations around the word - "blacklist" doesn't even appear in the bill.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Analyzed below are all statements made in the "No Exit" article where the author
referenced a specific page in the Health Security Act. An analysis of this article
leads to this conclusion: not one statement she makes referencing a
particular page o f t h e text is entirely accurate. Some are distortions and
misleading portrayals of elements of the Act. Others are outright lies.
ARTICLE:
"The bill guarantees you a package of medical services but you can't
have them unless ihey are deemed 'necessary and appropriate.'"
FACT:
Very misleading. Today, insurers can decide that procedures,
treatments, etc., are inappropriate or unnecessary. No insurance plan
guarantees you the right to unnecessary or inappropriate care. To
imply that such decisions are made only by doctors and individuals
today is deliberately misleading, at best. Under reform, most such
decisions will be made by patients and their doctors. In fact, the
Health Security Act gives consumers more guidance and more rights
about what is necessary and appropriate.
In addition, the Act does not, as the statement implies, forbid a plan
from delivering services -- even if it does consider them not necessary
or inappropriate. I t says they may do so. And under the Act you have
clear means of immediate appeal should you feel you deserve different
or additional care -- a guarantee that rarely exists today.
Most importantly, the bill (page 15-16) specifically states that
"Nothing in this Act shall be construed as prohibiting the following: (1)
An individual from purchasing any health care services." There is
nothing in the Act to prohibit anv individual from going to anv doctor
and paying, with their own funds, for anv service. There are also no
restrictions on the purchase of supplemental insurance.
ARTICLE:
"That decision (whether or not care is necessary or appropriate) will be
made by the government, not by you or your doctor."
FACT:
Untrue. I f anything, the "necessary and appropriate" care provision in
the bill delegates authority to the medical profession rather than
imposing further government bureaucracy between the patient and the
doctor. For most people today, their insurance company, not their
doctor, has final authority over what is necessary, appropriate and
therefore reimbursable. Today, insurers can decide that procedures,
treatments, etc., are inappropriate or unnecessary. No insurance plan
guarantees you the right to unnecessary or inappropriate care.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 2
Michael Kinsley criticized this article, saying: "It is pointless to
compare the Clinton plan with some idealized version ofthe classic
American system, in which you can go to any doctor you want, who can
perform any treatment he wants, order any test she wants, prescribe
any drug he wants, and charge whatever she wants, all paid for by
insurance." ["Health Care Nonsense", The Washington Poet. 1/27/94]
Under reform, most such decisions will be made by patients and their
doctors. The National Board has the authority to issue guidelines
relating to what is necessary and appropriate. The authority to issue
these guidelines does not infer that there are no options left to
physicians and patients, only that a benefits package guaranteed to all
Americans must be consistently defined across states.
Guidelines that are developed by the Board will be developed in an
open hearings process in which all interested parties can have input.
Regulations used by insurance companies today are developed by the
companies as those companies see fit.
ARTICLE:
"Escaping the system and paying out-of-pocket to see a specialist for the
tests and treatment you think you need will be almost impossible."
FACT:
This is a blatant lie. Under the Act, you can pay "out-of-pocket"
for anything you want at any time, to any physician or hospital
willing to treat you.
However, we should stress that, under reform, i t is very unlikely that
individuals will have to pay for such treatment. Every plan, even the
most structured HMO, must offer at the very least a point-of-service
option which enables you to go see a physician of your choice at any
time. In some plans you may have to pay somewhat more to do this,
but it is always an option, unlike today and unlike the alternative plan
(Cooper) endorsed by The New Republic.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 3
ARTICLE:
"If you walk into a doctor's office and ask for treatment for an illness
you must show proof that you are enrolled in one ofthe health plans
offered by tlie government. The doctor can be paid only by the plan, not
by you."
FACT:
False. You do not have to be enrolled in a plan to be treated. If you go
to a doctor and are not enrolled in a plan, the doctor will treat you. You
will then be given information on available plans and you may choose
any plan you want. The plan you choose then pays the physician. The
purpose of this provision is to assist all individuals in enrolling in a
plan.
However, as noted above, an individual may pay any doctor
any price for any service outside the comprehensive package
of services offered as part of a plan. So i f an individual wants to
go to a doctor and pay the doctor they can.
ARTICLE:
"The bill requires the doctor to report your visit to a national data bank
containing the medical histories of all Americans."
FACT:
Not true. The veryfirstprovision of this section ofthe Act states: "The
information system must be consistent with privacy security standards
in the Act." Physicians may be required to submit data on outcomes,
treatments, etc. for the purpose of improving quality and assessing
treatments and outcomes. But the Act very specifically prevents
against tying this data to specific individuals.
Sections 5101 and 5102 spell out detailed protections that assure that
patient records and individual health data are strictly protected.
Therefore, the implication that an individual's medical records will be
in a national data bank and that those records can be accessed by all
kinds of other agencies, individuals, etc., is patently untrue.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 4
ARTICLE:
If you work for a company with fewer than 5000 workers you "must
enroll in one ofthe limited number ofhealth plans offered by the
regional alliance where you live."
FACT:
Misleading. These individuals choose a health plan from the regional
alliance bargaining on their behalf. But i t is clearly misleading to
assume there w i l l be a l i m i t e d " number of plans offered by the
alliances. In contrast, the alliance is obliged to offer all plans
certified by the state, including at least one traditional "fee-for-service"
plan. The only exception is that an alliance may decide not to offer a
plan than charges 120% or more ofthe average premium cost in the
region.
For example, one of the real world models of an alliance - the
California Public Employees Retirement System -- offers its members a
choice of 24 different plans and individuals choose a personal
physician in the plan. And more than 2/3 of the members are so
satisfied with their plan that they would recommend it to a friend.
This is a big difference from today's system in which the great majority
of Americans face a very limited choice ofhealth plans. About 50% of
Americans insured through their employer have only one or two
options ofhealth plans. The great majority of Americans will have
more choice in the alliance system.
ARTICLE:
"Under the bill, a National Health Board... will decide how much the
nation can spend on health care beginning in 1996."
FACT:
This is untrue. The Health Security Act makes no attempt to "decide
how much the nation can spend on health care" and specifically
rejected the idea of global budgets or arbitrary price controls. The
National Board is only authorized to set the initial premium targets -•
the rates at which health insurance premiums (for the comprehensive
benefits package) ngt national health expenditures may increase from
year to year. These premium targets are important guarantee to
American taxpayers and businesses who are being asked to contribute
to their health care that their premiums will not continue to spiral out
of control, as they have done for years. There are no restrictions i n
the Act on the amount of money that may be spent by people
with their own funds for additional services or supplemental
insurance policies.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 5
ARTICLE:
"The bill outlaws plans that would cause a region to exceed its budget
or that cost 20 percent more than the average plan."
FACT:
Wrong again. No plan is "outlawed." The premium limit does not
preclude any plan from participating. The alliance has the option (not
the requirement) to refuse to contract with a plan charging more than
20% over the average premium (so that people have a safeguard
against insurance company price inflation).
ARTICLE:
"Even the bill's authors anticipate that restricting the dollars available
for health care in the teeth of these trends will produce grave shortages;
the bill provides that when medical needs outpace the budget and
premium money runs low, state governments and insurers must make
^automatic, mandatory, nondiscretionary' reductions inpayments to
doctors nurses and hospitals to assure that expenditures will not exceed
budget."
FACT:
This is misleading. The author here is clearly implying that such
a mechanism exists i n the main proposal — i t does not. The
section the author is quoting from here refers to states that choose to
form single payer systems, not from the description ofthe primary
system advocated in the plan. Virtually all single payer systems work
in this manner, adjusting payments to providers to make certain
budgets are met.
Even with regard to single payer systems, there is absolutely no
indication in the plan that the bill's authors are anticipating "grave
shortages." This is responsible legislation; the plan merely spells out,
in this special case, the mechanism by which a single payer system
would meet targets i f expenditures were running ahead of anticipated
costs. To spell out such a mechanism is hardly an admission that
"grave shortages" are expected.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 6
ARTICLE:
"Above a threshold level of quality, alliance officials will approve
health plans based on lowest cost, not highest quality."
FACT:
Not true. In contrast, the alliance is obliged to offer all plans certified
by the state, including at least one traditional "fee-for-service" plan.
The only exception is that an alliance may decide not to offer a plan
than charges 120% or more ofthe average premium cost in the region.
They are not required to do this however.
ARTICLE:
"What most of us call fee-for-service (choose your own doctor) will be
difficult to buy."
FACT:
Another lie. To the contrary, the Health Security Act preserves fee-forservice arrangements by requiring all alliances to offer at least one feefor-service plan. Today, more and more Americans cannot choose a fee
for service plan because their employers have chosen not to offer that
option. Recent reports have shown that"... a growing number of
employers have abandoned traditional indemnity [fee-for-service]plans
entirely. I n fact, more employers now offer managed care plans than
offer traditional indemnity plans." In fact, in 1988 , 89% of employers
offered fee-for-service plans but, by 1993, this number had dropped to
65%. ["1992 Health Care Benefits Survey', Foster Higgins, 1992; "Health Benefits
in 1993", KPMG Peat Marwick]
ARTICLE:
"Price controls on doctors' fees and other regulations will push
doctors.."
FACT:
Yet another lie. There are no price controls in the President's plan.
