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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:
Tarmey
Subseries:
1967
OA/ID Number:
FolderlD:
Folder Title:
[New Model Memo] [loose]
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S
56
1
9
1
�Jan.15,1993
TorWilliam J Clinton
P r e s i d e n t o f t h e U n i t e d States
A New Model of The U.S Health Care System
(A proposal to reform the U.S health care system)
Currently problem
The U.S h e a l t h care system i s i n c r i s i s .
The U.S spends much
more on h e a l t h care ($835.5 b i l l i o n , over 14% of GNP i n 1992)
t h a n any o t h e r c o u n t r y , and c o s t s are p r o j e c t e d t o i n c r e a s e t o
over $1.8 t r i l l i o n by t h e year 2,000, and a 12% annual r a t e o f
i n c r e a s e . D e s p i t e l a r g e e x p e n d i t u r e s on medical care, t h e
U.S.lags behind many o t h e r i n d u s t r i a l i z e d c o u n t r i e s i n b a s i c
h e a l t h s t a t u s measures: i n f a n t m o r t a l i t y ( ranked 18th) and l i f e
expectancy ( ranked 1 5 t h ) . Even comparisons w i t h China, a
d e v e l o p i n g c o u n t r y are u n f a v o r a b l e . China o n l y spends 3% of i t s
GNP on h e a l t h care and m a i n t a i n s measures s i m i l a r t o t h e U.S.
China a l s o was awarded a g o l d award of " h e a l t h f o r a l l " from t h e
World H e a l t h O r g a n i z a t i o n i n 1991. D e s p i t e t h e h i g h e s t per c a p i t a
expenditure($3,160 i n t h e U.S i n 1992) i n t h e w o r l d , t h e
u n i n s u r e d p o p u l a t i o n i n t h e U.S i s e s t i m a t e d t o be over 37
m i l l i o n , one t h i r d o f whom are c h i l d r e n . This s i t u a t i o n has
become i n t o l e r a b l e t o almost a l l p a r t i e s i n v o l v e d . Lack of h e a l t h
i n s u r a n c e coverage c r e a t e s problems f o r t h e i n d i v i d u a l , f o r t h e i r
f a m i l y , f o r persons who are covered t h e employers t h a t cover
them, f o r p h y s i c i a n s and h o s p i t a l s who share i n t h e burden of
uncompensated c a r e , and f o r s t a t e and l o c a l governments who are
unable t o p r o v i d e f o r a l l t h e u n i n s u r e d persons seeking medical
care. The U.S h e a l t h care system s u f f e r s from gross i n e f f i c i e n c y
a t b o t h macro (systemwide) and m i c r o ( i n d i v i d u a l p r o v i d e r
p a t i e n t ) l e v e l s . Researchers e s t i m a t e t h a t 20 t o 30% o f t h e
procedures performed by p h y s i c i a n s i n h o s p i t a l s i s e i t h e r
i n a p p r o p r i a t e , i n e f f e c t i v e or unnecessary. H o s p i t a l i z a t i o n
s i m i l a r f o r r a t e s r e v e a l t h a t 60% o f care i s a p p r o p r i a t e , 23%
i n a p p r o p r i a t e and 17% a v o i d a b l e . Medical and a d m i n i s t r a t i v e
waste a t t o t a l l e a s t $200 b i l l i o n , which c o u l d adeguately p r o v i d e
f o r u n i n s u r e d Americans. Too many o f h e a l t h care employees
f u n c t i o n as a d m i n i s t r a t o r s ( 1 0 % ) , r e s u l t i n g a d m i n i s t r a t i v e c o s t s
t h a t are 60% h i g h e r t h a n Canada and 97% h i g h e r t h a n B r i t a i n .
The abundance o f paper work and r e g u l a t i o n s confuse even t h e most
c o n f i d e n t consumer confused. M a l p r a c t i c e and d e f e n s i v e medicine
can be seen everywhere t h a t h e a l t h care s e r v i c e s are d e l i v e r e d .
Fraud i s another danger t o p a t i e n t s and i s l i k e l y t o be about 10%
of t o t a l a c c o r d i n g t o GAO.
The h e a l t h care has not worked w e l l
.1.
�i n the f r e e market, because the q u a l i t y of services i s not
associated w i t h health p r i c e . The development of services has
been l a r g e l y unplanned, and highly decentralized. As a r e s u l t ,
there i s very l i t t l e coordination across d i f f e r e n t types and
providers of medical care services. I t i s not s u r p r i s i n g t h a t 91%
of Americans believe t h a t the health care system requires
fundamental change or complete r e b u i l d i n g ( From Gallup P o l l
survey of Health care ) .
