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FOIA Number:
2006-0885-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
Health Care Task Force
Series/Staff Member:
Margherio
Subseries:
OA/ID Number:
4804
FolderlD:
Folder Title:
Myths & Realities
Stack:
Row:
Section:
Shelf:
Position:
S
53
3
5
1
�I.
PROBLEMS DOCTORS AND PATIENTS FACE IN THE CURRENT SYSTEM
A.
The power rests in the hands of the insurers
1.
Physician autonomy is being stifled
Increasingly, employers are entering into exclusive contracts with
insurance companies — national companies that have tremendous
leverage over providers. By locking in employers into these exclusive
contracts (a growing number of these are managed care plans), they
lock in individuals who no longer have the ability to choose among
plans or providers. With marketshare locked up, the insurers then
approach individual physicians, tell them the terms of the contract, and
the physician has little choice but to cooperate or risk losing patients
and income.
Physicians increasingly have less negotiating leverage. Insurers set the
rates they get paid
with little input from physicians. Insurers can
drop them without process.
Insurance companies second-guess doctors' medical decisions, using a
"black box" of utilization review protocols.
2.
Insurers decide who gets coverage and for how much
Insurers have the ability to grant and deny coverage. They compete on
their ability to attract healthier patients.
3.
Patients often don't know what they're getting in their benefits package
until it's too late
Fine print often results in coverage exclusions.
II.
C.
Paperwork and bureaucracy overwhelm providers
D.
Access problems/shortage of physicians and other providers
HOW REFORM ADDRESSES THESE PROBLEMS
A.
Freedom of choice for individuals and physicians
1.
Individuals have choice of plans and providers
�A.
2.
Requiring fee-for-service plans
3.
Requiring that HMOs offer a point of service option
4.
Doctors, too, will have a choice of plan and may contract with one or
several plans
Changing the balance of power
1.
Insurance reforms - universal coverage, no preexisting condition
exclusions
2.
Choice maximized through the creation of alliances
•
The creation of alliances enables individuals, not their employers, to
choose among health plans and providers. Through the mechanism of
the alliance, individuals will have the bargaining leverage of large
employers.
•
Having a large share of the market purchasing through alliances means
that fewer employers will enter into exclusive contracts with national
insurance companies. Because individuals in regional alliances will be
able to choose among plans and providers, we expect that smaller,
community-based health plans will grow up in regional alliances.
These plans could be run by physicians through their medical societies
(or other means). The more the individual consumer is in the driver's
seat, the more autonomy the physician has.
•
Physicians will have a choice of health plans in which to participate. In
all alliances, there will be a fee-for-service plan that accepts any
willing provider. This plan will not have a gatekeeper. A physician
may also choose to participate in an IPA, HMO, PPO, etc. (Note: all
plans except for the fee-for-service plan may limit the number of
physicians that participate in their plan.)
3.
Antitrust reforms
•
The Health Security plan will reform antitrust regulations and level the
playing field. Doctors and hospitals will have more freedom to work
together to determine the best and most efficient ways to deliver highquality services.
�C.
•
Doctors and other health providers will be able to band together to form
their own community-based health networks in which doctors will be
able to negotiate to reduce interference with their practice.
•
Doctors will also be able to negotiate collectively ensuring that they
will have a strong say in determining the fee-for-service reimbursement
rates, so long as they represent less than 20 percent of the physicians in
an area and share in the financial risk.
3.
Opening the "black box"
•
Standardizing the benefits package will simplify the system for patients
and providers. Reform will get rid of the fine print.
•
Under reform, utilization management protocols will be disclosed so
that doctors and patients know ahead of time what criteria health plans
are using when they cover services.
Reducing the "Hassle Factor"
�THREE COMMON MYTHS AND REALITIES
ABOUT THE HEALTH SECURITY ACT
�MYTH #2: PAYMENTS TO DOCTORS
MYTH:
INDIVIDUALS CAN'T PAY THEIR DOCTOR D I R E C T L Y
REALITY: INDIVIDUALS CAN SPEND THEIR OWN MONEY FOR ANY
MEDICAL SERVICES
There is nothing in the legislation to prevent individuals from
spending their own money for medical services for any price the
individual and the doctor agree on. [Section 1003]
NO LIMITS ON ADDITIONAL INSURANCE
•
Individuals can spend as much as they want to on additional
insurance to cover services outside the benefits package.
PENALTIES APPLY TO INSURANCE FRAUD
•
The penalties included in the bill apply to outright insurance
fraud, in which a doctor and patient conspire to commit
insurance fraud by billing a health plan for a procedure that is
not covered in the comprehensive package of benefits. [Sections
5433 and 5434]
�MYTH #1: CHOICE OF DOCTORS
MYTH:
T H E F E D E R A L GOVERNMENT WILL CHOOSE WHICH
DOCTORS INDIVIDUALS GET TO SEE.'
REALITY: INDIVIDUALS WILL CHOOSE THEIR OWN DOCTORS
•
Patients — not employers and not the government — will
choose their family's health plan from a number of plans,
including:
F E E FOR SERVICE
•
Patients will be offered the choice of a fee-for-service
plan. They will decide which doctor they want to see.
[Section 1322]
POINT OF SERVICE
•
All health plans, including closed-paneled HMO's, must
offer a point of service option that gives individuals the
flexibility to see any specialist they want, even outside
the health plan they choose. [Section 1402]
THE REALITY ABOUT CHOICE AND THE HEALTH SECURITY ACT
•
The Health Security Act will significantly expand choice for the
vast majority of Americans by offering them a choice of at least
three plans.
•
Robert Reischauer, Director of the Congressional Budget Office,
testified that the President's plan would "offer greater choice of
doctors [than today]..." ruSAToday, 2/10/941
•
The Los Angeles Times reported that "The Clinton plan gives
people at least three options to choose from — an increase in
choice for most workers." [11/2/93]
•
Choice is declining under the current system. In 1988, 89
percent of employers offered fee-for-service plans. By 1993,
this number dropped to 65 percent. [Foster Higgins, 1992, Peat
Marwick, 1993]
�MYTH #3: RATIONING
MYTH:
CLINTON PLAN WILL CAUSE RATIONING OF HEALTH CARE
REALITY: PLAN GUARANTEES HEALTH CARE THAT S ALWAYS T H E R E
B E N E F I T S PACKAGE GUARANTEED IN LAW
•
The Health Security Act guarantees "every eligible individual...the
comprehensive benefits package..." [Section 1001]
INCREASED HEALTH SPENDING IN THE EARLY YEARS
•
The plan increases national health spending during the expansion to
universal coverage, reducing any possibility of shortages. The rate of
growth of national health spending is projected to decline only after
the plan is fully implemented and the enormous waste in today's
system is reduced.
SOLVENCY STANDARDS FOR PLANS
•
Plans must meet strict solvency requirements, making it virtually
impossible for any plan to "run out of money." [Section 1551]
LOANS TO ALLIANCES TO COVER SHORTFALLS
•
The Secretary of Health and Human Services is authorized to make
loans to alliances to cover any temporary shortages in cash flow.
[Section 9201]
�
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
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2006-0885-F
Text
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Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Myths and Realities
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Lynn Margherio
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F Segment 2
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 29
<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/12093088" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
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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-12093088-20060885F-Seg2-029-002-2015
12093088