Price controls -- calling for government micro-management of every
health care service, doctor's fee, drug technology, and product -- were
considered and specifically rejected. The Health Security Act does have
-- as a backup mechanism for cost control -- a limit on how much
insurance premiums can increase every year. This is an important
guarantee. If employers are to be told they have the responsibility to
contribute to coverage -- and if the federal government is going to
provide discounts to small businesses and low-income individuals -then American businesses and families deserve the guarantee that
their premiums, and government spending, won't continue to rise
unchecked, [more]
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 7
Since, the federal government won't make market decisions on specific
prices; health plans will have to decide themselves how to become
more efficient in a way that won't drive consumers to another plan. As
Stephen Zuckerman and Jack Hadley, two leading health policy
analysts, wrote in support of the plan's premium limits, "it seems far
preferable that insurance companies that are responsible to their
subscribers make these decisions than having the federal government
involved in detailed price negotiations and review procedures with
individual hospitals and physicians." ["Clinton's Cost Controls Can Work",
Washington Post. 11/7/93]
ARTICLE:
"The bill limits what health plans can pay physicians and prohibits
patients from paying their doctors directly."
FACT:
False. Any health plan that pays physicians according to their own
contracts may pay those physicians anything they like. The bill only
tells most health plans what to pay physicians with whom i t has no
contract. These fees apply to fee-for-service plans and for charges
when individuals go out of the plans' network of doctors.
It is not clear why a patient would want to pay a doctor "directly," for
services that their insurance company is obligated to pay. I f the
implication is that individuals cannot go to any doctor and pay
for whatever they want, that is false. Their right to do so is
expressly protected.
ARTICLE:
"The Clinton bill calls utilization review a 'reasonable restriction'on
patient care and expressly includes it as a requirement for doctors
treating patients with fee for service insurance as well."
FACT:
This is a lie. The plan does not "require" fee for service insurers to use
utilization review. It says they may do so. The purpose is to define
what fee for service insurers -- who have no contracts with the
physicians they are paying -- may do in assessing charges.
Utilization review is one option they are expressly permitted,
not required, to do. [more]
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
PageS
In reality, the bill is just following common practice here,
acknowledging the typical practice of utilization review in fee for
service plans. If the author is implying that many Americans are
enrolled in plans where there is no review by the insurer, she is being
deliberately misleading. As Michael Kinsley said, "It so happens that
the New Republic's own fiealth care plan (of which I am a member) has
extensive "utilization review.'... Utilization review is one ofthe
developments rapidly spreading - for good or ill - under our current
health care system. It is one reason fiealth cost inflation has abated so
dramatically . . . " ["Heahh Care Nonsense", The Washington Post. 1/27/94]
ARTICLE:
"Some states recently have enacted laws to safeguard choices patients
want to make for themselves, such as which hospital or pharmacy to
use. HMOs protest that these laws hobble cost containment, and the
Clinton administration apparently agrees. The Clinton bill pre-empts
state laws protecting patient choice."
FACT:
Deliberately inaccurate. The Act guarantees all individuals full choice
by giving everyone the option many don't have today - access to a fee
for service plan in which they can choose any provider. The Act also
mandates that all HMO's and other managed care plans offer a pointof-service option in which individuals have a right to see any doctor
outside of their plan or its network. This, again, is far greater choice
than many individuals have today. In fact, current trends are towards
declining numbers of individuals in fee for service plans and therefore
fewer choice of doctors.
Most of the relevant laws that are being "pre-empted" are not geared to
protecting patient choice - which is fully protected and expanded in
the Act -- but to protect providersfiromprice competition and other
pressures of managed care organizations. The state laws the Act
overrides are those that bar managed care organizations from creating
their own networks -- for example, not allowing a managed care
network to refuse to admit a qualified physician into its network.
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 9
ARTICLE:
"Doctors in training will be assigned to the coveted specialty programs
based partially on race and ethnicity...."
FACT:
This is ridiculous. No physician or medical student is "assigned"
to any specialty or told what type of medicine they can
practice. The Act does make clear that funding of medical education
will put more emphasis on the widely-acknowledged need to train
primary, as opposed to specialty care physicians, and that attention
will be paid to the potential under-representation of minority groups.
ARTICLE:
"Under the Clinton bill you are entitled to a package of basic benefits,
but you can have them only when the are "medically necessary' and
"appropriate.' That decision will be made by the National Quality
Management Council, not be you or your doctor. The Council... will
establish "practice guidelines' to control "utilization' of health services."
FACT:
Another lie. You and your doctor will decide the type of care that you
need. The National Board has the authority to issue guidelines on
what may be necessary or appropriate. Its process of issuing any
guidelines will entail the fullest participation of all concemed.
Today, virtually all insurance plans can refuse to pay for services
deemed unnecessary and inappropriate, and i t is the insurance
company -- not the patient and physician - with the ultimate
authority. The decision-making process of insurers are not subject to
any public input or scrutiny. To imply that the new system will have
restrictions on what is necessary and appropriate, when the current
system does not, is anything but truthful.
There is nothing in the Act to suggest that the "practice
guidelines" referred to here will be mandatory or will control
anything. They are to assist plans, providers and others in providing
higher quality care. As the Act says, they "may be used by health care
providers to assist in determining how diseases, disorders, and other
health conditions can most effectively and appropriately by prevented,
diagnosed, treated and managed clinically."
�ANALYSIS OF THE NEW REPUBLIC ARTICLE
Page 10
ARTICLE:
"The Secretary of Health and Human Services has the power to set a
controlled price for every new drug, and to require the drug
manufacturer to pay a rebate to the federal government...
//a
producer balks at paying the rebate, the Secretary can "blacklist' the
drug, striking it from the list of medications eligible for Medicare
reimbursement."
FACT:
Very misleading. The word "blacklist," with quotation marks
around i t i n the statement, does not appear i n the bill. Putting
quotation marks around it implies i t is directly lifted from the text. In
this case, however, it obviously applies to the author's interpretation of
the text.
The Secretary can, in some circumstances, request a rebate on a drug
as a cost containment tool. This will apply only to those drugs
purchased in bulk by the federal government for the millions of
Medicare beneficiaries. Manufacturers are given process rights in
these negotiations as well. There is no "blacklist".
ARTICLE:
"Under the bill, the Secretary weighs the development costs and profit
margin for the single new drug, rather than the overall profitability of
investing in new cures."
FACT:
The statement refers to page 373 of the bill. The bottom of that page
and the next page list no less than 8 factors that must be considered
by the Secretary in negotiating a rebate in the Medicare drug program.
Clearly, there is no effort to exclude the consideration that many
efforts to produce new drugs cost a great deal and produce no profit to
drug manufacturers. Drug companies would certainly be given the
opportunity to raise these considerations and there is absolutely
nothing in the proposal would prevent the Secretary firom considering
that reality.
�llllllllllllllllllllllll
i liflll
7&7(.k<}<
II
ill
�What the Clinton plan will do for you.
No EXIT
By Elizabeth McCaughey
I
I'vou Ye noi worried abom tlie ('.lmi"n tw.ilih bill,
keep reading. If tlie bill passev MHI uill ii.ne in ^Mrle lor one ol (he lou-bud^ei healili (jl
»clci led
l)\ the i^ov ei'nnient. The 1 J^^ will pi I M H I ^ U :o un
goini; outside the -i\ ;tem to buv baMC lit-.ilili • ..wi.u{e
vou (hmk is better, even after \ou p.i\ tin' m.iml.uorv
premium (see the bill, page '244:. Tlie lull ^u.n .mtees
vtm .1 package of medical • ervice>. hm wm . .m t ha\e
them unle^s ihev are deemed "necc^an ' .md ".ippropnate I pages 90-911. That decision will (-.r made b\
the government, not
\ou and vour doi i, ,i F.M .ipmg
the -^vMem and paving out-of-pocket to M C .I -pi i MIIM
for the tests and treatment win th in k -.on , u-cd will lie
almost impossible. If vou walk into a dot mr > oil'u e and
ask lor treatment lor an illness, vou mu-i »h>iv\ pmot
that vou ate enrolled m one ot the health pl.niv <'tteted
bv the government (pages 139. 14'J). Tlie doctor can
be paid onlv bv the plan, not bv win i page J.'liii To
keep controls tight, the bill requires the doctor to
report vour visit to a national data bank containing the
medical histories of all Americans (page 'J3h).
If these facts surprise vou. it's because vou haven t
been given a straight storv about the Clinton health bill
Take two examples: on November 4. Leon Panetta. the
director of the Office of Management and Budget, testified to senators that the hill does not "set prices" and
"draw up rules tor allocating care", a month later Hillarv
Ri idham (Clinton assured a Boston audience that the govern ment will not limn what vou can pav vour dot. tor. Tlie
test of the bill proves these statements are untrue.
The administration also savs that the bill will not
lower the qualitv of your medical care or uke a*av
personal choices vou now make. This statement goes
right to the issues that matier most. Hov% true is u- To
help vou decide, here is a guide to the IJHl-page
Health Securitv Act.
No effort is made here to compare the Clinton bill
with the manv alternatives offered bv Republicans and
other Democrats or to assess the nature and t \teni of
the health care "crisis." The purpose is to an<.v»er one
question: L'nder the Clmton bill, if vou fx-conu- ill.
will vou be able to get the treatment vou need and
<
)
MrC.ar.HEV is John M Olm FManhattan Institute.
EUZ VUETH
low
. i i the
make choices about vour own health care.rkr Law Will Make You Get Health Care Through Vow
'Alliance.' L'nder the bill, unless vou get Medicare,
militarv benefit or veteran's benefits, or vou or \ou
>pouse work for a company with more than b.\W) cmplovees. vou must enroll in one of the limited number of health plans offered by the "regional alliance"
where vou live (page 15). Regional alliances are
government-run monopolies thai select health plain,
collect premiums from residents and their emplosen
and pav most of the money to HMOs and insuren II
vou fail to enroll, or the plan you choose is ovenufv
bribed, alliance officials will assign vou to one (page'*
144. 146). The goal is to curb health care spending bs
limiting what every .-Vmeriean is allowed to pav for
health insurance. Restricting how much people can
pav for insurance limits how much money ia in the pot
to take care of them when thev're sick.