H i s t o r y and L e s s o n s
The U.S has a long h i s t o r y of f a i l e d attempts t o enact n a t i o n a l
health insurance l e g i s l a t i o n . I n the early 1900's most of Europe
adopted comprehensive s o c i a l insurance programs which included
sickness insurance, as w e l l as insurance f o r i n d u s t r i a l
accidents, d i s a b i l i t y , o l d age and unemployment. The o r i g i n a l
f u n c t i o n of these insurance programs was t o p r o t e c t the working
class and wage earners. The American Association of Labor
introduced l e g i s l a t i o n f o r n a t i o n a l health insurance i n the U.S.
i n the early 1900's, but i t was opposed by both the American
Medical Association(AMA), representing physicians, and the
insurance i n d u s t r y . I n t e r e s t i n health care reform q u i c k l y waned
w i t h the U.S. involvement i n World War I .
The idea f o r n a t i o n a l health insurance re-emerged i n the 1930's
under President Roosevelt. The recommendations of the National
Committee on the costs of Medical Care, which supported the
development of voluntary p r i v a t e insurance, as w e l l as strong
opposition from the AMA, r e s u l t e d i n the i t s absence of n a t i o n a l
health insurance from the Social Security l e g i s l a t i o n enacted i n
1935.
In 1948, President Truman made the issue of n a t i o n a l health
insurance an important p a r t of his Fair Deal campaign. I n
response, the AMA organized the most expensive lobbing e f f o r t i n
American h i s t o r y up t o t h a t time t o defeat Truman's n a t i o n a l
health care proposal. Physicians d i d not want the government
i n t e r f e r i n g i n the p r a c t i c e of medicine. The AMA campaign
successfully defeated President Truman's e f f o r t s , and the issue
disappeared from the American agenda f o r nearly 20 years
f o l l o w i n g the U.S entry i n t o World War I I .
The enactment of Medicare and Medicaid i n 1965 was viewed by
many as a t a c t i c a l r e t r e a t from comprehensive n a t i o n a l health
insurance. The idea was t o take an incremental approach by f i r s t
covering the e l d e r l y and poor, and eventually extending b e n e f i t s
over time t o the r e s t of the population. A serious attempt t o
enact n a t i o n a l health care insurance was attempted i n the early
1970's under President Nixon, but many of the most powerful
i n t e r e s t groups opposed the plan. Once again, other
international(Vietnam) and domestic issues (Watergate) took
.2.
�Precedent over t h e i s s u e o f n a t i o n a l h e a l t h i n s u r a n c e , and
P r e s i d e n t Nixon r e s i g n e d b e f o r e any l e g i s l a t i o n c o u l d be enacted.
In a d d i t i o n , t h e costs o f t h e Medicare and Medicaid programs
exceeded e x p e c t a t i o n s , and t h e major h e a l t h care p o l i c y focus t h e
e a r l y 1970's was t o b r i n g medicare and medicaid costs under
c o n t r o l b e f o r e e x t e n d i n g access t o o t h e r uninsured groups.
H i s t o r y i s v e r y i n t e r e s t i n g t o teaches us t h a t n a t i o n a l h e a l t h
care r e f o r m w i l l r e q u i r e t h e f o l l o w i n g i n g r e d i e n t s : s t r o n g
P r e s i d e n t i a l l e a d e r s h i p , absence o f an i n t e r n a t i o n a l c r i s e s which
may draw t h e n a t i o n ' s a t t e n t i o n away from t h e domestic agenda,
s t r o n g support from a u n i t e d Congress, and an a p p r o p r i a t e r e f o r m
p r o p o s a l which has t h e s u p p o r t ( o r a t l e a s t n o t s t r o n g
o p p o s i t i o n ) o f p h y s i c i a n s , t h e i n s u r a n c e i n d u s t r y , l a b o r and
business.
Goals of reform
The g o a l s o f t h i s n a t i o n a l h e a l t h care r e f o r m p r o p o s a l a r e as
follows:
1. U n i v e r s a l access, b a s i c medical care f o r everyone. No
Americans w i l l be w i t h o u t h e a l t h i n s u r a n c e coverage.
2. C o n t r o l h e a l t h care c o s t s , reduce t h e r a t e o f growth and
impose l i m i t s on h e a l t h care e x p e n d i t u r e s .
