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Text
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:
Gatz, Carolyn/Klein, Jennifer
Subseries:
OA/ID Number:
5107
FolderlD:
Folder Title:
Overview of Health Reform
Stack:
Row:
Section:
Shelf:
Position:
S
56
5
5
3
�V
\
fh6
^
^'^d^thJ^^
��OVERVIEW OF HEALTH REFORM:
ALL AMERICANS ARE GUARANTEED:
•
COMPREHENSIVE BENEFITS
•
SECURITY AND PORTABILITY OF COVERAGE
•
•
CHOICE OF PLANS AND PROVIDERS
HIGH QUALITY CARE
FEDERAL GOVERNMENT WILL:
•
DEFINE BENEFITS
•
DEVELOP QUALITY, ACCESS, INSURANCE STANDARDS
•
REFORM MALPRACTICE
•
ESTABLISH FRAMEWORK FOR STATE-RUN SYSTEMS
•
SET BUDGETS
STATES WILL:
•
SET UP ALLIANCE TO REPLACE FRAGMENTED INSURANCE
MARKET
•
•
•
GUARANTEE AFFORDABLE COVERAGE THROUGHOUT STATE
ENFORCE QUALITY, ACCESS AND INSURANCE STANDARDS
ENFORCE BUDGETS
HEALTH ALLIANCES WILL:
•
ENSURE AVAILABILITY OF VARIETY OF HEALTH PLANS
•
NEGOTIATE PREMIUMS WITH HEALTH PLANS
•
MANAGE ENROLLMENT
•
PROVIDE CONSUMER EDUCATION AND PROTECTION
HEALTH PLANS WILL:
•
ACCEPT ALL APPLICANTS AT COMMUNITY RATE
•
PROVIDE GUARANTEED BENEFITS WITHIN AGREED-UPON
RATE
DETERMINED TO BE AN
ADMINISTRATiVE MAP '
INITIALS:3MiDATE:!2
4-24-W HETOEAT 1
fBTVTLBWD
fcTXBSEBB&VBBF
"^V.
^9
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS
PROBLEM
SOLUTION
LACK OF SECURITY
• ALL AMERICANS ARE INSURED
• INSURANCE CANNOT BE DENIED OR TAKEN AWAY
REGARDLESS OF HEALTH STATUS
• BENEFITS AT A COMPARABLE LEVEL CONTINUE
REGARDLESS OF EMPLOYMENT OR INCOME STATUS
• ALL AMERICANS AND THEIR EMPLOYERS PAY INTO THE
SYSTEM AT THE SAME RATE REGARDLESS OF THEIR
HEALTH STATUS
^GREATER-CHOICE OF PLANS FOR^IANY^AMERICANS
CONSUMER CONFUSION
• SIMPLE UNDERSTANDABLE BENEFITS PACKAGE
• ONE COVERAGE PACKAGE FOR A FAMILY ^
•-NO-COVERAGE BA'ITLES AMONG INSURERS
• GUARANTEED ACCESS TO PLANS
• CONSUMER COMPLAINT MECHANISM IN PLANS AND
ALLIANCE
• SIMPLE REIMBURSEMENT AND CLAIMS FORMS
• PUBLISHED QUALITY INFORMATION
4-M-M RETREAT 1
nOVILEOED A
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
SOLUTION
• STANDARD REIMBURSEMENT AND ENCOUNTER FORM
PROVIDER HASSLE
• SIMPLIFICATION OF REGULATIONS
HIGH ADMINISTRATIVE COSTS
• ELIMINATION OF INSURANCE UNDERWRITING AND
MULTIPLE RISK PRODUCTS
• SIMPLIFICATION OF CLAIMS AND REIMBURSEMENT
- MOVE TOWARDS CAPITATED PAYMENT SYSTEMS
- SIMPLE UNIVERSAL CLAIMS AND REIMBURSEMENT
FORMS DRIVEN BY UNIVERSAL ENCOUNTER FORMS
• ELIMINATION OF DUAL COVERAGE AND COVERAGE
DETERMINATION PRACTICES
• SIMPLIFICATION OF PRODUCT REDUCES NEED FOR
AGENT TO ASSIST CONSUMERS
• REDUCTION IN COSTS OF SMALL GROUP
ADMINISTRATION
• REDUCTION IN REGULATORY REQUIREMENTS — FORM
FILLING
• REDUCTION IN MALPRACTICE PREMIUMS
• REDUCTION IN TIME SPENT BY PROVIDERS AND
INSURERS INVESTIGATING OR DEBATING
RE 1MB URSABILITY
•-M-W RETREAT 8
PMVIUEOED *
cam
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
SOLUTION
UNNECESSARY TESTS AND
PROCEDURES
• BUDGETED/CAPITATED SYSTEMS DISCOURAGE
UNNECESSARY UTILIZATION AND INTENSITY OF SERVICE
BY PROVIDERS
• GATEKEEPERS GN HMOs OR PPOs), SOME USE OF COPAYS
IN FEE FOR SERVICE PLANS AND PRICE COMPETITION
WILL DISCOURAGE UNNECESSARY CONSUMER USAGE
• NATIONAL TECHNOLOGY ASSESSMENT AND BETTER
INFORMATION ON PRACTICE PATTERN DIFFERENCES AND
EFFECTIVENESS OF TREATMENT WILL ENHANCE COST
CONSCIOUS/HIGH QUALITY PRACTICE
• BUDGETED/CAPITATED SYSTEMS ENCOURAGE MORE
PRUDENT USE OF TECHNOLOGY AND MORE COST
EFFECTIVE CAPITAL INVESTMENT
• MALPRACTICE REFORMS WILL CUT THE COSTS OF
MALPRACTICE INSURANCE AND DEFENSIVE MEDICINE
UNDERSERVED POPULATIONS
• UNIVERSAL COVERAGE
• INCREASED INVESTMENTS IN INFRASTRUCTURE IN
POOR URBAN AND RURAL AREAS AND IN PUBLIC HEALTH
• PREVENTION OF "RED LINING" OF HEALTH ALLIANCES
• RISK ADJUSTMENT OF POOR POPULATIONS
• HEALTH ALLIANCE RESPONSIBILITY FOR BUILDING
HEALTH NETWORKS WHERE NONE EXIST
4-M-M RFTHEAT 4
PRIVILEGED it I
�ADDRESSING THE PROBLEMS: THE WORK TEAM PROPOSALS (CONT'D)
PROBLEM
SOLUTION
INADEQUATE LONG-TERM CARE
• EXPANDED OPPORTUNITIES FOR HOME CARE AS
BEGINNING OF SOCIAL INSURANCE PLAN
• RAISING MEDICAID SPEND DOWN LIMITS
• INCENTIVES/REGULATION FOR PRIVATE INSURANCE
MARKET
4-M-M RenBAT 6
PRIVILEGED *
eamoemti.
�W.' fn yd]
ct(U)ffs
�~
FRIDAY, APRIL 23,1993
THE WASHINGTON POST
A23
Charles Krauthammer
Holocaust
Vy^eum
WhefminfamY
achien 's imr
^Ishaveslong/be
.idMofa'Hol&a
iSgfon If there
the Jewish exp<
America, iwhy
^cafst'Why^
,:; *:such an epK
selves to P
7 - the grea
" Jew a?
. .want
may r
cam
ft
Iv
••••. V
3
;
raticxom-:„
1 of^hesel^ f
1
the^cere^, \
•impeachr^
to
filve^
hesWklu.
^ntm^sf|t
!g? W ^ ^ ^ B L
^utKwe-'donlElkJr
cW& W&™* $?'?
how'are we |oing to determme if the new system costs "
a
n
J
C0
4
tot^x^ife <4J3£**s
ca>ta
^ basis, jye are spending more or less' '
.
ion,'and * "i^ ^ M # e ^ i s - t h m M t h e sources of funding m the new
'^ystem^will tngt)ie t^s^bfuscated, it mayreality it will
expensive to & ^ v ^ i J m e r K a n , when in look more
w^Je^Sl
••eslPin-).
side of
u l
r
unveiled and i t s W s are analyzed- knowmgovhat we pay
noVfis our only hope if each American isfto honestly
evaluate this--:plah. If we-can compare costsriwe .can-ask
smart ^questions and make good decisions: .If: we cannot,;
we will be choosing blind
• •,'' v : V, T .: j
v
• In this case, the old saw is wrong: What you don't know!
can hurt you
A '. ' . .
_
The writer ts aDemocrattc senator from South Dakota.
:
;
: ;
:
�THE U.S. SPENDS FAR MORE PER PERSON THAN ANY OTHER COUNTRY
o
In 1990, the U.S. ($2,566) spent 45% more per person on health care than Canada
($1,770), the second highest country.
o
Americans spend almost 75 percent more than the French ($1,532) and Germans
($1,486), and over twice as much as the Italians ($1,236), Japanese ($1,171), and
British ($972).
o
Even taking account of its greater wealth, the U.S. spending is over $700 per capita
higher than it would be, if it were based on the average GDP-health spending
relationship found in other western industrialized countries.
o
Worse still, the gap between the U.S. and other countries has been widening over
time.