The Health Can You Can Get WiU Bt LimtUd. L n
der the bill, a Nauonal Health Board—seven people appointed by the president—will decide how much
the nation can spend on health care beginning m
199b uhe baseline year). Based on that national bud
set. the board will set a budget for each region and J
ceiling on what the average health plan in the region
can cost. The bill outlaws plans that would causr •
region to exceed its budget or that cost over '.'0 pr'
cent more than the average plan. After 19%. mcrrx* .
m health plan premiums will be strictly limited b\ m
milatiou factor* based on the consumer price mdrv
i pages J56. 984-987. 990. 995).
Putting pnce controb on premiums to limn thr
amount of money in the health care system mighi
wring out waste during the fint year or two, but there
is no doubt it will cause hardship later on. Seveniv
-even million baby boomers will be reaching the age
when thev need more medical care. Increasing num
bers of teen pregnancies and low-birth-weight babir*
also will require more health care dollars—$158.w
on average for each severely underweight newborn
Even the bill's authors anticipate that restneung the
dollars available for health care in the teeth of thev
trends will produce grave shortages: the bill provides that when medical needs outpace the budget
and premium monev runs low. state government
(
FamiANY r. iwa THE NEW fttn-aui r
�and insurers must make "automatic, mandatorv
nondiscretionary reductions in pavments" to doctors,
nurses and hospitals to "assure that expenditures will
not exceed budget" (pages 113. 137).
Above a threshold level of qualitv, alliance officials
will approve health plans based on lowest cost, not
highest qualitv. to stav under the premium ceiling set
bv the Nauonal Health Board, explains Cara Walinsky
of the Heakh Care Advisorv Board and Governance
Committee, which advises 800 hospitals worldwide
That is whv Anthony L. Watson, chief execuuve of the
Health Insurance Plan (HIP) of Greater New York, is
optimistic. If the Clinton bill passes, "New York is
mine," he told The .Wew York Times. "I'm going to be
the lowest-cost plan." HIP. with a physician staff that is
57 percent foreign-trained, alreadv has what that
newspaper calls "the image of being the least desirable
health care opuon for city workers and others who
cannot afford anvthing more."
S
, ,
With the Docton You Use Sow Will Be Hard.
Deciding for yourself when to see a specialist or
get a second opinion and selecung the hospiul
vou think is best will be even harder The bill is
designed to push people into HMOs, which restrict
vour choice of physicians and hospitals, and use gatekeepers to curb the use of specialists, expensive tests
and costlv high-tech treaunents. What most of us call
fee-for-service (choose-your-own-doctor) insurance will
be difficult to buy. The ceiling on premiums and the
20 percent rule will eliminate most fee-for-service
plans, which tend to be more expensive than their
pre-paid counterparts. .Although the Clinton administration insists that Americans always will be able to
choose fee-for-service insurance, experts such as Dr
John Ludden. medical director of the Harvard Communirv Health Plan, sav that option will "vanish
quicklv "
Even where it is possible to buy fee-for-service insurance, it will be hard to find doctors practicing on that
basis. According to Walinsky, the Clinton proposal
contains "verv strong incentives" against fee-for-service
"on the consumer side but also on the provider side."
Price controls on docton' fees and other regulations
will push doctors to give up independent pracuce and
sign on with HMOs. We've been told that the government won't be putting price controls on docton. but
the bill limits what health plans can pay physicians and
prohibits pauents from paving their docton directlv.
Alliance officials post a schedule of fees, and it is illegal for doctors to take more (pages 134, 236).
In addition, alliance officials set yearlv limits on pavments to fee-for-service doctors in each field of
medicine, like cardiology or pulmonology. What if a flu
epidemic causes pulmonologists to see more pauents
with breathing problems than the region's budget
allows? The bill compels insurance plans to slash doctors' fees or cut off their payments entirely unul the
next vear "to assure that expenditures will not exceed
the budget" (page 137).
H\\f\ Un ihf jnh of R/uioning. I inter the ( '.lintou IMII iiutederal g.nernment uses price coriiroK . .n uw im;.::> t.
curb dollars paid into the health carr »\»ieu! I.::::.:i::^
how those dollars are spent is a job -hated b\ .liiiam c
officials, who budget pavments to doctori i aumdlmg fee-for-sersice sector, and HMO administrators, who
are expected to do the lion's share of health care
rationing. Is "rationing" too strong a word.- Not according to Ludden. whose HMO serves 570.000 people He
prediccs that "price controls on premiums will drive us
straight tn rationing at bedside." Princeton Pmtes-oi
Paul Surr. a kev designer of the Clinton plan, prefers K .
sa\ that premium caps will induce "a different frame of
mind" m both doctors and health care admmisiraior"The\ will have to manage under constraint.''
m
H
u
MOS alreadv have a track record of tighdv controlling a patient's access to• phvsicians. Ai
Kaiser Permanente. the first person a -uk
patient sees is the "advice nurse." who makes
the decision whether adoctor is needed. In HMOS. the
ratio of phv sicians to members averages 1 to S0O. about
hall the rauo of phvsicians to the general population
Specialise are parucularlv hard to sec.
Current HMO cosKutung methods alreadv are drawing criticism from Congress, government investigaton
and worried doctors. The Clinton bill's premium caps
will compel HMOS to use even more stringent methods
of limiting care, but the bill omits anv safeguards to
protect patients from abusive praciic.es.
For example, missing from the bill is anv effort to
put a stop to "the withhold." the pervasive IIMO pracuce of punishing doctors financiallv for providing care
thev believe their pauents need. Almost all large, forprofit HMOS. including those operated bv Aetna
Methfe. Oxford and Prudential (but not Cigna) withhold betvteen 10 percent and 2b percent of a doctor *
compensaiiuu until vear's end, and return it onlv it
the doctor hai met HMO targets for limiting patiem
tests, referrals to specialists and hospitalizations. Doc
tors report that targets are so siringeiu that HMI is
almost alwavs keep part of the withhold, which means
that what a doctor orders for a patient comes out oi
the doctor's own pocket at the end of the vear.
The withhold has caused a surge in dangerous "hallwav consuluuons." according to Dr. .-Man Jasper, a pulnionologisi and critical care specialist at St. Vincent *
Medical Center in Los .Angeles. Other doctors stop
Jasper m the hospital corridors, describe then
palient s breathing problem and seek a diagnosis, m
order to avoid referring the patient for a specials
consultauon and incurring points against the with
hold. The danger, savs Jasper, is that the other doctoi
might fail to mention a critically important aspect ol
the pauent s condition.
The withhold motivates primary care doctors to take
a "we II see how vou feel next week" or "let's trv this
fint" approach, even if it means additional worn ami
needless sufTering for the patient. At a Humana-owned
HMO in San Antonio, for example, a 40-vear-old woman
�wiih back pain wai toid bv the urmupenisi mat sne
needed an MRI. Bui her primarv care docior rejected
the specialist's request for the test, saving the patient
would have to trv something less expensive, and sent
her for acupuncture, followed bv months of hot packs
and phvsiotherapv. When nothing worked, the gatekeeper authorized the MRJ. which revealed that the
woman needed a lumbar dischetomv (disc removal),
as the orthopedist had suspected. The storv was
i elated bv the woman's surgeon. Dr. William V. Healev,
a clinical professor at the L'niversitv of Texas, who said
the lesson was that HMO cost-cutting incentives, such as
the withhold, fail to
account for the graver cost—the months
a patient is home
from work, worried
and in pain.
Another HMO costcutting strategy that
makes doctors and
patients worrv is the
utilization review—a
sick patient must wait
while the doctor telephones a utih/ation
review companv. describes the symptoms
and medical historv
to a nurse or clerk
seated at a computer
terminal and hopes
for an o K. to proceed with tests and
treatment.
Three
hundred
and fiftv utilization
review
companies
that claim to slash
health care costs sell
their
services
to
HMOS. hospitals
and
others at a rate of si
to S3 per patient
reviewed. It s a $7 bil11 R \ U I M . F»> V I N T I
lion industrv. Such
"cookbook medicine" ignores the non-average, abnormallv sick patient who may need more intense treatment than the computer program recommends It
also discounts the value of examining a patient, and
ignores the phvsician s judgment and expertise. Dr.
Jerome Groopman. head of oncology and hematology
at the New England Deaconess Hospiul in Boston,
savs. "It s an 800 number. Thev don't know me from
Adam!"
"Horror stones abound" about utilization review,
according to a 1993 report for the Nauonal \isociation of Atiornevs General. Doctors' treatment plans
are "rejected bv inadequatelv trained personnel."
according to the report, and utilization review compa-
nies retuse to give reasons tor their decisions, even to
doctors, because it is presumed doctors would Figure
out wavs to get around the review guidelines once
thev were known.
Even when doctors' recommendations are ultimatelv approved, it can take weeks longer to diagnose
and begin treating an HMO patient than a patient
with fee-for-seruce insurance. Jasper explains, because
of the successive delavs in getting each test approved. One HMO patient wuh coughing trouble was
given antibiotics by his primary care doctor, who
thought the problem was pneumonia. The patient lost
thirty-five
pounds
while waiting from
October 27 to December 24 for an O.K.
to see Dr. Jasper, then
to have a GAT scan
and lung biopsv. and
finally to learn that
the correct diagnosis
was a lung fungal
disease. Jasper said
he could have had a
fee-for-service pauent
on ana-fungal medicine within fourteen
days, instead of nine
weeks.