3. Reduce a d m i n i s t r a t i v e waste, e l i m i n a t e t h e d u p l i c a t i o n and
i n e f f i c i e n c i e s i n a d m i n i s t e r i n g h e a l t h care and h e a l t h insurance.
4. Improve t h e q u a l i t y and e f f e c t i v e n e s s o f h e a l t h care.
A New
Model
This new model f o r t h e U.S h e a l t h care system draws from
lessons and l e a r n e d from t h e h i s t o r y o f t h e American h e a l t h care
system, and i n t e r n a t i o n a l h e a l t h care models from b o t h
i n d u s t r i a l i z e d c o u n t r i e s and d e v e l o p i n g c o u n t r i e s , and takes i n t o
account t h e American t r a d i t i o n s o f an independent n a t u r e , an
e n t r e p r e n e u r i a l s p i r i t , a g e n e r a l l y p o s i t i v e view o f t h e p r i v a t e
sector, competition, cooperation
and i n d i v i d u a l i s m . The c u r r e n t
h e a l t h care system and my own 16 years experience w o r k i n g a t t h e
M i n i s t r y o f P u b l i c H e a l t h as s e n i o r a d m i n i s t r a t o r , and a l s o
p r o v i d e me w i t h a w e a l t h y o f i n f o r m a t i o n .
The Canadian h e a l t h care model may be an i n s t r u c t i v e model f o r
t h e U.S r e f o r m . Canada's h e a l t h care model,financed t h r o u g h t a x
revenues w i t h s e r v i c e s p r o v i d e d by p r i v a t e h o s p i t a l and
p h y s i c i a n s , i s a s i n g l e payor p r o p o s a l t h a t p r o v i d e s u n i v e r s a l
access t o h e a l t h insurance. The Canadian system has
s u b s t a n t i a l l y decreased a d m i n i s t r a t i v e waste and c o n t r o l s h e a l t h
care costs t h r o u g h g l o b a l b u d g e t i n g and t h e i m p o s i t i o n o f
n e g o t i a t e d f e e s . Because Canada does n o t have a s o c i a l i z e d system
f o r t h e d e l i v e r y o f medical care, most h e a l t h resources a r e i n
t h e p r i v a t e s e c t o r l i k e U.S. Most p h y s i c i a n s a r e independent and
.3.
�are reimbursed by f e e - f o r - s e r v i c e . N i n e t y - f i v e percent of
Canada's doctors work f o r themselves and 90% of hospitals are
p r i v a t e , n o n p r o f i t corporations. I f we are t o r e l y on the
Canadian health care model, however there were be major p o l i t i c a l
b a r r i e r . The Canadian model would e s s e n t i a l l y eliminate the
p r i v a t e health insurance i n d u s t r y and may also be opposed by
taxpayers, would be u n w i l l i n g t o take a major increase i n taxes
to pay f o r coverage.
The B r i t i s h health care model would also be objectionable t o
many. In the B r i t i s h health model, government both finances and
provides services, l i k e l y t o encounter serious opposition from
p r i v a t e physicians and h o s p i t a l s which would be placed under
government c o n t r o l . This model has too strong of a government
Function t o be accepted i n America.
My new model f o r the U.S health care system i s p o l i t i c a l
v i a b l e . I t would not receive strong opposition from any of the
major i n t e r e s t groups, i n c l u d i n g physicians,hospitals,insurance
companies,labors, or p r i v a t e corporations. Most importantly t h i s
model w i l l achieve the goals of American health care reform.
.4.
�A New Modelforthe II. S, Heath
l Care Sysetm
Government
National Health Plan, Policy, Laws
and Regulations, Information, Administration
and Surveillance, Cost Control.
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Global budget to control cost
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Notes:
DRGs: Diagnosis Related Groups System.
HPAQ: Health Price Associated with Quality.
PSRO: Professional Service Review Organiztion.
CON: Certification of Need.
5'
�Implementation
A. Government: H e a l t h care i s a b a s i c r i g h t f o r human b e i n g s ,
and h e a l t h f o r a l l i s g l o b a l s t r a t e g y by t h e WHO. Government has
a r e s p o n s i b i l i t y t o provide f o r the welfare of i t s c i t i z e n s ,
which i n c l u d e s u n i v e r s a l coverage f o r h e a l t h care. A N a t i o n a l
H e a l t h Plan, should be f e d e r a l l y mandated and a d m i n i s t e r e d a t
s t a t e s and l o c a l l e v e l s . H e a l t h p o l i c y and r e g u l a t i o n s a r e a l s o
v e r y i m p o r t a n t . Without r e g u l a t i o n , a c o m p e t i t i v e market may
d r i v e o u t s e r v i c e s f o r t h e v e r y people who need h e a l t h care t h e
most. One i m p o r t a n t r e g u l a t i o n i s t o improve medical e t h i c s and
address t h e problems o f m a l p r a c t i c e , d e f e n s i v e medicine, f r a u d ,
unnecessary t r e a t m e n t and u t i l i z a t i o n , and h e a l t h resources
waste. I f a p r o v i d e r breaks from these e t h i c s , he/she w i l l
be p e n a l i z e d a c c o r d i n g t o t h e circumstances.