�THE U.S. SPENDS THE LARGEST SHARE OF ITS GDP ON HEALTH
o
In 1990 the U.S. spend 12.1% of its GDP on health, 59% more than the 7.6%
OECD average.
o
The next highest countries were Canada (9.3% ), France (8.8% ), Sweden (8.6% ),
Iceland (8.6% ), Austria (8.2% ), the Netherlands (8.2% ), and Germany (8.1% ).
o
The U.K. (6.2%) and Japan (6.5%) were substantially lower.
While most other OECD countries have had relatively stable shares since the erly 1980's,
the U.S. share continues to increase.
�1
I
DISCUSSION
We cannot make definitive judgements due to our inability to evaluate outcomes.
Nevertheless, there do appear to be large differences in availability, use, costs, and gross
outcomes across countries.
The United States generally differs from other countries in these respects:
1.
No single payor or set of rules affects the whole system.
2.
Other countries generally make greater use of prospectively-established global
budgets for hospitals and inpatient physician services. Ambulatory care physicians
are often paid on a salary or capitation basis.
3.
Many countries have stringent planning for both hospital capital investment and
outpatient diagnostic equipment.
4.
Some countries place far greater responsibility for thefinancingof health care at
regional and local levels.
5.
Private insurance and insurance subsidies are much less pervasive and private
insurers see themselves as secondary to the public system.
�Acute Hospital Average Length Of Stay For
Selected OECD countries
14
12 in
11.2
10.5
o
X)
10 -
in
8-
CP
7.0
6-
c
V
0)
o
Canada
(89)
France
(90)
Germany
(89)
Italy
(85)
S U C : Schleber, G J., Poullier. J. P . Greenwald, L. M,
ORE
.
.
.
" . S. Health Expenditure Performance: A International
U
n
Comparison and Data Update,"
Health Care Financing Review, S m e 1992,
umr
�. .
Inpatient Days Of Care Per Capita
for Selected OECD Countries, 1990
4. 1
I
I
.I
OECD
-----+-j..... Average
1.8
~
!
2.0
•
1.2
~~~
.....
2.6
.
�Nutnljer of Meflicfil ttetln prr 1,000 population
tor Hnh^'itMl (WV\) iMHinlricR, l J«9
f
IB
•i 1
4
I
OECO
Average
9.1
7,2
6..6
1
5
< 3f< < 2
& fi & & i
fPrQfPKc^
©^fWK3rf^
Uttfiri^
UK.
�U.S. HAS FEWER HOSPITAL BEDS, AN AVERAGE NUMBER OF PHYSICIANS,
USES LESS SERVICES PER PERSON, AND HAS THE
HIGHEST COSTS PER UNIT OF SERVICE
o
The U.S. has fewer inpatient medical care beds per capita than most other OECD
countries.
o
The U.S. has lower use rates of inpatient medical care beds than most other OECD
countries.
o
U.S. average lengths of hospital stays are the lowest of all major OECD countries.
o
U.S. costs per day, per stay and for specific medical procedures are the highest in
the world.
We appear to practice a much more intensive and costly style of medicine in the U.S.. but
we don't know if we have a sicker population, are merely inefficient, have more amenities,
and/or have a higher quality of care.
�Number of physicians per 1,000 population
41
-l
I
I
I
!
.3.0
3 :0
0
0
'
I
- 2 !t-
2."i
-----------
2.2
------------·-·
-----~-
~~-
~-2.3
~
1.6
'
"QJ
a..
1.4
1.3
1
'
L.
.
'
!
I
I
oL
Canada
(90)
France
(90)
Germany
Italy
(89)
(89)
Japan
(90)
SOURCE: Schieber. G. J .• Poull1er. J. P .. Greenwald. L. M
..
"U. S. Health Expenditure Performance: An International
Comparison and Data Update. •
Health Care Financing Review. Summer 1992.
U.K.
(89)
u.s.
(88)
- - - 1 ·.......
OECD
Average (90)
2.4
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
�Volume and Intensity Explains Most of the Growth in Health Spending
3.50%-
3.00»-
1980-1990
1970-1980
VOIUBM & bitaMitjr Per Capita
H
1990-2000
Mediod Inflation in Exoew of Gcnenl Inflation Q Relative Aging of Population
D
fHEDECMPJCLWJsourceB of red growth
�Inpatient Hospital Services Today Contribute Less to Health Care Cost Growth than Physician
Services
-i
Inpatient
Hospital
Outpatient
Hospital
Other
Hospital
1
Physician
Services
1
Dental
Services
1
1
1
1
r
Other
Home
Drugs*
Durable
Nursing
Other
Professional Health Care
NonMedical
Home Care
Personal
Services
Durable
Equipment
Health Can
11970-1980 E l 1980-1990 B 1990-2000
(COSJ(LW]contrib 7040,80-90,90-00
�Administrative Costs Are Higher for Health Insurance Sold to Small Business
40% - r
mm
3 35%
I
& 30%
s
£ 25%
WM
20%
3 15%
10% - -
5% - 0%
--i
<5
Workers
5-9
10-19
20-49
50-99
101-499
5002499
25009999
>10000
Workers
Small Business Admin
�Despite Having Higher Inpatient Costs, the US has Fewer Hospital Beds Than Most Other
Countries
Canada
Franco
Germany
1977 • 1986
UK
US
�US Physicians Earn More than Physicians Elsewhere
160000
140000
120000
100000
80000
60000
Mi
Sill
•unit
ittti
Pi
40000
ft
20000
M r
Canada
Germany
i i 1975 •
UK
US
1981 • 1986
ancbttctwrtlS
�WHAT IS RIGHT WITH AMERICA'S HEALTH CARE SYSTEM?
MOST AMERICANS ARE HAPPY WITH THE QUALITY OF CARE
THEY RECEIVE FROM THEIR DOCTORS.
MOST AMERICANS HAVE ADEQUATE CHOICE OF DOCTORS
AND TYPES OF CARE (THOUGH NOT IN UNDERSERVED
AREAS).
MOST AMERICANS HAVE NEGOTIATED HEALTH CARE
BENEFITS WHICH THEY FEEL ARE ADEQUATE (THOUGH THEY
FEAR LOSING THEM).
DETERMINED TO BE AN
ADMINISTRATiVE MARKING
INITIALSi-l^-DATE^lpi/t^
�MAJOR PROBLEMS WITH TODAY'S HEALTH SYSTEM
COSTS ARE HIGH AND RISING TOO FAST — OVER 14% OF GDP
VS. LESS THAN 9 IN GERMANY AND LESS THAN 8 IN
%
%
JAPAN.
LACK OF SECURITY ~ ONE IN FOUR AMERICANS LOSES
COVERAGE EVERY TWO YEARS.
NOT USER OR PROVIDER FRIENDLY — IN SURVEYS, MOST
CONSUMERS AND PROVIDERS FIND THE SYSTEM TO BE
BUREAUCRATIC, CONFUSING AND FRUSTRATING.
MANY AMERICANS ARE UNDERSERVED — 37 MILLION LACK
COVERAGE; 22 MILLION HAVE ONLY "BARE BONES"
COVERAGE; MANY RURAL AND POOR URBAN AREAS LACK AN
ADEQUATE MEDICAL INFRASTRUCTURE.
INADEQUATE LONG-TERM CARE — AN INCREASING NUMBER
OF PEOPLE REQUIRE LONG-TERM CARE.
WHIVIUCZD* tioiirnBwnii'i n-m-i
�WHY COSTS ARE RISING IN HEALTH CARE
HIGH ADMINISTRATIVE AND TRANSACTION COSTS
•
INSURANCE UNDERWRITING AND CLAIMS
PROCEDURES
•
INEFFICIENT REIMBURSEMENT AND QUALITY
SYSTEMS
INCENTIVES FOR UNNECESSARY CARE
•
PROVIDERS PAID BY THE TEST OR PROCEDURE
ENCOURAGING MORE TESTS AND PROCEDURES TO
BE PERFORMED
•
CONSUMERS ABLE TO ACCESS THE SYSTEM AS
THEY WISH WITH FEW INCENTIVES TO LIMIT USE
TO NECESSARY OCCASIONS
•
FEW INCENTIVES TO EVALUATE NEW TECHNOLOGY USAGE AND CAPITAL INVESTMENTS FOR
COST EFFECTIVENESS
•
TO A LESSER EXTENT, DEFENSIVE MEDICINE
PRACTICED TO AVOID LAWSUITS
HMWILBGED
* miliumin n-w-i
�WHY THERE IS LACK OF SECURITY
THE ORGANIZATION OF THE U.S. INSURANCE MARKET
•
INSURANCE COMPANIES COMPETE BY RISK
SELECTION — TRYING TO INSURE ONLY THOSE
WHO ARE UNLIKELY TO BECOME ILL AND
DROPPING THOSE WHO DO BECOME ILL — IF YOU
ARE LIKELY TO NEED CARE, YOU HAVE DIFFICULTY
BEING COVERED
•
HEALTH CARE BENEFITS FOR MOST AMERICANS
(THOSE WHO ARE NOT OVER 65 YEARS OLD OR WHO
ARE NOT POOR OR SEVERELY DISABLED) ARE TIED
TO EMPLOYMENT
NOT ALL EMPLOYERS PAY TO COVER THEIR
EMPLOYEES
LOSING OR CHANGING JOBS CAN MEAN LOSS
OF COVERAGE
-
AS COSTS RISE, MORE EMPLOYERS ARE
DROPPING COVERAGE AS A COMPANY PAID
BENEFIT OR INCREASING THE EMPLOYEE
REQUIRED PAYMENTS WHICH CAUSES SOME
EMPLOYEES TO CANCEL COVERAGE
�WHY THERE IS LACK OF SECURITY (CONT'D)
AS A RESULT, 37 MILLION AMERICANS ARE
UNINSURED AND ANOTHER 22 MILLION LACK
ADEQUATE INSURANCE. MANY ADDITIONAL
AMERICANS LIVE IN FEAR OF LOSING THEIR
COVERAGE IF THEY LOSE THEIR JOB, THEIR
EMPLOYER CUTS BACK ON HEALTH CARE
PAYMENTS OR THEY OR A FAMILY MEMBER
BECOME ILL
ntrameoED * OONRBMIMM-U-W - •
�THE SYSTEM IS NOT USER OR PROVIDER FRIENDLY
THOUGH MOST AMERICANS FEEL OKAY ABOUT THE QUALITY
OF CARE THEY RECEIVE, THEY ARE FRUSTRATED BY:
•
THE COMPLEXITY OF THE CLAIMS AND
REIMBURSEMENT PROCESS
•
UNCERTAINTIES ABOUT WHAT IS OR IS NOT
COVERED IN THEIR INSURANCE POLICY
HEALTH CARE PROVIDERS ARE ALSO FRUSTRATED BY THE
BUREAUCRACY THEY MUST ENDURE AND THE MICROMANAGEMENT BY GOVERNMENT AND INSURANCE
COMPANIES OF THEIR DAILY ACTTVITIES.