The Attorneys General report urges
state lawmakers to
look into curbing uulization review in
HMOs. In contrast the
Clinton bill calls utilization review a "reasonable restricuon'
on patient care and
expressly includes it
as a requirement for
docton treating patients with fee-for
service insurance
well (page 134)
K i K r •<» NEW H E P U B L I C
Tht
Govern mfn
Won t Protect You From HMO Abusts. If most Americans
are moved into HMOS, who will ensure that they get
good health care? The Clinton bill establishes two
national boards to develop quality standards and
depends on alliance officials in each state to enforce
them (pages 843-844). But history show that federal
and sute officials have failed to protect patients from
HMO abuses, even in small pilot programs.
In 1990 Florida newspapen printed lurid accounts
of abuses by Humana Medical Plan, an HMO paid to
care for the elderly under a small, experimental program to reduce Medicare costs. Congress ordered an
mvesugauon of Humana's performance, and Janet
Shiklcs. in charge of the probe for the General
FnnuAMVT.im
THE NEW REHJUJC
a
�Accounting Office testified about the companv s
failure to order appropriate diagnostic tests and failure to follow up on abnormal test results " Con^umirReports (August 1992) also investigated the shortcomings of the pilot Medicare-HMO program in Florida,
and concluded that government oversight was "lackadaisical."
A nationwide investigation for Congress drew
the same conclusion. Pointing out that onlv twentvone of fiftv-seven HMOs investigated received a passing grade, the late Senator John Heinz warned thai
the priority "has been to promote enrollment m HMOS
and we have not given equal priority to monitoring what happens" to people "after thev have
enrolled."
Far from protecting patients in HMOs, the Clinton
bill ties the hands of state lawmakers who want to pass
protective legislation. Some states recentlv have
enacted laws to safeguard choices patients want to
make for themselves, such as which hospital or pharmacv to use. HMOS protest that these laws hobble cost
containment, and the Clinton administration apparendv agrees. The Clinton bill pre-empts state laws pro
tecting patient choice (page 238).
Y
ou'// Get More Pnmary Care Than High-Tech
Medicine, and That's Mot Good News. Will pauents
get the care they need when gatekeepers limit
their access to specialists and high-tech
medicine, as the Clinton bill intends? The evidence
strongly suggests that low-tech care will not be good
enough. People with heart disease, for example, will
suffer, HMOS alreadv ration high-tech care to heart
attack patients, according to a study in The Sew England Journal of Medicine (December 1993). HMO pauents
hospitalized with coronary disease (myocardial infarction, unstable angina, angina pectoris or ischemic
heart disease) are 30 percent less likelv to be given
bvpass surgerv or a coronarv angioplasty (declogging
of the arteries) than similarly sick patients with fee-forservice insurance. Another recent study by Duke L'niversitv points to the consequences of such low-tech
care In the study, American heart atuck patients who
tended to be treated with three cosdv. high-tech procedures—catheterization (inserung a thin tube into the
heart for diagnosis), angioplasty and bypass surgerv —
recovered far better than Canadian heart atuck
patients, who had less access to the procedures. American patients, who were twice as likelv to undergo the
procedures, tended to have a better quality of life after
a heart atuck. Canadians suffered more recurring
pain, felt more depressed and were less able to go back
to work and pick up their old acuvities. Dr Robert
Califf savs the Duke studv may help people undersund
"the implications of reducing services in a health care
svsiem."
Is it true that we need less care bv specialists- Not
according to the National Institutes of Health, which
recently issued a warning that patients with manv common conditions should be treated routinelv bv a renal
'kidnevi specialist. According to the \ I H panel, primarv caie doctor- trequentlv are m eriooki i ig ;he e.ulv
-ign- oi kidnev tailure and are hanging ..n to p.iiirnitoo long. Patients should he reterred to -pru.ili-itor dialvsis sooner, said the MH. before it is too late to
save their lives. Twenrv-five percent of kidnev patients
v\ho don't receive dialvsis until it is an emergencv die
Dr C. Craig Tisher. chairman of the M H panel,
warned that patients with high blood pressure, diabetes, weight problems and metabolism abnormalities
should be regularK cared for bv a renal specialist, noi
onlv a primarv care doctor.
In the short run. the Clinton bill depends on HMOS
to limit access to specialists and high-tech care. As a
longer-term strategy to limit such care, the Clinton bill
seizes control of medical education and requires that
bv 1998. no more than 45 percent of noting doctors
be permitted to go on to advanced trnining in a specialtv Specialrv programs at leading medical schools
will be downsized. Doctors in training will be assigned
to the coveted specialty programs based paruallv on
race and ethnicitv. depending on how "underrepresenied" each racial or ethnic group is "in the field ol
medicine in general and in (lie various medical specialities' (pages 509. 514-515).
Restricting medical education bv government fiat
undoubtedlv will reduce the consumption of expensive, cutting-edge care. Doctors who are not trained in
sophisticated technology cannot use it. But preventing
doctors from learning about the most advanced medical procedures is a lethal wav to curb health care consumption Keeping doctors uninlormed could not
possiblv be an improvement.
•
•
nurntten Rationing Rules. L nder the Clinton
bill, vou are entitled to a package of basic benefits. but vou can have them onlv when thev
are "medically necessary" and "appropriate
That decision will be made bv the National Qualm
Management ( ouncil. not bv vou and vour docior. Thr
council (filteen presidential appointees) will establish
"practice guidelines" to control "utilization" of health
services ipages 91. a36, 848). These guidelines will
compel doctors to uniformly practice low-budget
medicine. "There needs to be some point of reference
for [health) plans to determine what is appropriate
care," Starr said. "There is an enormous amount ol
excessive, inappropriate care." In Surr s view, the bill
provides "high quality care." People who want access to
more are asking for a "neurotic" level of care. What is
most troubling about the practice guidelines is that
thev are not spelled out in the bill. Congress and thr
public are asked to approve the concept without knowing the content.
How rigorous will the sundard of "medically necev
sarv" and "appropriate" be? In other words, how much
rationing based on cost-effectiveness will we have to
endure- When a kidney transplant is needed, will ihr
paueni's age matter, as it does in Great Britain, where
older pauents are routinelv denied high-tech treatI
I
�pnirK
nis >
ists
to
nts
lie.
iel.
lia- _
ties
noi
IOS
J>
a
liat,-..
ors
.ed
on
^
iire- - -'•
Bsjor/' Sitrninir On. You Should Know.... The Clinton
inents.' Will patients with advanced \IDS be entitled to
bill will prevent people from buving the medical care
intensive carer Oregon's standard of appropriate care
thev need. Price controls on premiums will push most
for needv residents excludes high-tech, life-sustaining
Americans into HMOs and pressure HMOS into sharplv
procedures for advanced UDS cases, as well as for
cutting access to specialists and effective, high-tech
extremely premature babies and advanced cases of
cures.
Price controls on doctors fees and regulations
certain cancers. Groopmaa. yho treats cancer and
tving doctors hands will curb the care phvsicians can
UD** patients, worries that decisions now made bv the
give patients Price controls on new drugs will keep
patient, doctor and famt+v will be made b\ a council of
people over n5 trom getting the medication-! thai can
•omniscient hUreautrats". who "are-looking at two
help-fliem. Most important, government controls on
tilings: dollars a n i l
medicaf education will limit what future doctors know,
e
American
Medi- Manv wgatliBBoak
eostihg
lives and suffering no one can calculate.
iooFtHrs
aiid
insurericai Association, jpeciafi^Thcadimnistration often cites two stadsucs—Ameralreadv devise.what jta^alT^praqlce guidelines* to
ica's relaiivelv high infant mortalicv rate and its lower
-help physicians keep "abceat^ofc tbe most effiective
life expectancv—to support the need for the Clinton
ireatme^jLitdden-exDl^S^.thal "doctors appr-ecihealth bill. But these have almost nothing to do with
ate guidelines" wtteiMtlgfrjUfcTegbmmendatiuht, *faut
the qualitv of American medical care. Both statistics
not uiK«juhcj£Lbe.come matters of Ua."
refleci the epidemic of low-birth-weight babies born to
NUtuy ptrrsiciitftin^lto; treat j t i c n o f ' i mwe pnptilateenage and drug-addicted mothers, as well as the
tion-arr troublert: tRa jE^CIiiiton plan \ pracuce
largenumber of homicides in American cities and
^uidHrncs wiW prevent tfrem.frgtm trying new stn»tedrug-related deaths.
g t « m fii^.^e^erafe "p«teais. Jasper recalK tli^ he
learned -<^iid^ "<hF©u^4he^apes H>e* "iTur other-"
n fact, if vou are scnouslv ill, Jfe best place to be
"3^Ctorr w e c j ^ i & y i n ^ ^ ^ w ^ g c c e s s witfL irratif^fnrAT Uie United States. Among all indusmalpneijjmoosil^TlftllttuufilJiS WIK*eUwd -Uluesyt^fc-- ^
izftf nations, the United States has the highesi
adjunctive" coftK-este rowlsi. AfoiWaior% prac i ic»-^mnecure rates for stomach, cervical and uterine canlines would have stifled sucTi innov-atiou and -pwrcers, the second highest cure rate for breast cancer
ACyKfJJnsper from keeplft§-JSwtie»»*^lav. SimiJartyr
and is second to none in treating heart disease In
" l M' f o• u••^ U a r -•' _wip_v\ere ti\ing aenisol
bwrit+ui r e c a
othee countries that spend less, people who are sick
IGttaJ&Bf * U* trfSt-i
"rguidtinw'^i^tfcFftave-- g?t ItMt tsn.. arc less likely to survive and have a
ths. I
poorer quality of life after major illness. Consider
what
hapfMps in Canada, whose health care system
to-a
sRjw-movlflg
"hold chan
up as a model for the United Sutes. In
~jpown»acni
ical
technology is radoned to danger\ti*
els. The United States has 3.26 open_ v units per million people; Canada has
tSits per million. Cardiovascular disease is
CanadSViUmber one health problem, yet open-hean
sfirgerv^urfKs and catheterizadon equipment are kepi
m such short supply that the average wait for ur
and human services has the pov\er to set a congent
i not elective) surgery is eight weeks. The shock
trolled price for even new drug, and to requne the
mg
result
is that in Canada, a cardiac pauent is tm
drug manufacturer to pav a rebate to the federal govtimes
.