I n f o r m a t i o n i s a v e r y i m p o r t a n t f o r c i t i z e n consciousness t o
h e l p people t o make i n f o r m e d d e c i s i o n s about h e a l t h i n s u r a n c e and
p r o v i d e r s . P r e v e n t i o n a c t i v e s should a l s o become an i n t e g r a l
p a r t o f t h e h e a l t h care system. I n v e s t i n g i n p r e v e n t i o n i s
c r i t i c a l t o c o s t containment, access t o e n s u r i n g , and g u a l i t y i n
the h e a l t h care system. Government must enhance on t h e h e a l t h
s u r v e i l l a n c e t o m a i n t a i n g u a l i t y i n h e a l t h care s e r v i c e s go i n t o
a good way. I t i s e s s e n t i a l t h a t t h e government has c o n t r o l o f
the macro r e g u l a t i o n s i n t h e h e a l t h care system.
B. H e a l t h Insurance Purchasing C o r p o r a t i o n s : E s t a b l i s h H e a l t h
Insurance Purchasing C o r p o r a t i o n s t o s e l e c t approved h e a l t h
insurance plans a v a i l a b l e f o r t h e p o p u l a t i o n o f a s t a t e o r
d e s i g n a t e d geographic r e g i o n . This new o r g a n i z a t i o n i s d i r e c t l y
under t h e government, and w i l l assume many o f t h e c u r r e n t
i m p l e m e n t a t i o n f u n c t i o n s o f t h e government. This o r g a n i z a t i o n
w i l l a l s o c r e a t e some t e c h n o l o g i c standards f o r h e a l t h care
s e r v i c e s t o c o n t r o l c o s t s and t o improve t h e g u a l i t y o f h e a l t h
s e r v i c e s . This s i n g l e sponsor p l a n p r o v i d e s u n i v e r s a l coverage
f o r t h e e n t i r e population through a c a p i t a t i o n of h e a l t h
i n s u r a n c e . Premium payment would be based on t h e a b i l i t y o f
employers and employees t o pay t o t h e H e a l t h Insurance Purchasing
C o r p o r a t i o n s . Each i n d i v i d u a l o r f a m i l y would have t h e choice o f
one o f s e v e r a l approved plans and would r e c e i v e t h e i r medical
care from p r i v a t e p h y s i c i a n s and h o s p i t a l s p a r t i c i p a t i n g i n t h a t
chosen p l a n .
C. Insurance companies: H e a l t h Insurance Purchasing
C o r p o r a t i o n s would s e l e c t e f f e c t i v e i n s u r a n c e plans t h a t would
have a g l o b a l , n e g o t i a t e d budget t o cap t o t a l e x p e n d i t u r e s . A
g l o b a l budget f o r a h o s p i t a l means a p r o s p e c t i v e l y s e t , lump-sum
payment, i n s t e a d o f reimbursement f o r i t e m i z e d s e r v i c e s . On t h e
o t h e r hand, g l o b a l b u d g e t i n g f o r p r i v a t e p h y s i c i a n s might mean
annual n e g o t i a t i o n s between payers and d o c t o r s t o predetermine a
t o t a l compensation p o o l . An i n s u r a n c e p l a n may use e i t h e r o r b o t h
of these forms o f g l o b a l b u d g e t i n g . Insurance companies can a l s o
.6.
�use medicare DRGs t o c o n t r o l h o s p i t a l c o s t s and h o s p i t a l
u t i l i z a t i o n by p a y i n g p r o s p e c t i v e l y r a t h e r than r e t r o s p e c t i v e l y .
This system encourages c o m p e t i t i o n among insurance companies.