•
DRG AND RBRVS REQUIREMENTS
•
MULTIPLE UTILIZATION REVIEWS
•
CLIA
•
PRO'S
•
MULTIPLE REGULATING AUTHORITIES
OtmOVILIQB) * K.miUMWMll 11-W • •
�WHY MANY AMERICANS ARE UNDERSERVED
PROVIDING COMPREHENSIVE HEALTH BENEFITS FOR
UNINSURED AND UNDERINSURED AMERICANS WILL STILL
LEAVE MANY AMERICANS WITHOUT ADEQUATE HEALTH
CARE.
•
INADEQUATE INFRASTRUCTURE— DOCTORS,
HOSPITALS, ETC. — IN MANY RURAL AND POOR
URBAN AREAS
•
POOR HEALTH EDUCATION AND INADEQUATE
PREVENTIVE SERVICES
M/PEVmOED
U U I H M I W m i l I I I I -T
�INADEQUATE LONG-TERM CARE
AN INCREASING NUMBER OF AMERICANS WILL REQUIRE
LONG-TERM CARE AT SOME TIME DURING THEIR LIVES
•
AGING OF THE POPULATION
•
INCREASING ABILITY TO MAINTAIN LIFE AFTER
SEVERE ACCIDENTS, BIRTH DEFECTS, SEVERE
ACUTE ILLNESSES
THE FAMILY IS LESS ABLE TO PROVIDE CARE AT HOME
(
•
MOBILITY OF POPULATION
•
AGING OF POPULATION MEANS CHILDREN OF OLD
ELDERLY MAY THEMSELVES BE ELDERLY
•
INCREASED PARTICIPATION OF WOMEN IN THE
WORK FORCE
•
DECLINING REAL INCOMES OF MANY FAMILIES
THE PROBLEM GROWS DRAMATICALLY IN 20-30 YEARS
DUWILBOED
* eamDBnuM-u-n - •
�4
�TOPS FORM
75<81
�To.
Data.
.Time
f.
WHBLE Y O U W S R E O U T
^ Tom eicR-e.
at.
Phone
Area Code
Extension
Number
TELEPHONED
PLEASE CALL
CALLED TO SEE YOU
WILL CALL AGAIN
WANTS TO SEE YOU
URGENT
RETURNED YOUR CALL
Message.
c
Operator
AMPAD
EFFICIENCY®
23-021 -200 SETS
23-421 -400 SETS
"7
CAR BONLESS
�04-20-1993 15:34
P.13
THE
PPBERTWCJDD
JOHNSON
FOUNDATION
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TELECOPIER TRANSMITTAL COVER SHEET
DATE i
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�04-S0-1993
P.01
15:29
(had)
convftraationt on Health«
Text and Conmentary
(copy)
w
o
fditor'0 note; In March, the foundation
hosted tour "Conversation* on Jfealth,"
at vhich pro and con puJblic comment vas
elicited on the condition of the
nation's health care system. The forums
in Tampa, Florida and Des Moines, lova
were attended hy Mrs. Hillary Aodhara
Clinton and the joeetingr in DearJborn,
Michigan and f/ashingrton, DC were
attended by Sec. ot HHS, Division of
and by Mrs. T. Gore.
The full proceedings o/ those
hearings will he availahle this summer.
This Aflyances
provides a
sampling ot the testimony, interleaved
vith commentary on the hearings and the
issues they addressed from Dr. Stephen
Schromdmr, the Foundation's president,
who chaired
the
hearings.
There are people left out, hurting,
dying, who have no place to go. I have
minimal insurance tbat does not cover m
y
••
�P.02
04-20-1993 15:29
probl*a. X'B toarad to daath.
I'M a
prof•••ional, I have tvo children and
Z'a tingle, who ia going to help «•
when I have ohaaotbarapy and have to go
home along and don't even have anybody
to pay Ay billa?
Helen* Kramer, Tampa bladder
cancer patient who is unable
to obtain health insurance
Several factors impelled us to hold
• 'i
I:
if'..:. •
»
these hearings — the most powerful
being that, for the first time in the
Foundation's history, health care reform
had moved to a position of high
r•
prominence in public debate, and a very
real prospect existed that major changes
might be eminent.
We also had polling data that
indicated there was a major discrepancy
between what the public thought was at
the root of the problem, and what the
experts thought — the kind of dichotomy
that makes i t hard to convert political
intent into good public policy.
Remember what happened with catastrophic
•til.
�04-20-1993
P. 03
15:30
health insurance several years ago.
The
experts thought that a specific type of
legislation vould benefit the elderly.
It vas proposed by the Reagan cabinet,
passed by a Democratic Congress and
instantly shouted out of existence by
the very people i t was intended to
assist.
We saw a role for the Foundation in
o
bringing to the surface the public's
perception of the real issues in health
care, in part for the benefit of the
administration's health care task force.
o
The task force at that point was an
anonymous group of academic experts
working behind closed doors. We thought
o
i t worthwhile to expose the task force
2
or, at least, i t s spokesperson,
Mrs. Clinton — to what real people
thought about these issues.
I don't like to go into town
anymore, beoause I just can't see how
I'm going to buy anything because a l l my
money i s going for health oare.
You
have to sell a oow every month to pay
for health insurance — a big one.
�04-20-1993
P. 04
15:30
Jin Kaplan, Chelsea, Iowa,
fanner
My husband and daughter are both
diabetic, whieh males a them ineligible to
obtain any other inauranoe than we have
at the present time ... This year we are
paying $0/400 in premiums. Our income
this year from our 160-acra farm was
$12,300 ... Ky ooneern is, if we had to
drop our insuranee and had to be in the
'
I., . v
hospital for any length of time, i t
would deplete our resouroes and our
farm, which has been in my husband's
family for •6 years, would be in
jeopardy.
Betty Lange, Garner, Iowa
I came away from these
Conversations with several impressions:
First, how central an issue health
care is, how deeply it touches many,
many people. And not just those we
invited to talk, but those who commented
from the audience or spoke to me at
intermissions, or who wrote the many,
•»
o
�04-20-1993 15:31
P.05
5
many letters we received after the
hearings
Health ears eeverage fer the
uninsured, childhood immuniiation and
other preventive oars, long-term
institutional oare, in-home nursing
©
ears, servioes for the chronically i l l
and disahled, prescription drugs, mental
health oare, substanoe abuse treatment,
?
ehiropraotio treatment, transportation
and other outreaoh servioes to the
disadvantaged, continuation of the
Indian Health serviee as a separate
entity, genetio research, servioes of
nurse praotitionera, physician's
assistants and physical therapists, AIDS
researoh and treatment, skilled nursing
oare, dental oare, oatastrophio illness
ooverage, hospice oare.
Partial l i s t of services
requested for inclusion under
universal health care by
1
"Conversations' participants
Secondly, we learned that the needs
and demands that people had of health
r
,
�04-20-1993
P. 06
15:31
car* ware almost inexhaustible.
Everybody was able to say what they
wanted. But how to pay for that was
less clear. We could see the dilemma
that Congress will have to face. There
is a huge public appetite for more, but
there i s a public resistance to paying
more. Somehow, Congress must reconcile
<
those two.
* - « :
>
Third, the importance of
voluntarism and the spirit of
«v • • •i
'
"• 'A <•••••
voluntarism is crucial to any current or
future system.
a
i
V.,4'
And, perhaps above a l l , we must
maintain an emphasis on need values and
caring: that came up over and over
again.
There is a real concern that, in
our quest for efficiencies, and the
tendency recently to view health care as
a business, we run the risk of turning
i t into a bloodless commodity.
I work for the Department of Health
and Rehabilitative servioes ... X deal
with a lot of poor people ... who didn't
choose to be poor. They are people who
worked hard a l l their lives, they
'.