L
>
likelv
to die waiting in line for surgerv as .n
eriimeiit on each unit sold to Medicare patienu> at marthe
operaung
table.
In the United States, there n MO
ket price instead ofthe controlled price. If a producer
T
1
p^l
!'iat
cn---
f
LJ
-
lOt
itv
ie
-h
;h
.11
et
e
'e
•»f
.11
io
is
it
>e
balks at paving the rebate, the secretarv can "blacklist"
the drug, striking it trom the list of medications eligible
for .Medicare reOThurwmrrrUpMiM B65-379). The piop o s e c r t t f S M r o i t f f ^ B B W ^ ^ p a n e w drug inch a
Tacrine- C^^eatfiiflffittfer AhHeimer'sV from older
patients.
L'nder tfee _bi%^ .ft^Wgettitf y-^Cjl^
development costi aad-"pfdffir5@Shrjor rtre singje drug,
rather than the overtfcpfafitteiUp' ofeinxTsting in new
cures (page 37ST. BiotecR itivestorTpoint out that for
everv drug that reaches market, more than 1.000 others dead-end. with a 100. percenuioss for investors.
Limiting the price and profitabtHrr-of the one drug in
a thousand that succeeds will halt research into new
cures, including drugs for ovarian and hrea>i cancers
now in the pipehne...
5
l h t ;
wail
The choice is not between the Clinton bill and the
suius quo Members of Congress should read this bill
instead of reiving on what they hear, and then turn
their auenuon to alternatives sponsored bv Democnu
and Republicans. These alternauves provide urgenth
needed reform of the health insurance industry, oui
-tewing iu worst abuses, without taking important dectsions away from pauents and their docton and with
out depriving Americans of effecuve. high-tech
medical care when they are seriously ill. Congress al»>
should consider ways to provide insurance for thov
who cannot afford it, and level with the public about
what universal coverage will cost. Whatever the pner
uliimaielv. it will be less expensive than the conse
quences of the Clinion bill. •
pamMirr r. ISM THE NEW furi sut a
�The admission by.the ANC'S lo.ngume,^ndard^arec™
among-eoloreds._ihe,Rev.erend Allah. Boesi^tq^xi-ngi:
- an affair-withilTwhite reporter: ^ a s - . f u n f e P W g ^ ^
- mised its'
rep^tidn"?Acfimai)TOdjK^^^'^;^^
didate
fer^fi^^WKG^^j^^g^^
;
ropes.
h
admits, 7 h i s - i s ; « a M p s f e 1 p i « S S ^ a 5 r a ^ ^ ^
not f o r ^ ^ S i f c B S S t t b i n a S a * ^ ^
CK!
White House press office
t questioning the accuracy
je in TNR ("No Exit," Februilcome this opportunity to
;the White House about the
I did in my original article,
lescription of the bill—and
of their arguments—with
ivember 20,'l993, version. If
s challenge the accuracy of
[ope they will provide page
Naders can compare the eviIves.
challenge focused on this
:
In South Africa discussions of policy are rarely free
from questions of racial identity. During apartheid, the
people of the Cape were encouraged to believe that
because thev did not have a black majority, they would
not face the same political, social and moral reckoning
as the rest of the country. Through a labor system that
gave them preference over blacks, coloreds were encouraged jpjrfcfil superior to an^jiutuicrfroi^.the^
•e to settle for one of the lowby the government. The law
(utside the system to buy basic
better, even after vou pav the
bill, page 244) . The bill guarical services, but you can't have
"necessarv" and "appropriate"
j will be made by the govemoctor. Escaping the system and
specialist for the tests and treatjll be almost impossible. If you
wufK-nw. vi^w^ »
ind ask for treatment for an illness, vou must show proof that vou are enrolled in one of
the health plans offered bv the government (pages 139,
143) The docior can be paid only bv the plan, not by you
(page 236). To keep comrols tight, ihe bill requires the doctor io report vour visii io a national daia bank containing ihe
medical histories of all Americans (page 236).
The White House responded:
lis Act to prohibit any individ' ar and paying, with their own
jider the Act, you can pay 'out' :siepchififincfe'<
Sg you want at any lime, to any
-adif
jig to treat you." Price controls
For coioredtlea
iis wrong," according to the
.qred ij_
*io price controls—"
ri-re
pernic-iou^sjEeiic^pfH^!
statements from the White
elect^\iP>r^roi}il-g^^
111
proves
they are untrue.
would4^tutionaliz"ekln t h e i ^ ^ ^ f ^ ^ ^ A t f ^
jny
price
for
any servict you wan t ?
colored jazz p i a n i s t l t b d a ^ I b ^
gSo
buy
cosmetic
surgery, psyremih^iS^p^t^aj^^J^RKffil^pgP^^
""bvere'd services out-of-pocket,
from accepting payments
-'; identity crisis;"-—
»••-A^J-W^'^^S^^^^
basic kinds of medical care
t package. Below are the regPETER BEINAKTJS
^n^m^^itrnU^h^^^^
,
r a . I « M THE NEW REPUBLIC IT
i •
97
�The bill's authors anticipate that restricting dollars
available for health care will produce shortages: when"
medical needs outpace the budget and premium
monev runs low, state governments and insurers must
make 'automatic, mandatory, nondiscretionary reducuons in payments" to doctors, nurses and hospitals.to
"assure that expenditures will not exceed budget"
(pages 113, 137).
In a charge echoed bv Michael Weinstein of The Sew
York Times, the White House accused me of misleading
readers by "implying that such a mechanism exists in the
main proposal." The White House stated emphatically
that "it does not." The White House and Weinstein
argue that only under a single-payer svstem would payments to doctors and others be cut off if needs outpace the budget and premium monev runs low. They
expresslv charge me with quoting the single-payer regulations and misrepresenting them to be rules for the
"main" Clinton heakh proposal.
The text of the bill proves that the White House and
Weinstein are wrong. Cutting or delaying payments to
doctors, other health care workers and hospitals to stay
in budget is an integral mechanism in the administration's bill, and one of the two passages I quoted (page
137) is from the "main proposal." It provides that if
needs exceed budget and premium money runs low:
Sec. 1322(f)(2) PROSPECTIVE BLDGETING DESCRIBED ... the
plan shall reduce the amount of pavments otherwise made
io providers (through a withhold or delay in payments or
adjustments) in such a manner and bv such amounts as necessarv to assure that expenditures will not exceed budget.
The goi'emment will decide what is 'necessary" and "appropriate" care. The White House attacks as "wrong" and
"very misleading" my statement that "the bill guarantees
vou a package of medical services, but you can't have
them unless thev are deemed necessary' and 'appropriate.' " The administration also says it is "untrue" that
that decision will be made bv the government, not by
vou and vour doctor.
Let's look at the actual bill:
Sec. 1141. ESLCLISIOSS
(a) MEDICAL NECESSITY—The
comprehensive benefit package does not include
(1) an item or service that is not medically necessary or
appropriate: or,
(2) an item or service that the National Health Board may
determine is not medically necessary or appropriate in a regulation promulgated under section 1154 [pages 90-911.
Sec. 1 154. ESTABLISHMENT OF STANDARDS REGARDING MEDICAL
NECESSITV
The National Health Board may promulgate such regulations as mav be necessary to carry out section 1141 (<i) (2)
(relating to the exclusion of certain services that are not
medicallv necessary or appropriate).
The bill uses the word "regulations," not "recommendations," to describe the National Health Board's decisions. The bill also grants the National Health Board
power to change the preventive treatments guaranteed
in the benefit package and decide at what age and how
often you are entitled to tests and screenings, immunizations and check-ups (page 94). Regarding practice
guidelines, the bill makes it clear that the National Qual30 THE NEW REPUBLIC naRUARV 2S. 1M4
ity Management Council "wiljv develops measures of
"appropriateness of health care services- (page-839)
and "shall establish standards and procediires.for evaluating the clinical appropriateness of protocols used to
manage health service utilization" (page 848).
Racial quotas in medical training. The White House calls
such a suggestion "ridiculous," but the bill shows it is
true. Government will allocate graduate training positions at the nation's teaching hospitals based on race
and ethnicity. In determining how many training positions teaching hospitals will have, the National Council
on Graduate Medical Training will calculate the percentage of trainees at each teaching hospital "who are
members of racial or ethnic minority groups" and which
minority trainees are from groups "under-represented
in the field of medicine generally and in the various
medical specialties" (page 515).