Managed c o m p e t i t i o n depend on t h e k i n d s o f h e a l t h p l a n s t h a t can
remain competive i n t h i s system. HMOs today i n c l u d e many o f t h e
b e s t h e a l t h - c a r e o r g a n i z a t i o n s i n t h e c o u n t r y . They have shown
t h a t i t i s p o s s i b l e t o p r o v i d e h i g h - g u a l i t y care a t s i g n i f i c a n t l y
lower c o s t . The h e a l t h p l a n s are much more l i k e l y t o keep c o s t s
under c o n t r o l by p r e s s u r i n g d o c t o r t o d i s c o u n t t h e i r fees and by
r e g u i r i n g telephone a p p r o v a l h o s p i t a l i z a t i o n and o t h e r
procedures. HMO's l i k e l y be among those o r g a n i z a t i o n s t h a t remain
competive.
D. Employment-Based and Tax I n c e n t i v e s . The employment-based
system o f h e a l t h i n s u r a n c e i n t h i s model r e g u i r e s employers t o
o f f e r t h e i r employees h e a l t h insurance c o v e r a g e ( p l a y ) o r pay a
t a x i n t o h e a l t h i n s u r a n c e p u r c h a s i n g c o r p o r a t i o n s t o purchase
h e a l t h i n s u r a n c e f o r persons who do not have coverage t h r o u g h
t h e i r employer. A t a x - i n c e n t i v e s p r o p o s a l m o d i f i e s F e d e r a l o r
s t a t e t a x laws t o h e l p i n d i v i d u a l s purchase insurance o r
encourage more e m p l o y e r s , p a r t i c u l a r l y s m a l l employers,to purchase
h e a l t h i n s u r a n c e . Tax c r e d i t s h e l p low income i n d i v i d u a l s t o
s u b s i d i z e t h e c o s t o f h e a l t h i n s u r a n c e , c r e a t i n g a voucher
program u s i n g t h e F e d e r a l t a x system by a l l o w i n g people who do
not i t e m i z e t h e i r d e d u c t i o n s on t h e i r Federal income t a x r e t u r n s
t o deduct p a r t o f t h e i r h e a l t h care c o s t s . I n t h i s case, t h e
p u b l i c i n s u r a n c e program would a l s o cover unemployed, u n i n s u r e d
persons, and leave i n p l a c e t h e e x i s t i n g Medicare and Medicaid
programs.
E. P r o v i d e r s : For managed c o m p e t i t i o n , p r o v i d e r s would compete
t o p r o v i d e t h e h i g h e s t s t a n d a r d of care a c h i e v a b l e w i t h i n
f i n a n c i a l l i m i t s , as consumers can choose between them.
Insurance company uses g l o b a l b u d g e t i n g and DRG, PSRO and o t h e r s
i n c e n t i v e t o make h o s p i t a l s and p h y s i c i a n s c o n s i d e r g u a l i t y and
c o n t r o l over use o f s e r v i c e s t h a t have l i t t l e o r no m a r g i n a l
b e n e f i t t o the p a t i e n t .
F. Consumers: Managed c o m p e t i t i o n r e g u i r e s consumers t o be
conscious o f c o s t s i n choosing among h e a l t h care o r g a n i z a t i o n s
and h e a l t h p r o v i d e r s . Government p r o v i d e s i n f o r m a t i o n t o
consumers so t h e y can make i n f o r m e d d e c i s i o n s by themselves.
One t h e o r y m a i n t a i n s t h a t t h e p a t i e n t should have an u n r e s t r i c t e d
choice o f p r o v i d e r . A Second m a i n t a i n s t h a t consumers
should have an u n r e s t r i c t e d choice o f h e a l t h p l a n s .
I n my p l a n , d e d u c t i b l e and copayments, would range from 10-30%
of h e a l t h s e r v i c e fees depending apon what s e r v i c e s are
p r o v i d e d . For example, a p a t i e n t would pay f o r 20% o f t h e c o s t o f
an o f f i c e v i s i t , 10% o f t h e c o s t o f h o s p i t a l i z a t i o n f o r acute
i l l n e s s o r emergency t r e a t m e n t , a n d 30% o f t h e c o s t s o f
h o s p i t a l i z a t i o n f o r c h r o n i c i l l n e s s . This method o f payment can
.7.
�be an i n c e n t i v e t o consumer t o lessen consumption o f h e a l t h
s e r v i c e s which w i l l h e l p t o c o n t r o l growth o f e x p e n d i t u r e s .