'
•.
1
�04-20-1993 15:31
P.07
7
retire, tbey come to Florida, one of
tbea gets »ioX end they kiss their
••vings goodbye, vow they're very poor.
They era people who have to nake very
baaio ohoioea betveea food and aedioine.
They Make partial payment! on their
•0
«»*
eleotrioity every month beoauae they
have to buy their medicine ... A great
<
mieooneeption ia that xedioare buya
medioine. That'a not true.
fc i ;
Florida, social worker
What the Conversations did not do
C.
V'-i .-.
f'-'
Ruby Gackney, Sarasota,
I'..
I.
i
d
well was get at the issue of trade-offs,
which were only hinted at, but which
will be the core of the debate to come.
I think that mirrors a problem with the
political process. It's much better at
responding to groups trying to mobilize
support for something than i t is at
judging how to balance the inevitable
trade-offs and options.
Our Bodioal staff consists of two
medical doctors and tvo physician's
assistants, but 16 full-time and two
n
�04-20-1993 15:32
P. 08
8
part-tiat •mployaai. four and a half of
thaaa amployaaa do nothing but inauranoe
billing and rebilling...1 spend
approxiaataly an hour and a half a day
doing office paperwork, whioh inoludea
dictation, signing records, doing
insurance reports, billing and
rebilling.
a
Dr. Gerald Stanley, Onawa,
Iowa, family practitioner
if.l'.a;'
if.,.
<f....
W estimate that the cost of a car
e
produeed in Japan has $500 less health
oare cost in i t than a oar produced in
the U.S. And the situation gets even
worae in trying to ooapete in our own
country against German and Japanese
transplant companies. The average age
of a B W worker coming into Spartanburg,
M
South Carolina i s 15 years less than the
average age of our employees. They will
not have any retirees for probably tbe
next 20 to 30 yeara...we have
approziaately one retiree for each
aotive worker.
�04-20-1993 15:32
P.09
9
Richard O'Brien, Vice
President, corporate
personnel, General Motors
The Clinton administration i s to be
congratulated for bringing the issue of
• *.-vi
.*
YH
Si,,"-
health care reform to center stage, and
imbuing i t with a sense of urgency.
But
. ,
1
i t may have set a trap for i t s e l f by
,,
('i
,,
promising a solution to the problem
•
!
\ ,:''
this year.
The fact i s , we w i l l never
fully resolve i t . W w i l l be working on
e
1
•
•
'
1
•
1|
!
health care and trying to get i t right
forever.
I don't know any country has
1
1
i t right. Some countries have i t better
in some respects than ours.
But the
conflict between what people want and
our ability to pay for i t , given the
state of technology, may well be
irreconcilable.
Even i f our political
leaders came up with a solution that
everyone considered "right" in 1993, i t
would be inadequate to deal with
whatever situation exists in 1997.
i s a perpetually moving target.
This
.VL,
.V-
�04-20-1993
P. 10
15:33
10
M f«tfa«r-ia-Uv, at tha aga of 52,
y
had to zatiro uadar peraaaant dlaabllity
or two major heart attaeka. He brings
in a total of fio ooo per year for him
#
and his wife. Over $5/000 of that goes
Z
0
for his health ooverage. Ha lives on
$319 a months/ whioh is a disgraoe.
Something has got to be done.
Linda Snyder, Tampa witness
•ran
a
u, n
Some Republican leaders have been
highly critical of the "Conversations on
Health," accusing the Foundation of
allying itself with the Democratic
administration, i f the G P had retained
O
the White House, the Democrats would
probably be mad at us for inviting the
head of the Republican administration's
health care reform team to such
hearings.
Health care reform was destined to
be on the American agenda, regardless of
which party won last year's election,
and these Conversations flowed very
directly from the Foundation's
21-year-old mission to improve to
o
�0 4 - 2 0 - 1 9 9 3 15:33
P.11
11
improve hoalth and health oare for a l l
Amerioane.
Anything this — one-seventh of our
national budget — takes on powerful
political aspects,
so the price of
getting involved in i t i s the assumption
of some political vulnerability.
2!
But
*'
*
that risk was worth taking, because to
be inactive was to become irrelevant to
AW- '
our own mission.
I know we need change, but please
go at i t slowly and precisely.
Investigate a l l avenues. Keep asking
\*>"
^
h
^
V: " t ^
'
> "'i
a l l these questions over and over. W
e
do not need to exchange one set of
problems for another. And please, I
enoourage you, please keep government
and the politicians out of your final
plan. Their record on management i s not
one I look up to.
Bonnie Dellinger, small
business office manager in
Detroit
I greatly hope that health care
will not be framed as a partisan issue.
•_„
.O
�04-20-1993 15:33
P. 12
12
I t i s too vital, too laden with values.
Our best hope of giving this country a
system that meets its needs rests with
keeping those values always before us.
To the extent that we fragmented i t ,
make i t partisan, make i t parochial, we
endanger our hopes of an adequate
solution.
•«
V
o
�Average Annual Percent Change: Private Health Insurance Spending
Per Insured Person, and Medicare Spending Per Enrollee, 1975-98
Time Frame
P r i v a t e Insurance
1975-80
1975-85
1975-90
1975-95
1980-85
1980-90
1980-98
1985-95
1980-95
Medicare
15.96%
13.97%
12.20%
11.07%
12.02%
10.36%
NA
8.25%
9.49%
SOURCE: O f f i c e o f the Actuary, HCFA
14.72%
15.92%
NA
10.75%
11.93%
9.66%
9.17%
8.25%
9.46%
�Average Annual Percent Change: Private Health Insurance Spending
Per Insured Person, and Medicare Spending Per Enrollee, 1975-98
Time Frame
P r i v a t e Insurance
1975-80
1975-85
1975-90
1975-95
1980-85
1980-90
1980-98
1985-95
1980-95
Medicare
15.96%
13.97%
12.20%
11.07%
12.02%
10.36%
NA
8.25%
9.49%
SOURCE: O f f i c e o f the Actuary, HCFA
14.72%
15.92%
NA
10.75%
11.93%
9.66%
9.17%
8.25%
9.46%
�REPORT TO CONG
POLICY PAPERS
OP-ED/OTHER
WEEK1: 4/17
ORGANIZE/
OUTLINE/
ASSIGN/
BEGIN DRAFT
COMPILE
TOPICS/
ORGANIZE
EDITORS/
ORGANIZE STAFF
LETTER FROM
IRA/BOORSTIN
SOLICIT IDEAS
WEEK 2: 4/24
WRITE
ASSIGNMENTS
DUE 4/19,20,21
SET TENTATIVE
TOPIC LIST/
MAKE
ASSIGNMENTS
SOLICIT IDEAS
WEEK 3: 5/1
DRAFT COMPLETE
REVIEW
NEW
ASSIGNMENTS
STRATEGY FOR
DISTRIBUTION/
ARRANGE
PLACEMENTS
WEEK 4: 5/8
REWRITE
REVIEW
PAPERS DUE/
EDITING
DRAFT NEW
ENGLAND
JOURNAL/
ACCEPT
SUBMISSIONS
WEEK 5: 5/15
REWRITE/POLISH
REVIEW
EDITING
COMPLETE NEW
ENGLAND
JOURNAL/
ACCEPT
SUBMISSIONS
WEEK 6: 5/22
REVIEW
COMPLETE
EDITING
PLACE OP-EDS
WEEK 7: 5/29
PRINTING -RELEASE DATE
OF PRESIDENT'S
ADDRESS
EDITING
PLACE OP-EDS
REVIEW/REWORK
PUBLISH IN
JUNE
PLACE OP-EDS
CONTINUE
THROUGH SUMMER
WEEK 8: 5/31
j
�A p r i l 14, 1993
EDITORIAL ORGANIZATION
HEALTH CARE REFORM WORKING GROUP
FOR REPORT TO CONGRESS:
WALTER ZELLMAN
SECTION DRAFTERS:
LOIS QUAM
MARK SMITH
GARY CLAXTON
ROBYN STONE
CHRISTINE HEENAN
JENNIFER KLEIN
BERNIE ARONS/CHARMAN STEVENS
SHOSHANA SOFAER
ATUL GAWANDA
SHERRY GLEAD
ARNIE EPSTEIN/ REESA LAVISSO-MOUREY/ ROZ
LASKER
LIAISONS:
JENNIFER KLEIN
JUDY WANG
SCENARIOS:
JENNIFER KLEIN
CHRISTINE HEENAN
SIMONE RE«zSN¥BER'fc.\)£$CU&M<&V£K.
JUDY WANG
SHOSHANA SOFAER
LINDA BERGTHOLD
RESEARCHERS:
POLICY ASSISTANTS
(MEET 8 A.M. THURSDAY, APRIL 15)
POLICY COMPENDIUM:
EDITORS:
PAUL STARR
CAROLYN GATZ
ROBYN STONE
KATHY MARCONI
JENNIFER KLEIN
BILL SAGE
CHARMAN STEVENS
LYNN MARGHERIO
�A p r i l 15, 1993/P.S.