P
rotecting consumen or HMOs? The White House
calls it "deliberately inaccurate" to say that the
bill pre-empts important state laws protecting
the ability of patients to choose the hospital thev
think is best and make other choices about their health
care. Here is what the bill provides:
Sec. 1407. PRE-EMmON OF CERTAIN STATE LAWS RELVTINC TO
HEALTH PLANS
(a) ... no state law shall apply ... if such law has the effect
of prohibiting or otherwise restricting plans from—
(1) ... limiting the number and type of health care
providen who participate in the plan:
(2) requiring enrollees to obtain health services (other
than emergency services) from participating providers or
from providen authorized by the plan:
(3) requiring enrollees to obtain a referral for treatment
bv a specialized physician or health institution
(6) requiring the use of single-source suppliers for pharmacy, medical equipment and other health products and
services.
Fee-for-service will be almost impossible lo buy. The White
House labels it wrong to predict that fee-for-service
insurance will be extremely hard to buy. They point to j
the provision that "in general, each regional alliance
shall include among its health plan offerings at least one
fee-for-service plan." But many doctors, hospital administrators and health insurance experts say confidentlv
that in practice, because ofthe broader provisions of the
bill, fee-for-service will seldom be available. I cited these
experts in my article. Here are their reasons:
(1) Regional alliances cannot permit the average premium paid in the region to exceed the ceiling imposed
by the National Health Board (pages 1,000-1.005). Feefor-service insurance, which allows patients to get a second opinion when they have doubts and see a specialist
when they feel they need one, generally costs more than
prepaid health plains that control patient access to medical care.
(2) Regional alliance officials are empowered to
exclude any plan that costs 20 percent more than the
average plan (page 132). They will have to apply the
20 percent rule virtually all thetime,in order to keep
total spending on health plans below the ceiling
imposed by the National Health Board. In order to offer
�Many Dop't Realize It's Clinton
Plan Thev Like '
By HOJUY STOUT
Staff JUportcr vf T m W /UA STmnr J oumiui.
YORK. Pa. - Jahan Bastitr doesn't tike
President Clinton's health-care plan. She
thinks It's too confusing:, too complex and
probably too expensive.
What about a plan that would guarantee a standard private healtb beneflu
packagetoall Americans, try to promote
competition in the medical industry, include some government regulation to keep
prices under control andrequireall employers to buy health insurance for their
workers with the promise r. ?overnrc?:.
subsidies to help the smallest companies.
"It sounds good," says Mrs. Basbir, a
43-year-old secretary and mother of seven.
"Employers may pick up a lot of the
burden, but If tbe employer can't afford It.
the government will subsidixe. So you're
going to have the employer, the governmem and the insurance companies worKing together."
Actually, that plan ii the Clinton plan,
riintnn 1$ losing the battle to define
Health-Care Satisfaction
1*1
Not
his own~fiealth-care bill. In tne cacophony
ol negative television ads and sniping by
fTTrirs_ foes are raising doubts aboiTt the THI ViLL STEER JOUXUL/MP MM wa
-n^inmnjiap fastpr man the nrpsidem and
ments. "If the White House had had access
""TnilaryRodham Clinton can eialain it. Congress didn't pass a plan this year.
to these people in York, what it would
- H W T g c r j E j p ( - l i n f n n s r g n r i ' t t h m n g h Thp
"The White House should find this bor. recognize is they have to be able to
contusion, the outlook for passage ol maior satisfying and sobering,' says Mr. Har: simplify their message, to say this is what
pWipntt of their bill is ip doubt
"Satisfying because the basic ideas which we're doing: A. B and C." he says. "They
A new Wall Street Journal/NBC News they ve drawn up are therightideas'" in have to be able to get out there and talk
poll shows that public support for-^w- the view of many people, he says. Bu: about it. day in and day out."
Clinton health plan" is eroding^Yet the, "sobering because they clearly have comEveryone in the York group also agrees
samepoll. conducted hv Republiran Rob- municated very little to the public, and ir. that health-care reform means coverage
ert Teeter and Democrat Peter H&rt. that respect have ceded too much to the for every American. No one in theroomis
showfthat bacnng lor the basic provisions interest groups."
willing to accept a compromise of anything
in the president's plan is strong!
To further test public sentiment in the less. "We've got to have universal health
Ifl M i poll. 45^ nf Ampnr«n<; nnw ^ay health-care debate, the Wall Street Journal care, whether you make a million bucks or
asked Mr. Hart to convene a small group of nothing," says Ms. Doll.
«h»yn£i|»«f 'fieriln"™r ""! "P "m
--'TTganuaa-fljiri 18^ in SpptemUr^ust people In York, a medlum-stzed city in the
In the Journal/NBC poll, 33% of AmeriaTteTThepresident outlined the plan in southern part of Pennsylvania. Everyone
cans rank universal coverage as the most
a televised address to Congress. in the group - including a woman whose important goal of health-care reform, the
Thirty-seven percent of those surveyed family lost Its health coverage when her highest for any of the suggested choices.
favoHhe Clinton program, downfrom3T~c husband lost his job and a union member Lower medical rates and capping costs
with a plan that "covers everything you placed second, with 18%.
' injanu^anfl sift.m September.
// BuTwhe.'- n'P'1 ^ ^isTirrw nf \b? can imagine" - believes the U.S. health
In contrast to the sentiments of the
. /1 ma'iorprovisions of the White House bill- svstem is badly broken and needs to people in York, though, the poll found some
.jffiilhmu irlpnU /ing u - 76gi of the recpoo. be overhauled to guarantee health cover- willingness to accept a bill that doesn't
^jlprn^say If hai «ith<r "a groat d«g| of age for everyone.
guarantee coverage for everyone. In the
" • ^ p ^ a r n "ymp appeal •• That is far
But no one expresses support for Mr. new poll. 43% of Americans say Mr. Clinton
"^oetter than th» response to descriptions of Clinton's sweeping proposal. In fact, no shouldrefuseto sign a bill that doesn't
one can explain it. "I think nobody in this guarantee universal coverage; 43% says he
four other congressional proposals:
room realizes where Clinton's coming from shouldn t refuse.
A description of a plan by Rhode Island with
plan, and it doesn't speak
When the people in York discuss their
Sen. John Chafee and other moderate clearly,his complains
Beatty, who own health care, they reflect the feeling
Republicans, which would require all indi- runs a local youth-careKeith
program.
among many Amencans about the precarividuals to obtain health coverage and
Yet
when
the
group
is read a descrip- ousness of medical coverage in the U.S.
provide financial assistance to low-income tion of the Clinton bill (without
today. Of the 12 people, seven have
people, appeals to 4STc of those surveyed. An as th? president's plant and identifyinc
of the fou: oeen without health insurance at some
plan by Democratic Rep. Jim Cooper o: otner leading proposals in Congress,
tm- time in the past five years. Another. Linda
Tennessee that has bipartisan backing and Clinton plan is the first choice of everyone
would require employers to offer - but not in the room. Referring to the unidentified Luther Baumer. who works part-time,
worries that she'll lose her coverage when
pay for-coverage for their workers and Clinton proposal, Mr. Beattv declares
r husD.md retires in the next year or two
seek to control prices throuen market With the plan you just presented, it
Either
1 ve got to get a fulltime job that
competition gets a 34^ approval rating. A speaks clearly. "
provides benefits or - we don't know what
plan by conservative GOP Sen. Phil
Most members of the group say they get we re going to do." she says.
Gramm of Texas that would allow people to their
information about health care from
Fred Bingaman. a customer service
set up tax-free savings accounts for medi- television
and newspapers. To many, the representative, receives coverage for his
cal expenses gets \T<. approval. And a most memorable
has been health- family through his employer inreturnfor a
government-run, taxpayer-funded svstem insurance-industrysource
strongly
$37.98 weekly contribution. He's satisfied
pushed by Rep. Jim McDermott of Wash- criticizing elementscommercials
of the Clinton plan,
ington and some other liberal Democrats including the famous "Harry and Louise" with his health coverage now, but figures
"I may not be in good shape tomorrow - or
appeals to 31%.
ads that depict an "ordinary couple" wor- an hour from now."
Forty percent of those surveyed sav rying about the White House bill.
While the people In York worry about
requiring employers to pay for their
the Pennsylvanians insist they
rising health costs, they all say they
workers' health coverage, a cornerstone ol don'Yet
t place much stock in such messages would pay something to ensure universal
the Clinton plan. Is the best way to achiev- Robin
a 44-year-old financial special coverage - if the system is fair. " I don t
universal health coverage. This compare- ist forDoll,
York County who has a Blue
pay now. but I'd be willing to pay an equal
with 22% who favor requiring individuals to Cross/Blue
Shield health plan paid for bv
purchase their own coverage, and 18% who her employer, says she sees critical adver- percentage as everyone else." says Mr.
Rentzel. the steelworkers representative.
back having the government collect money tisements from the health-insurance inthroueh taxes and use it to pav medic- dustry constantly." But. she declares,
Tht Atu Jtrett jourmi/NBC H n n a > » »«iMMOor. .
W K n o o t Itmnont m w r v i m 0* l.XO Mum conouOec
bills. Moreover, by 58% to 34%. Americans "they're in it to make billions, so who's
Pria«v mrou*i T U M W V tn rm Minis srwniuncni o>
say the government should set controls on going to believe them?"
* * m M»n M M v t T « t r .