G. Market: This p l a n w i l l develop a h e a l t h care f r e e market,
and
e s t a b l i s h an o p t i m a l p r i c e system. H e a l t h p r i c e should be
a s s o c i a t e d w i t h g u a l i t y . Q u a l i t y i s i m p o r t a n t t h a t h e a l t h care
p r i c e s r e f l e c t t h e g u a l i t y and v a l u e o f s e r v i c e s d e l i v e r e d . As
t h e system stands how p r i c e s i n c r e a s e w i t h o u t any assurance t h a t
g u a l i t y and s e r v i c e i s improved.
B e n e f i t and future
I f t h i s new model i s implemented, I t would a s s i s t America's
economic recovery and d e f i c i t r e d u c t i o n , and I s t r o n g b e l i e v e l y
t h a t t h e America's h e a l t h care system w i l l have a g r e a t f u t u r e .
Under t h i s model, government has t h e power t o c o n t r o l h e a l t h
care e x p e n d i t u r e ,
t h e r e w i l l be u n i v e r s a l coverage, b a s i c
level
of h e a l t h care s e r v i c e s f o r everyone, i n c l u d i n g low income groups
and a h i g h e r l e v e l o f h e a l t h care s e r v i c e s f o r employers and
employees i f t h e y choose t o pay more f o r coverage.. Managed
c o m p e t i t i o n w i l l use market f o r c e s t o c o n t r o l s k y r o c k e t i n g h e a l t h
costs and t o improve t h e h e a l t h care system's performance.
Managed c o m p e t i t i o n w i l l a l l o w groups o f p r o v i d e r s t o compete
w i t h each o t h e r by a l l o w i n g consumers t o choose i n t e l l i g e n t l y
between them. This encourages cost-conscious d e c i s i o n - m a k i n g by
p r o v i d e r s and insurance companies. Managed c o m p e t i t i o n c r e a t
i n c e n t i v e s f o r p r o v i d e r s , i n s u r e r s and consumers t o supply and
seek t h e most e f f i c i e n t care. Large p u r c h a s i n g pools w i l l keep
costs.down by n e g o t i a t i n g p r i c e s w i t h HMO's^PO's, and o t h e r
providers.
Government w i l l t h r o u g h t h e H e a l t h Insurance Purchasing
C o r p o r a t i o n s t o use g l o b a l b u d g e t i n g t o set s t r i c t t a r g e t s f o r
n a t i o n a l and s t a t e h e a l t h e x p e n d i t u r e budgets. The t a r g e t s would
cover p r i v a t e as w e l l as p u b l i c h e a l t h care spending, i n c l u d i n g
Medicare and M e d i c a i d . G l o b a l b u d g e t i n g and managed
c o m p e t i t i o n w i l l moves h e a l t h care i n t o a w o r l d o f e x p e n d i t u r e
l i m i t s . I n t h i s model, H e a l t h Insurance Purchasing C o r p o r a t i o n s
s e l e c t e f f e c t i v e h e a l t h insurance plans and use g l o b a l b u d g e t i n g
at t h e m a c r o - l e v e l t o c o n t r o l h e a l t h e x p e n d i t u r e . Each insurance
companies use g l o b a l b u d g e t i n g a t p r o v i d e r s l e v e l t o c o n t r o l
h e a l t h care s e r v i c e s and u t i l i z a t i o n . Insurance companies a l s o
use DRGs,HPAQ,PSRO and o t h e r technology standards t o i n c e n t i v e
p r o v i d e r s t o c o n t r o l h e a l t h s e r v i c e s and u t i l i z a t i o n . This makes
p r o v i d e r s compete t o reduce t h e p r i c e t o improve t h e g u a l i t y o f
d e l i v e r y a t t h e m i c r o - l e v e l . Consumers w i l l be more conscious o f
costs and reduce h e a l t h care u t i l i z a t i o n . I n t h i s p l a n market
p r i c e s w i l l r e f l e c t s e r v i c e s and g u a l i t y more a c c u r a t e l y . M e d i c a l
and a d m i n i s t r a t i v e waste w i l l be reduced by a t l e a s t $200
b i l l i o n . These s a v i n g w i l l h e l p t o p r o v i d e coverage f o r t h e
uninsured p o p u l a t i o n .
.8.
/
�
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
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Identifier
An unambiguous reference to the resource within a given context
2006-0885-F
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
[New Model Memo] [Loose]
Creator
An entity primarily responsible for making the resource
Task Force on National Health Care
White House Health Care Task Force
Marjorie Tarmey
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 42
<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/12092971" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Preservation-Reproduction-Reference
Date Created
Date of creation of the resource.
2/6/2015
Source
A related resource from which the described resource is derived
42-t-12092971-20060885F-Seg2-042-002-2015
12092971