AN AMERICAN CHALLENGE
National Health Security
Report t o Congress
Rough O u t l i n e
Introductory
Letter of transmittal
C o n t r a c t w i t h t h e American people
Chapter 1. AMERICA'S ACHIEVEMENT, AMERICA'S CHALLENGE
Our achievements i n h e a l t h care
The nature of the challenge
What we cannot do
What we can do (goals of reform)
Accepting the challenge
Chapter 2. WHY WE NEED COMPREHENSIVE REFORM
The s p i r a l of c o s t s
The s p i r a l of i n s e c u r i t y
The s p i r a l of complexity
The case f o r comprehensive reform
Chapter 3. A NEW SYSTEM OF HEALTH SECURITY
Capsule d e s c r i p t i o n : how new system works
Consumers' p e r s p e c t i v e : c h o i c e s and b e n e f i t s .
Consumer h e a l t h a l l i a n c e s
New r u l e s f o r h e a l t h plans
R e s p o n s i b i l i t i e s of stand-alone employer p l a n s
How coverage would be financed:
f o r t h e employed p o p u l a t i o n
f o r t h e nonworking p o p u l a t i o n
�Cost control
State f l e x i b i l i t y i n organizing health care
Chapter 4. IMPROVING HEALTH CARE
P r i o r i t y : Quality
P r i o r i t y : Less Hassle
P r i o r i t y : Prevention and Primary Care
P r i o r i t y : Protecting Vulnerable
Chapter 5. REINVENTING REFORM
The path to a reformed system
The future of current programs
The health care devolution
Populations
�A p r i l 15, 1993/P.S.
AN AMERICAN CHALLENGE
National Health S e c u r i t y
Report t o Congress
Rough O u t l i n e
Introductory
Letter of transmittal
C o n t r a c t w i t h t h e American people
Chapter 1 . AMERICA'S ACHIEVEMENT, AMERICA'S CHALLENGE
Our achievements i n h e a l t h care
s c i e n t i f i c and t e c h n i c a l e x c e l l e n c e ;
w e a l t h o f p r o f e s s i o n a l t a l e n t , commitment;
improvement i n h e a l t h o f t h e aged and t h e
poor s i n c e Medicare and Medicaid;
c r e a t i v e a p p l i c a t i o n t o medicine o f new
technologies;
i n n o v a t i o n s i n o r g a n i z e d systems o f c a r e .
The n a t u r e o f t h e c h a l l e n g e :
( 1 ) i n s e c u r i t y - - l a c k o f r e l i a b l e coverage;
j o b l o c k ; uninsured.
( 2 ) c o s t s - - t o i n d i v i d u a l , t o economy, t o
public sector.
misuse o f r e s o u r c e s - - o v e r i n v e s t m e n t
and u n d e r u t i l i z a t i o n o f h o s p i t a l s
and t e c h n o l o g y ; b i a s toward
s p e c i a l i z a t i o n and h i g h - c o s t
procedures; inadequacies o f
p r e v e n t i v e and p r i m a r y c a r e .
(Theme: Because we m i s d i r e c t
r e s o u r c e s , we f a i l t o p r o v i d e b a s i c
s e r v i c e s Americans need.)
( 3 ) admin c o m p l e x i t y , h a s s l e , waste
C h a r t s : # u n i n s u r e d ; c o s t s — U S and
abroad; d e c l i n i n g p r i m a r y care
docs.
Sidebar: t h e p u b l i c ' s view o f
problems i n h e a l t h c a r e .
Sum up: o u r i n s u r a n c e system no l o n g e r p r o v i d e s t h e
�s e c u r i t y t h a t i n s u r a n c e i s supposed t o r e p r e s e n t . The
h e a l t h c a r e system, w i t h a l l i t s achievements, has a
m i x t u r e o f w a s t e f u l excess and gaping i n a d e q u a c i e s .
Sidebar: The e t h i c a l b a s i s o f
h e a l t h care reform
What we cannot do: o f f e r everyone h e a l t h c a r e f o r f r e e
(we can make i t a f f o r d a b l e , b u t n o t f r e e ) ; r e s o l v e many
o f t h e p r o f o u n d e t h i c a l q u e s t i o n s about modern m e d i c i n e
(we b e l i e v e those should be l e f t t o i n d i v i d u a l s ) ;
d e c i d e what s t y l e o r t y p e o f h e a l t h c a r e i s t h e b e s t
( a g a i n , Americans should have t h e r i g h t t o make t h o s e
decisions).
What we can do ( c a p s u l e statement o f o b j e c t i v e s ) :
p r o v i d e f o r s e c u r i t y from r u i n o u s c o s t s ;
c r e a t e a framework f o r a r a t i o n a l system
a wide range o f c h o i c e and f l e x i b i l i t y ;
with
enable Americans t o g e t b e t t e r v a l u e f o r
t h e i r h e a l t h care d o l l a r s ;
p r o t e c t t h e i n t e r e s t s o f t h e most v u l n e r a b l e
among us.
For 12 y e a r s , t h e problems have grown worse, t h e
i n a t t e n t i o n o f n a t i o n a l l e a d e r s h i p ever more c o s t l y .
T h i s a d m i n i s t r a t i o n now accepts t h e burden o f
r e s p o n s i b i l i t y . The p u b l i c wants r e f o r m . N a t i o n a l
l e a d e r s h i p groups, i n c l u d i n g those o f t h e h e a l t h c a r e
i n d u s t r y , accept t h e need f o r fundamental change. We
must now g a l v a n i z e t h a t consensus around t h e
fundamental need f o r change and make i t t h e b a s i s o f a
new e r a f o r h e a l t h c a r e .
Chapter 2. WHY WE NEED COMPREHENSIVE REFORM
[Note: T h i s c h a p t e r a m p l i f i e s and develops t h e themes
announced i n Chapter 1 . I t e x p l a i n s how t h e t h r e e c o r e
problems ( c o s t s , i n s e c u r i t y , c o m p l e x i t y ) developed and
why r e f o r m must be comprehensive r a t h e r t h a n piecemeal
or i n c r e m e n t a l . ]
.
The s p i r a l of c o s t s
How growing h e a l t h c a r e c o s t s have a f f e c t e d
r e a l employee compensation; p r o f i t s ; f e d e r a l ,
s t a t e , and l o c a l budgets.
Concrete meaning t o f a m i l i e s (examples)
P r o j e c t i o n s f o r t h e 9 0 s — i m p a c t on wages,
economy, budgets.
�C h a r t s ; r e c e n t growth and
p r o j e c t i o n s i n t o t h e 90s.
What w i l l happen i f we don't do a n y t h i n g :
W i t h o u t r e f o r m , t h e a b i l i t y even t o s u s t a i n
e x i s t i n g l e v e l s o f coverage w i l l be i n
jeopardy.
The
s p i r a l of i n s e c u r i t y
How t h e h e a l t h i n s u r a n c e market became
segmented by r i s k - - t h e d e c l i n e o f community
r a t i n g , emergence o f r e d l i n i n g and p r e e x i s t i n g c o n d i t i o n clauses, d e v a s t a t i n g r a t e s
f o r s m a l l business, u n i n s u r a b l e i n d i v i d u a l s ,
e t c . , and r i s i n g numbers o f u n i n s u r e d .
Sidebars
S t o r i e s about i n d i v i d u a l s and s m a l l
b u s i n e s s e s — p e r h a p s from l e t t e r s t o
the task force.
The
s p i r a l of complexity
Growth o f a d m i n i s t r a t i v e burdens i n system-why a d m i n i s t r a t i v e c o s t s a r e so much g r e a t e r
i n U.S. t h a n i n o t h e r c o u n t r i e s .
The impact on d o c t o r s , nurses, and o t h e r
providers—frustration of professional
i n i t i a t i v e ; d e p e r s o n a l i z a t i o n o f c a r e ; sheer
loss o f time.
Sidebar: examples o f u n p r o d u c t i v e
hassle.
Problems o f m a l p r a c t i c e
litigation.
The consumers' p e r s p e c t i v e : c o p i n g w i t h
b i l l s , c l a i m s forms, i n s u r a n c e c o n t r a c t s .
The case f o r comprehensive reform:
Merely adding t o e x i s t i n g system c o u l d
compound problems o f c o s t and c o m p l e x i t y .
Merely c u t t i n g p u b l i c programs would s h i f t
c o s t s t o t h e b e n e f i c i a r i e s and t o t h e
p r i v a t e l y insured, thereby i n c r e a s i n g
i n s e c u r i t y among b e n e f i c i a r i e s and
a g g r a v a t i n g problems i n t h e p r i v a t e s e c t o r .
Some suggest t h a t t h e r i s i n g h e a l t h c o s t s may
n o t be so u r g e n t a problem. A f t e r a l l , we
don't worry about r i s i n g spending f o r f a s t
�food.
But h e a l t h spending i s d i f f e r e n t : most c o s t s
t a k e n o u t o f paychecks b e f o r e people e v e r see
t h e money. They can't c u t down c o s t s on t h e i r
own. And when t h e y ' r e s i c k & i n h o s p i t a l ,
i t ' s also largely out of t h e i r control. At
t h a t point, everyone—the doctor, t h e
h o s p i t a l , and t h e p a t i e n t - - i s drawing on an
i n s u r a n c e f u n d , i n e f f e c t spending o t h e r
people's money.