Tht M f f l M W M O-aan f r o n ) U randnntfv a t o c M
health prices. The Clinton plan would place Nevertheless, the people In this group
»«og-tBH>c nwrm tn t r » a r \ \ \ i m i \ t \ U.S. E«t»i rwton »«>
in Droocrrwr to i f i ooovKtion HouMfteiai
caps on the annual increase in privat'- seem to be taking away the ads' message- rtsrrwntto
« f f i»ifCfc ov « mtwoa m«i M « < «" ifitonone nurrv
health insurance premiums. Plans Dein,, and are waiting for Mr. Clinton to respond otrt,
H U M i n o u u f s i M . «n M I M I awnc* of Mine inpushed by Republicans and some other more clearly about his plan. "I'd like to
OnfMult, | |
hMMMDv*!
Democrats wouldn't.
know
exactly
how
It's
going
to
work."
says
m t l t tna tamtit t n u t t m n . T h i r a u t t t « Iht i w Y t v
Surprisingly, despite the push for fast Debbie RudlsUl. a stationery-store salesm n mnwmti ty m w t M Mr M I tna t t x to t n w r t m t f itw
soil t c c u r t i f v r t f i t c n n r w a m t j nown ntnamvtti
action on health-care overhaul. Americans woman
no health coverage. "One day
Cfttncit art i t or K m»i M i l l tduiti w i n M n u u m m
by 60% to 35% say It would be acceptable if he says with
mt comintntii U.S. r*a o—r turvrMd. m t findingi tnuid
this, one day he says that."
amtr from m n t M I m u m ov i » mort m t n 14 o t r o m » Mnilltd numotr at aunMr. Hart says the administration could tnoot mmMr nr ti t inw tt of lat wn udlrtctton.
f f m u t m o t t . tor m n t , m t m t r o i n
leam a valuable lesson from such com
al trrgr wis J i o t r c t n i t o t oointv Tnt mtrgm ( v «n,
1
fp
X
u
<
Q
r
no
It
tuograuo oouM a t o m an m t Mtt of mtf grouo
<
Z
X
�and socialistic. But the Administration
is searching for a new way to sell its
ideas before Republican attacks take
firmer hold.
"Wffkt w e X alwfeys s l i d atawt t l *
afllancto — and we know we have nw
done a good job about conveying thia —
Is w« have certain objectives we are
trying to achieve there," Ira C Magaziner. the White Houae health policy
adviser, said in an interview. "We want
to try to give consumers choice. If
other people have other ideas, we've
always said that we are open to that"
But Mr. Magaziner and others criticized the approach proposed today.
The chief sponsors of the bill. Representatives J . Roy Rowland,
of Georgia, and Michael Bill!
publican of Florida, said the
posed Interim steps on which thWtt Was
bipartisan agreement. Most elements
of the proposal are Included in President Clinton's health plan and.in bills
offered by Senator John H. Chafee and
Ctrnton Defends Idea ofRegional Insurance Pool, but Offers to Bend
By G W E N I F I L L
ilMM » Th» Htm Yort Th
_
TON, March 3 — Moving
to a A n & s growing concerns about how
care plan would work, Presl
said today that one of Its
previsions — (he creation of
JJInsurance pools known as
ilHances — Is neither bureau
< rat|t m r unworkable.
Mr. Clinton also suggested that If
Itton continued to grow toward
of al nances, he would be will
ing l|taipport modifications, as long as
the) ttll guarantee that every citizen
wou receive health coverage.
" * aHUmce is not a government
bur htracy," Mr. Clinton said in an
lift* rta* on the television news progi^ " C B S i This Momlng." "It t a
btlf
t co-op of employees and empkr «.' That'i what It is. If people
don ike the alliances
Look, if you
waiVto make them smaller, you can
dfcin smaller, but you have to
size. You have to have aome
juaranteeftig that
Cbntm AdministraUon's heaMt
c a r K r t a n has come under assault In
as Congressional com
prepared to study it and
i n t f l f c .irttape have run advertise
It Senator Bob Dole, the
leader, and Representative
rk, the California Democrat
a critical health care subHave Identified alliances as
ton plan's weak link.
Project, a coalition of labor and health
policy organizations, today sprang Into
action.
The group Includes several organizations that have withheld endorsements
for the plan In recent weeks, including
the American Association of Retired
Persons and American Airlines.
New Advertising Campaign
Among the endorsements and at
tacks that have surrounded the Clinton
plan, these organizations have fallen
Intb a gray area: they will not embrace
every element of the plan, but they are
willing to support advertising that
commends the overall direction of Mr.
Clinton's proposal. The n e ^ commercials adopt much of the Administra
tion s campaign language, criticizing
Insurance companies as price gougers
Zahn. posed most of the qiiesttons, and
placed the President on the defensive.
He was forced to explain why his plan
will not deprive Americans of the bulk
of benefits that they have now.
"What we're trying to do is to gl^e
those smaller people piore bargaining
power." Mr. Clinton said of the allT
ances. "That's the only purpose of the
alliances. If we can fliii some other
way to do that, that's fine. In other
Mr. Cllntoni who has tried to remain words, they are not supposed to b*
largely above the day-to-day fray, was government, groups — they are co-ops
drawn into the argument today when of purchasers that are private."
he agreed to appear on the CBS proRetrieving Discarded Language
gram. Aides advised him that he would
answer general questions about the
By describing the alliances as cohealth care overhaul from viewers operatives, Mr. Clinton is reaching
rather than specific questions about it back (o a description that White House
from journalists. Instead, the pro- strategists initially rejected because
gram's hosts, Harry Smith and Paula they feared it sounded too bureaucratic
and emptiafetai m ^ p m n ' s cortimltment to providing "affordable private
insurance."
The g r o d ^ M w M by John Rqther of
the retirees' asMciatran, plans to spend
$750,000 to broadcast two advertisements over the next few weeks. Each
features footage of blue-collar workers
along with shoU dl Mr. Clinton speaking before d Joint session of Congress.
Repreaentatlvea Jim QaMer, Robert j j l
H. Michel and Jim MdtaniMtt
Unter tha new bill, Wbtkera cowM noi
be denied health Insusaaee baaauaeo*
medical probtama, and #»ey wo«ld be
assured of coverage what they rtioved
froknone job to another. Self-employed
people could, takf Federal tax deductions for IW percent 6f thtUr health
Insurance expensea, As against 25 percent under curreiW law: The Mil does 4
not require hwtirance companies to
charge the same premfUtn for all customers in a parttcillar regldn, a s some
other proposals would.
4
• Asked whether the biiDL nteeta President Clinton's demand for universal
coverage, Repreaentettve Rowland, a
ptiyaicjan, said that efforts to provide
universal"coveraae would continue for
several years.
"We are nt* fnfcklijg[ifi? fcudfhltoeii
about how many people" wouM be covered by the bill, Mr. Rowland said.
1
Miw PfeAaore Offered
Xiod in the Houae today, 15 Deiriocralfc and IS Republicans offered a bill
to rfagulate the health tnsuranoe mar
ket.and make other changes Intended
to provide coverage to millions more
people. Sponsors said the measure
l^oUM improve the health care system
it would not provide universal
officials dismissed
THB
NEW
YORK
TIMES,
FRIDAY,
MARCH
4, 1994
�Truth Lands in Intensive Care Unit as New Ads
Seek to Demonize Clintons Health-Reform Plan
9
By R K K WARTZMAN
Sio;;' Reporter 0/ T H E W VM. S T R ^ R T J-K.-RV \ L
WASHINGTON - 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 healthcare center is now closed,'' says the recording at the other end of the line.
"However, if this is an emergency, you
may call 1-S00-Govemment." 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."
Tlie only problem with the radio spot,
produced by a Washington-based group
called Americans for Tax Reform, is that it
isn't true. Neither the Clinton health-care
bill nor any of the alternatives on Capitol
Hill would force people to call for government approval before visiting a doctor or
rushing to the hospital. "It scares people,
and that irritates the dickens out of
me. " says Democratic Rep. Jim Slattery, a
critical vote on the House Energy and
Commerce Committee whose eastern
Kansas district was a target of the ad.
Battle Heating Up
Such fear-mongering is rampant as
Congress moves forward on compromise
health-care legislation. The complexity of
the Clinton proposal and the fact that the
issue affects every American have resulted
in a flood of alarmist propaganda that
makes Harry and Louise, the health-insurance industry's fictitious Clinton critics,
look like Ozzie and Harriet.
Some of the horror stories stem from
ideological differences. Many of the groups
twisting the facts are hard-line conservatives, bent on stopping any government
presence in health care. But clearly there
are other motives as well. Some groups, in
issuing direct-mail warnings about healthcare reform, are soliciting money to help
their cause.
Americans for Tax Reform, which
claims 60.000 members, makes no apologies for the 1-800-Govemment ad. "Is it
frightening? Yes. Do I think we overstate
the case? No." insists Grover Norquist, the
president of the group, which is perhaps
best known for asking lawmakers to sign a
pledge opposing all income-tax increases.
Yet even some of the toughest critics of
the Clinton health-care proposal, upon
hearing the ad, condemn it. " I think it's
unnecessary to use scare tactics," says the
Manhattan
Institute's
Elizabeth
McCaughey, whose own attack on the
Clinton plan in The New Republic magazine was denounced by the White House
and its allies.
Ms. McCaughey, who defends her critique by noting that it cites specific passages in the Clinton bill, finds all sides of
the debate guilty of playing to people's
emotions. That, she says, includes the
administration and its supporters, who
eagerly recount stories about people who
lose their health insurance, get sick and
are then financially wiped out. "That's a
kind of scare tactic, too." she says.
Still, some groups have taken the terrifying images to a different level, serving
up wholly fictional accounts of people
denied the most basic care by a heartless
bureaucracy.