A genuine s o l u t i o n has t o i n t r o d u c e a b r a k e
on c o s t s as much i n t h e p r i v a t e s e c t o r as f o r
government, i f Americans a r e t o have a system
o f coverage t h a t ' s secure, a f f o r d a b l e , and
understandable. But t h a t brake must n o t b l o c k
improvements i n q u a l i t y and i n n o v a t i o n s i n
s c i e n c e , n o r r e s t r i c t Americans from choosing
t h e s t y l e o f h e a l t h care t h e y want. Can
c h o i c e be combined w i t h i n n o v a t i o n and
g r e a t e r consciousness and c o n t r o l o f c o s t s ?
We t h i n k i t can.
Chapter 3. A NEW SYSTEM OF HEALTH SECURITY
Opening capsule d e s c r i p t i o n : how new system works and
w i l l achieve s e c u r i t y , assure access, c o n t r o l c o s t s
Consumers' p e r s p e c t i v e : how people w i l l o b t a i n h e a l t h
s e c u r i t y c a r d ; what choices t h e y w i l l have; what
b e n e f i t s t h e y w i l l be guaranteed.
I l l u s t r a t i o n s : sample c a r d .
Sidebar
L i s t o f guaranteed b e n e f i t s
Consumer h e a l t h a l l i a n c e s : b a s i c concept,
work.
how t h e y
will
New r u l e s f o r h e a l t h p l a n s : open e n r o l l m e n t , community
r a t i n g , no pre-ex e x c l u s i o n s , no r e d l i n i n g , e t c .
R e s p o n s i b i l i t i e s of stand-alone employer plans
How coverage would be financed:
f o r t h e employed p o p u l a t i o n
f o r t h e nonworking p o p u l a t i o n
I l l u s t r a t i o n s : (1) structure of
h e a l t h a l l i a n c e s , showing f l o w o f
funds from employers, employees,
g o v t . , t o t h e a l l i a n c e s and h e a l t h
plans.
�(2) comparison o f r o l e s o f
employers, employees, aHrionooa,
and h e a l t h plans i n o l d and new^
systems.
[Note: Depending on decisions, there could be
a discussion o f long-term care and Medicare
here.]
Cost control
[short-term measures]
the concept o f a global budget
t o o l s a v a i l a b l e t o the s t a t e s t o enforce the budget
State f l e x i b i l i t y i n organizing health care
Single-payer o p t i o n
Other decisions facing the s t a t e s
how t o set up and govern a l l i a n c e s
how t o achieve budgets
Chapter 4. IMPROVING HEALTH CARE
P r i o r i t y : Quality
Why q u a l i t y improvement i s c e n t r a l t o reform
The o l d regulatory model o f q u a l i t y c o n t r o l :
formal c e r t i f i c a t i o n , minimum standards f o r
process, u t i l i z a t i o n review, l i t t l e focus on
outcomes.
The new concepts o f a c c o u n t a b i l i t y — r e p o r t
cards, benchmarking, TQM.
Sidebar: a sample report card.
Other elements i n q u a l i t y
assurance.
Provider-patient r e l a t i o n s h i p s — c l e a r i n g away
b a r r i e r s t o good care.
P r i o r i t y : Less Hassle
malpractice reform
administrative simplification
Illustrations:
the
uniform claim form,
i n f o r m a t i o n system o f the f u t u r e
�I l l u s t r a t i o n : a community
i n f o r m a t i o n network
health
P r i o r i t y : Prevention and Primary Care
coverage o f p r e v e n t i v e
services
p r i m a r y c a r e i n t h e new system
Sidebar: mental h e a l t h
services
new p o l i c i e s f o r p r o f e s s i o n a l e d u c a t i o n
expanding n o n - p h y s i c i a n p r o v i d e r s '
scope o f p r a c t i c e
P r i o r i t y : P r o t e c t i n g Vulnerable Populations
how t h e new system addresses t h e needs o f t h e
underserved: r e s p o n s i b i l i t i e s o f t h e h e a l t h
alliances; special allocations f o r
i n f r a s t r u c t u r e ; expansion o f N a t i o n a l H e a l t h
S e r v i c e Corps; e t c .
s p e c i a l needs o f h i g h - c o s t and c h r o n i c a l l y
i l l patients
S i d e b a r s : AIDS
Persons w i t h d i s a b i l i t i e s
TB?
Chapter 5. THE WAYS AND MEANS OF CHANGE
The path t o a reformed
system
Where we can achieve economies--elements o f
a d m i n i s t r a t i v e and c l i n i c a l s a v i n g s .
C h a r t s : Savings p r o j e c t i o n s .
How we can expand c o v e r a g e — c o s t s ; t i m i n g ;
the r o l e of the states.
Sidebar: A t i m e l i n e f o r change.
The f u t u r e of c u r r e n t programs
I n t e g r a t i o n o f Medicaid
Medicare (???)
Long-term c a r e
�VA
DOD
Indian Health Service
Federal Employees Health Benefit Plan
^—Chapter 6. REINVENTING REFORM
Reform through devolution
This approach proposes t h a t t h e f e d e r a l govt
set broad guidelines; states be given t h e
leeway t o carry out the program i n d i f f e r e n t
ways; the p r i v a t e sector provide t h e care;
consumers have chance t o choose.
A d i v e r s i t y of solutions i s l i k e l y — a n
opportunity f o r experiment, adaptation, midcourse c o r r e c t i o n s .
Thus, while guaranteeing i n d i v i d u a l h e a l t h
s e c u r i t y and i n s i s t i n g on o v e r a l l spending
l i m i t s , fed govt i s not mandating how s t a t e s ,
h e a l t h a l l i a n c e s , and consumers choose t o
carry out those o b j e c t i v e s .
Rather, we are o f f e r i n g a framework f o r
devolving change downward--on t h e s t a t e s ,
h e a l t h a l l i a n c e s , health plans, and
u l t i m a t e l y i n d i v i d u a l consumers and
providers.
Even f o r f e d e r a l government (e.g., VA) reform
should devolve decisions on lower l e v e l s ,
reducing c e n t r a l c o n t r o l .
The concept o f reform: a strategy f o r
empowering consumers and f r o n t - l i n e
providers. I t o f f e r s s e c u r i t y ; i t imposes
responsibility—that i s , responsibility to
make choices.
V
�APPENDIX
How the plan evolved
consultation process
involvement of congressional and state and l o c a l
government staff
L i s t of working group members
�Report t o Congress
Sidebars, C h a r t s , and
Illustrations
Chapter 1 .
Charts:
# uninsured
(Ken)
c o s t s — U S and abroad
(George S c h i e b e r )
d e c l i n i n g p r i m a r y c a r e docs ( F i t z h u g h M u l l a n , Steve Schroeder)
Sidebars
t h e p u b l i c ' s view o f problems i n h e a l t h c a r e
(Stan?)
The e t h i c a l b a s i s o f h e a l t h c a r e r e f o r m ( e t h i c s
group)
Chapter 2.
Charts
r e c e n t g r o w t h i n c o s t s and p r o j e c t i o n s i n t o t h e 90s
o r Randy L u t t e r )
(Len N i c h o l s
Sidebars
S t o r i e s about i n d i v i d u a l s and s m a l l b u s i n e s s e s — p e r h a p s
l e t t e r s t o t h e t a s k f o r c e (Steve E d e l s t e i n ) .
Examples o f u n p r o d u c t i v e h a s s l e (LiyiTit^glLJi^Bwa^^^ I r w i n
from
Redlener)
Chapter 3.
Illustrations
sample c a r d
(???)
u n i f o r m e n r o l l m e n t form (Tim H i l l , Shoshana S o f a e r )
s t r u c t u r e o f h e a l t h a l l i a n c e s , showing f l o w o f funds from
employers, employees, g o v t . , t o t h e a l l i a n c e s and h e a l t h p l a n s
( W a l t e r Zelman & h e l p e r s ) .
comparison o f r o l e s o f employers, employees, a l l i a n c e s , and
h e a l t h p l a n s i n o l d and new systems (words done; needs g r a p h i c
design c o n s u l t )
�Sidebar
L i s t of guaranteed b e n e f i t s (Linda Bergthold & b e n e f i t s group)
Chapter 4.
Sidebar
a sample r e p o r t card (Arnie Epstein)
mental h e a l t h services (Bernie)
C k* r
* n -^/^-t«^
AIDs (Mark Smith)
Illustrations
uniform claim form (Tim H i l l )
a community h e a l t h information network (Mark S i l v a )
Chapter 5.
Charts
Savings p r o j e c t i o n s (Rick Kronick)
Sidebar
A t i m e l i n e f o r change (Lois Quam, post-decisions)
�The Vice President of the United S t a t e s
Address to the American Medical A s s o c i a t i o n
March 24, 1993
I'M DELIGHTED TO BE WITH YOU TODAY.
THE FIRST LADY REGRETS VERY MUCH THAT HER FATHER'S ILLNESS
PROHIBITS HER FROM BEING HERE WITH YOU TODAY.
I KNOW YOU JOIN ME
IN WISHING HER WELL.
IN THE LAST SEVERAL WEEKS NO ONE HAS WORKED HARDER THAN SHE
TO IMPROVE HEALTH CARE IN AMERICA.
SHE HAS REACHED OUT TO SO
MANY WITH HER CARING HEART AND SHARP MIND TO HELP US SHAPE NEW
AND BETTER POLICIES, AND WE ARE IN HER DEBT.