Citizens for a Sound Economy, a conservative group that gets about half of its
$8 million budget from corporate and foundation sponsors and half from individuals
who send in contributions averaging about
S20, has also run radio ads in key congressional districts featuring a distraught
mother on the phone. This time, she's
trying to visit "Dr. Murray" so her son's
earache can be treated.
-SET'"
«£R)«M
How Mrs. QBtfon's H r a k h Care
R e f o r m p b m wiB aOect > W !
Rrad M b f t t r . k r m 4 d b r <tar i i m
fa^nr-
crive. Brifetv me — Y e w Hfc — \<nw hi wMi.
m vi t t v
y r a r k v m l nnr*
hr ( r w H y
^ ^ m l I*
b p u k « u n hi V <
I
I .-uufcl l u u - i . u n >uur >
|M> o
Ig! IO you i n n m
- m> voud
HcrikCacT^Farxtann
Freadacnttcfcooit your t^i ptnmd dtctartoba
Maud
oafertlM CWin Pha for Mk on ntm
CS* ibavt ii juil M t of tilt link knowa, but
fntfntniim proviiiom hidden it tilt Preudml'i
j « r t t httRh n r t rfform pita. Thnt pro>iiiom i r t
lummirtud it tht American Cotim. il i new
contumtr'i (uid*book. Health Ctirt Reform 19*4.
The Octioni. \ i icon 111 rtcnvt your btllw. I'll
kno» you're inltmlfd, and rinh voo vour tree
jaidtbook on htallh cart rfform.
U t e j a i a d l A J k m n n t e n l Kti. a i m
«tofmm you tnm <*Kxm% gwn tfcaar
American Council for Health Care Reform s direct mail literature
"You will not see Dr. Murray," the
United Seniors was founded by conser"government gatekeeper" replies. "Dr. vative direct-mail pioneer Richard ViJohnson will see your son next week. . . . guerie. though he is no longer associated
Under health reform all Americans, and with it. The organization is under criminal
that includes you and your son, will have to investigation by the Postal iispection
go through government health alliances Service and the Federal Bureau of Investiwith gatekeepers like me. We will decide gation, according to postal inspector Larry
who, when, or even if you need to see a Fryer. The association, which says it
doctor."
hasn't heard from any federal investigaBrent Bahler of Citizens for a Sound tors since October, complains it's the vicEconomy claims that "what we're present- tim of a political witch hunt. "It's frustrating is a likely outcome" if legislation like ing," says United Seniors spokesman Stethe Clinton bill is passed. But that's impos- ven Allen, a former Senate aide.
sible. None of the health-care proposals on
Another of the big canards about the
the table, including the president's, has a Clinton plan is that people face "5-year's
"government gatekeeper."
in jail if you buy extra care," as the
Some opponents of the Clinton bill American Council for Health Care Reform,
worry that such spurious claims could an Arlington, Va.. group, puts it in a
backfire. "It becomes all too easy to fault
direct-mail package it has sent out to
anyone who has legitimate criticism."
says Pam Bailey, president of the Health- millions of people. The council, which
according to tax records had revenue of
care Leadership Council, a coalition of
S302.259 in 1993, was founded 11 years ago
medical industry representatives that is
to get the government out of health care.
lobbying against the Clinton plan.
"We aren't being alarmist," says the
Sometimes, the fabrications are bom of
group's Christopher Manion. "We think
real concerns. Many experts worry that
the Clinton bill is alarming."
the Clinton bill, with its regional insurBut in fact, while there is an antibribance-buying pools and a National Health
Board to oversee the system, would give ery provision in the Clinton proposal, the
bill explicitly says that people are free to
too much power to the government.
purchase "any health care services" they
Moreover, many believe the Clinton
plan would hasten the already fast-grow- want out of their own pockets.
"I don't see anybody going to jail on a
ing trend of "managed care," where a
liver-transplant rap." says John Sheils. a
person's choice of doctors is limited and
vice president at health-care consulting
physician "gatekeepers" often decide
whether a certain treatment is appropri- firm Lewin-VHI Inc. "They're trying tc
ate. Some analysts caution that because of scare little old ladies."
strict health-care spending caps in the
Clinton bill, rationing is possible.
The groups taking the hardest line
against the Clinton plan tend to oppose the
president's goal of guaranteeing comprehensive health coverage for every American. Many favor instead a more limited
scheme that includes tax-free savings accounts from which people could pay their
medical expenses.
Under Investigation
Americans for Tax Refonn, for one, is
in a coalition called Citizens Against Rationing Health that backs such an approach. Another member is the United
Seniors Association, which says it is a
free-market advocate for older Americans,
but which was accused by lawmakers
during a 1992 congressional hearing of
preying on the elderly for their money.
THE WALL STREET JOURNAL FRIDAY, APRIL 29, 1994
�
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
Health Care Task Force Records
Creator
An entity primarily responsible for making the resource
White House Health Care Task Force
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="https://catalog.archives.gov/id/10443060" target="_blank">National Archives Catalog Description</a>
Description
An account of the resource
<p>This collection contains records on President Clinton’s efforts to overhaul the health care system in the United States. In 1993 he appointed First Lady Hillary Rodham Clinton to be the head of the Health Care Task Force (HCTF). She traveled across the country holding hearings, conferred with Senators and Representatives, and sought advice from sources outside the government in an attempt to repair the health care system in the United States. However, the administration’s health care plan, introduced to Congress as the Health Security Act, failed to pass in 1994.</p>
<p>Due to the vast amount of records from the Health Care Task Force the collection has been divided into segments. Segments will be made available as they are digitized.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+1"><strong>Segment One</strong></a><br /> This collection consists of Ira Magaziner’s Health Care Task Force files including: correspondence, reports, news clippings, press releases, and publications. Ira Magaziner a Senior Advisor to President Clinton for Policy Development was heavily involved in health care reform. Magaziner assisted the Task Force by coordinating health care policy development through numerous working groups. Magaziner and the First Lady were the President’s primary advisors on health care. The Health Care Task Force eventually produced the administration’s health care plan, introduced to Congress as the Health Security Act. This bill failed to pass in 1994.<br /> Contains 1065 files from 109 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+2"><strong>Segment Two</strong></a><br /> This segment consists of records describing the efforts of First Lady Hillary Rodham Clinton to get health care reform through Congress. This collection consists of correspondence, newspaper and magazine articles, memos, papers, and reports. A significant feature of the records are letters from constituents describing their feelings about health care reform and disastrous financial situations they found themselves in as the result of inadequate or inappropriate health insurance coverage. The collection also contains records created by Robert Boorstin, Roger Goldblatt, Steven Edelstein, Christine Heenan, Lynn Margherio, Simone Rueschemeyer, Meeghan Prunty, Marjorie Tarmey, and others.<br /> Contains 697 files from 47 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+3"><strong>Segment Three</strong></a><br /> The majority of the records in this collection consist of reports, polls, and surveys concerning nearly all aspects of health care; many letters from the public, medical professionals and organizations, and legislators to the Task Force concerning its mission; as well as the telephone message logs of the Task Force.<br /> Contains 592 files from 44 boxes.</p>
<p><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+4"><strong>Segment Four</strong></a><br /> This collection consists of records describing the efforts of the Clinton Administration to pass the Health Security Act, which would have reformed the health care system of the United States. This collection contains memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, newspaper articles, and faxes. The collection contains lists of experts from the field of medicine willing to testify to the viability of the Health Security Act. Much of the remaining material duplicates records from the previous segments.<br /> Contains 590 files from 52 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+5">Segment Five</a></strong><br /> This collection of the Health Care Task Force records consists of materials from the files of Robert Boorstin, Alice Dunscomb, Richard Veloz and Walter Zelman. The files contain memoranda, correspondence, handwritten notes, reports, charts, graphs, bills, drafts, booklets, pamphlets, lists, press releases, schedules, statements, surveys, newspaper articles, and faxes. Much of the material in this segment duplicates records from the previous segments.<br /> Contains 435 files from 47 boxes.</p>
<p><strong><a href="http://clinton.presidentiallibraries.us/items/browse?advanced%5B0%5D%5Belement_id%5D=43&advanced%5B0%5D%5Btype%5D=is+exactly&advanced%5B0%5D%5Bterms%5D=2006-0885-F+Segment+6">Segment Six</a></strong><br /> This collection consists of the files of the Health Care Task Force, focusing on material from Jack Lew and Lynn Margherio. Lew’s records reflect a preoccupation with figures, statistics, and calculations of all sorts. Graphs and charts abound on the effect reform of the health care system would have on the federal budget. Margherio, a Senior Policy Analyst on the Domestic Policy Council, has documents such as: memoranda, notes, summaries, and articles on individuals (largely doctors) deemed to be experts on the Health Security Act of 1993 qualified to travel across the country and speak to groups in glowing terms about the groundbreaking initiative put forward by President Clinton in his first year in the White House. <br /> Contains 804 files from 40 boxes.</p>
Publisher
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William J. Clinton Presidential Library & Museum
Identifier
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2006-0885-F
Text
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Paper
Dublin Core
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Title
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[Media] [2] [Loose]
Creator
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Task Force on National Health Care
White House Health Care Task Force
Paul Jamieson
Identifier
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2006-0885-F Segment 2
Is Part Of
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Box 24
<a href="http://clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0885-F-2.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12093080" target="_blank">National Archives Catalog Description</a>
Provenance
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Clinton Presidential Records: White House Staff and Office Files
Publisher
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William J. Clinton Presidential Library & Museum
Format
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Adobe Acrobat Document
Medium
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Preservation-Reproduction-Reference
Date Created
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2/6/2015
Source
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42-t-12093080-20060885F-Seg2-024-001-2015
12093080