IN OUR CAMPAIGN AND IN THE FIRST WEEKS OF OUR ADMINISTRATION
WE HAVE FOCUSED MOST INTENSELY ON THE TWO ISSUES THAT THE
AMERICAN PEOPLE ARE MOST CONCERNED ABOUT: RESTORING OUR ECONOMY
TO LONG-TERM HEALTH AND RESTORING OUR HEALTH CARE SYSTEM TO WELLBEING.
DURING MY ENTIRE CAREER, BUT ESPECIALLY IN THE LAST YEAR,
I'VE
TALKED TO THOUSANDS OF PEOPLE ABOUT HEALTH CARE AND, AS
VICE-PRESIDENT, HAVE SAT IN OUR CABINET MEETINGS AND VISITED AT
LENGTH WITH THE PRESIDENT AS WE COLLECTIVELY TRY TO COME TO GRIPS
WITH THE ENORMOUS HEALTH CARE PROBLEMS.
BUT I BELIEVE WE CAN DO I T .
�IN FACT, I BELIEVE WE ARE ON THE BRINK OF AN HISTORIC MOMENT
—
THAT WE ARE ABOUT TO DELIVER THE CHANGE THAT AMERICAN PEOPLE
VOTED FOR IN NOVEMBER, AND FUNDAMENTALLY REFORM THE HEALTH CARE
SYSTEM IN AMERICA.
ON JANUARY TWENTY-FIRST, THE PRESIDENT ASKED THE FIRST LADY
TO CHAIR THE TASK FORCE ON NATIONAL HEALTH CARE REFORM.
AND THE
PRESIDENT CHALLENGED THEM TO WORK EXTREMELY HARD TO SEEK OUT THE
VERY BEST ADVICE, TO REACH OUT, AND TO HEAR ALL SIDES, AND TO
PREPARE COMPREHENSIVE LEGISLATION THAT THE PRESIDENT CAN SUBMIT
TO CONGRESS THIS SPRING.
ALL TOLD, 500 PEOPLE SERVING ON 3 0 WORKING GROUPS, AND
INCLUDING MORE THAN 60 PHYSICIANS, HAVE HAD HUNDREDS OF MEETINGS,
AND LISTENED CAREFULLY TO LITERALLY THOUSANDS OF EXPERTS AND
CONCERNED MEN AND WOMEN ACROSS THE NATION.
WE ARE STILL IN THE FACT-FINDING STAGE, AND TRYING TO BUILD
ON THE GOOD WORK OF SO MANY OTHERS.
HOW DIFFICULT THIS I S —
NOBODY KNOWS BETTER THAN YOU
BUT THE TASK FORCE I S DEADLY SERIOUS
ABOUT MEETING ITS DEADLINE AND DELIVERING TO THE PRESIDENT THE
FULL SET OF OPTIONS HE NEEDS TO WRITE AND PASS HEALTH CARE REFORM
THIS YEAR.
I T HASN'T BEEN A PERFECT PROCESS, BUT I T I S A VERY
GOOD ONE GIVEN THE SIZE OF THE TASK, THE SHORTNESS OF THE TIME,
AND THE ABSOLUTE IMPORTANCE OF ACHIEVING COST CONTAINMENT AND
OTHER BASIC REFORMS NOW.
�BUT MY PURPOSE TODAY I S NOT TO DESCRIBE OUR PROCESS.
MOST
OF YOU READ THE PAPERS SO YOU PROBABLY K O WHAT I T I S WE ARE
NW
DOING - ALTHOUGH I CAN TELL YOU AS SOMEONE WHO HAS BEEN I N THE
ROOM THAT A LOT OF WHAT YOU'VE READ BELONGS IN THE FICTION
SECTION.
I WANT YOU TO KNOW WHERE WE ARE AND WHAT WE'VE LEARNED,
BECAUSE I T I S SO VITALLY IMPORTANT THAT WE REFORM THE HEALTH CARE
SYSTEM THIS YEAR.
AND I WANTED TO COME HERE AND SPEAK WITH YOU
DIRECTLY BECAUSE AS OUR PRIMARY CARE-GIVERS YOU MUST BE PART OF
ANY SOLUTION TO THIS PROBLEM.
ONE OF THE THINGS THAT I DON'T LIKE ABOUT THE HEALTH CARE
DEBATE IS THAT WE THROW AROUND SLOGANS AND JARGON, AND I'M AFRAID
WE SOMETIMES LEAVE THE IMPRESSION THAT HEALTH CARE REFORM IS SOME
ABSTRACT NOTION.
JUST THE OPPOSITE I S TRUE.
THIS CRISIS HITS AT
THE HEART OF EVERY AMERICAN FAMILY.
WE HAVE LEARNED THIS, AND A GREAT DEAL MORE, MUCH OF I T VERY
PAINFUL, SOME OF I T HOPEFUL, ALL OF I T CRITICALLY USEFUL.
WE'VE LEARNED WHAT I T IS LIKE FOR A HARD WORKING FAMILY TO
SIT AROUND THE DINNER TABLE AND DECIDE TO DECLARE BANKRUPTCY
BECAUSE A PARENT HAS ALZHEIMER'S.
�WE'VE LEARNED HOW FRIGHTENING AND FRUSTRATING I T I S TO LOSE
YOUR COVERAGE.
I T IS EVERY BIT AS DEVASTATING AS GETTING LAID
OFF, AND IT'S HAPPENING TO MORE THAN 100,000 OF US EVERY MONTH.
WE'VE LEARNED WHAT I T I S LIKE TO BUILD A SMALL BUSINESS AND
HAVE TO DENY YOUR EMPLOYEES HEALTH CARE BECAUSE YOU CAN'T AFFORD
TO PROVIDE I T .
AND I'VE LEARNED FROM PHYSICIANS WHAT I T I S LIKE TO BE
TRAPPED IN A NIGHTMARE OF PAPERWORK AND REGULATION THAT YOU HAD
NO ROLE IN DESIGNING, BUT THAT BASICALLY FORCES YOU TO PRACTICE
WITH THE GOVERNMENT LOOKING OVER YOUR SHOULDER.
-
IT'S NOT RIGHT -
AND IT'S WRECKING THE SYSTEM.
YOU BECAME DOCTORS TO GIVE CARE AND FIND CURES, TO BE AMONG
THOSE WHO SERVE A HIGHER PURPOSE AND FEEL BETTER FOR I T .
I KNOW
YOU ARE THE BACKBONE OF OUR SYSTEM, AND THAT MANY OF YOU ARE
ANGUISHED WHEN TALENTED YOUNG PEOPLE CHOOSE TO AVOID MEDICINE
BECAUSE THE REWARDS NO LONGER EXCEED THE DEMANDS.
PART OF OUR GOAL IS TO HONOR YOUR ORIGINAL MOTIVES —
MOTIVES —
BY RE-CREATING A SYSTEM THAT ALLOWS YOU TO PRACTICE
MEDICINE THE WAY YOU THOUGHT YOU WOULD WHEN YOU CHOSE YOUR
CAREER.
GREAT
�THAT'S WHY I'M DELIGHTED AT THE FLEXIBILITY AND LEADERSHIP
AND REFORM-MINDEDNESS
SHOWN BY THE AMA AND DOCTOR TODD.
THIS ADMINISTRATION KNOWS THAT WE CANNOT, AND DO NOT WANT
TO, BUILD A BETTER HEALTH CARE SYSTEM WITHOUT THE COOPERATION AND
LEADERSHIP OF THE AMA.
BUT THE DAYS WHEN ONE ASSOCIATION —
MATTER HOW PRESTIGIOUS —
NO
CAN DOMINATE THE HEALTH REFORM DEBATE
ARE OVER, AND THEY SHOULD BE.
WE MUST ALL JOIN IN AND PULL IN
THE SAME DIRECTION.
I BELIEVE THAT NO AMERICANS HAVE MORE TO GAIN FROM A
COMPLETE OVERHAUL OF THE MEDICAL SYSTEM THAN DOCTORS.
YOU'RE THE
ONES WHO SEE THE SCARED FACES OF THE MOTHERS WHO DELAY SEEKING
CARE FOR A FEVERISH CHILD.
YOU'RE THE ONES WHO SPEND HOURS
WORKING THE PHONES IN SEARCH OF PERMISSION TO ADMIT YOUR PATIENTS
OR TO PRESCRIBE A CERTAIN TREATMENT.
YOU'RE THE ONES WHO WONDER
WHAT TO DO WHEN A NEIGHBOR OR FRIEND COMES FOR TREATMENT AND HAS
NO INSURANCE.
YOU'RE THE ONES FOR W O THE STATUS QUO I S
HM
UNACCEPTABLE.
AND SO HERE IS WHAT WE OFFER YOU: WE ARE GOING TO ASK YOU TO
HELP US CONTROL SKYROCKETING HEALTH CARE COSTS.
IN RETURN, WE
ARE GOING TO WORK VERY HARD TO REFORM THE MALPRACTICE LAWS AND
CUT THE BUREAUCRACY AND THE PAPERWORK WHICH MAKE I T DIFFICULT FOR
YOU TO BE CAREGIVERS.
�FIXING THIS SYSTEM, AS YOU WELL KNOW, WILL NOT BE EASY.
BUT
THE AMERICAN PEOPLE HAVE DEMANDED THAT WE FUNDAMENTALLY REFORM A
SYSTEM THAT COSTS TOO MUCH AND WASTES TOO MUCH AND SERVES TOO
FEW; AND, THAT WE MAKE THE SYSTEM WORK BETTER FOR REAL PEOPLE
WITH REAL PROBLEMS.
WE WILL NEVER SUCCEED I F OUR REFORMS FAIL AT THE CRUCIAL
MOMENT WHEN SOMEONE IS SICK AND NEEDS HELP.
OUR GOALS ARE SIMPLE.
THAT I S THE TEST.
FIRST, WE MUST CONTROL COSTS THAT ARE
RISING FOUR TIMES THE RATE OF INFLATION.
I F WE DO NOT I T WILL
COST OUR NATION AN AVERAGE OF $14,000 PER FAMILY BY THE END OF
THE DECADE.
WE MUST CUT WASTE AND INCREASE COMPETITION AND STOP
THOSE IN THE INSURANCE AND PHARMACEUTICAL INDUSTRIES WHO ARE
PROFITEERING EXCESSIVELY.
SECOND, WE WANT PEOPLE TO BE SECURE AND TO BE GUARANTEED A
BENEFITS PACKAGE THAT IS TRULY COMPREHENSIVE.
THIRD, WE WANT THE SYSTEM TO BE SIMPLE.
THE PRESIDENT HAS
ALREADY MADE A SERIOUS COMMITMENT TO REFORM THE WAY GOVERNMENT
DOES BUSINESS.
HE HAS MADE HISTORIC CUTS IN THE BUDGET, STARTING
WITH HIS OWN STAFF AND FEDERAL WORKERS.
WE MUST MAKE THE SAME
COMMITMENT TO BETTER MANAGEMENT AND GREATER SAVINGS IN THE HEALTH
CARE SYSTEM, INCLUDING IMPLEMENTING TOUGH NEW ANTI-FRAUD AND
ABUSE MEASURES.
�I F WE DO NOT, WE WILL WASTE ANOTHER 8 0 BILLION DOLLARS NE^T
YEAR AND EVERY YEAR ON PAPERWORK AND^BURESUCRA"CY-,—WHEN—THG'Sl
RESOURCES ARE NEEDED TO IMPROVE THE SYSTEM AND CARE FOR PEOPLE.
AND YOU WILL KEEP SPENDING THE EQUIVALENT OF TEN WORKING DAYS
EACH MONTH JUST TO KEEP UP WITH THE PAPERWORK.
FOURTH, OUR HEALTH CARE PLAN WILL PROVIDE CONTINUITY IN TWO
SENSES: WE WILL PRESERVE YOUR PATIENTS' RIGHT TO PICK THE DOCTOR
THEY WANT, AND WE WILL CONTINUE TO OFFER THEM THE HIGHEST QUALITY
CARE IN THE WORLD.
IN ADDITION, WE WILL PROVIDE THEM WITH A NEW
RIGHT: TO CHOOSE THE COVERAGE THEY WANT, NOT SIMPLY WHAT THEIR
EMPLOYER OR INSURANCE COMPANY WILL ALLOW.
FINALLY, HEALTH CARE REFORM SHOULD ALSO BE COMPREHENSIVE, IN
THE SENSE THAT ALL AMERICANS SHOULD BE COVERED.
IN REACHING THESE GOALS, REST ASSURED THAT WE WILL TRANSLATE
WHAT YOU HAVE TOLD US INTO REALITY.
THAT MEANS MALPRACTICE
REFORM.
TODAY, MALPRACTICE TOO OFTEN LIVES UP TO ITS NAME - I T HAS
MADE THE PRACTICE OF MEDICINE WORSE AT THE JUNCTURE I T MATTERS
MOST - THAT CRITICAL POINT OF COMMUNICATION AND TRUST BETWEEN
DOCTOR AND PATIENT.
I T IS AN ANCILLARY INDUSTRY WHOSE
PRACTITIONERS OFTEN ONLY DO WELL I F YOU ARE ACCUSED OF DOING
WRONG, AND THAT IS WRONG —
AND WE SHOULD DO SOMETHING ABOUT I T .
�IT ALSO MEANS RELIEVING PRESSURE ON YOU.
WE'VE HEARD AND WE BELIEVE THAT PRACTICING MEDICINE HAS
BECOME TOO BIG A HASSLE.
THE BUREAUCRACY HAS GOTTEN TOO BIG AND
THE TIME FOR TREATMENT TOO SMALL. THE TRADITIONAL AUTONOMY
BETWEEN YOU AND YOUR PATIENTS HAS GIVEN WAY TO THE NEW TRIAD OF
MEDICINE - A DOCTOR, A PATIENT, AND AN ACCOUNTANT.
WE WANT TO WRITE A PLAN THAT ALLOWS YOU TO RETURN FULL TIME
TO MEDICINE.
LIKE YOU THE AMERICAN PEOPLE ARE FRUSTRATED WITH THE COST
AND THE WASTE AND THE FRUSTRATION AND THE FEAR.
NOW.
THEY WANT CHANGE
MOST OF YOU HAVE YOUR OWN DEEP DISAPPOINTMENTS IN THE
SYSTEM.
YOU WANT CHANGE NOW.
AS A DOCTOR TOLD MRS. CLINTON AND MY WIFE WHEN THEY VISITED
ST. AGNES HOSPITAL IN PHILADELPHIA: "YOU KNOW THE SAYING, ' I F I T
AIN'T BROKE DON'T FIX I T . ' WELL MRS. CLINTON, THE SYSTEM I S
BROKE AND IT'S TIME TO FIX I T . "
THE AMERICAN PEOPLE DESPERATELY NEED A SYSTEM THAT WORKS FOR
THEM AGAIN, AND THE TIME HAS COME TO BALANCE YOUR NEEDS WITH
THEIRS.
UNDER A GOOD PLAN NO ONE WILL GET EVERYTHING THAT THEY
WANT, BUT EVERYONE WILL GET A BETTER DEAL ALL AROUND.
�LAST YEAR, THE AMERICAN PEOPLE PROVED THAT THEY HAVE THE
COURAGE TO CHANGE.
NOW I T IS TIME FOR US TO PROVE OURS, BY
ENACTING REAL HEALTH CARE REFORM.
OUR SYSTEM CAN BE IMPROVED, DRAMATICALLY IMPROVED.
WE KNOW
WE CAN DO BETTER BECAUSE MANY IN OUR NATION ARE DOING BETTER
ALREADY.
BUT THIS IS THE YEAR TO ACT.
THE PRESIDENT UNDERSTANDS THIS.
HE HAS SAID HE WILL TAKE THE HEAT WHEN THINGS GO WRONG AND
DOESN'T CARE WHO GETS THE CREDIT WHEN THINGS GO RIGHT.
AND THE AMERICAN PEOPLE HAVE RALLIED TO HIS SIDE.
AFTER YEARS OF POLITICAL GRIDLOCK WE ARE BEGINNING TO MOVE
QUICKLY TO SOLVE OUR MOST SERIOUS PROBLEMS.
MOST IMPORTANTLY,
WE HAVE BEGUN THE GLORIOUS ACT OF UNITING AGAIN AS AMERICANS
DETERMINED TO LEAVE OUR CHILDREN THE AMERICAN DREAM.
THANK YOU VERY MUCH.
�AMI 1
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�REPORT TO CONG
POLICY PAPERS
OP-ED/OTHER
WEEK1: 4/17
ORGANIZE/
OUTLINE/
ASSIGN/
BEGIN DRAFT
COMPILE
TOPICS/
ORGANIZE
EDITORS/
ORGANIZE STAFF
LETTER FROM
IRA/BOORSTIN
SOLICIT IDEAS
WEEK 2: 4/24
WRITE
ASSIGNMENTS
DUE 4/19,20,21
SET TENTATIVE
TOPIC LIST/
MAKE
ASSIGNMENTS
SOLICIT IDEAS
WEEK 3: 5/1
DRAFT COMPLETE
REVIEW
NEW
ASSIGNMENTS
STRATEGY FOR
DISTRIBUTION/
ARRANGE
PLACEMENTS
WEEK 4: 5/8
REWRITE
REVIEW
PAPERS DUE/
EDITING
DRAFT NEW
ENGLAND
JOURNAL/
ACCEPT
SUBMISSIONS
WEEK 5: 5/15
REWRITE/POLISH
REVIEW
EDITING
COMPLETE NEW
ENGLAND
JOURNAL/
ACCEPT
SUBMISSIONS
WEEK 6: 5/22
REVIEW
COMPLETE
EDITING
PLACE OP-EDS
WEEK 7: 5/29
PRINTING -RELEASE DATE
OF PRESIDENT'S
ADDRESS
EDITING
PLACE OP-EDS
REVIEW/REWORK
PUBLISH I N
JUNE
PLACE OP-EDS
CONTINUE
THROUGH SUMMER
WEEK 8: 5/31
|
�
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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Overview of Health Reform
Creator
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White House Health Care Task Force
Health Care Task Force
Carolyn Gatz
Identifier
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2006-0885-F Segment 4
Is Part Of
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Box 42
<a href="http://clinton.presidentiallibraries.us/items/show/36149" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/12093616" 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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Reproduction-Reference
Date Created
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4/16/2015
Source
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12093616
42-t-12093616-20060885F-Seg4-042-006-2015