Op-Ed
                       By Donna E. Shalala
             Secretary of Health and Human Services
                  10/10/94, The Washington Post
               Health Care Reform is Still Alive"

     When a newspaper reporter asked Mark Twain in 1897 to
respond to the news of his death, he said: "Reports of my death
have been greatly exaggerated." 

     Like Twain's demise, the death of health care reform has
been greatly exaggerated.  There are, of course, those who would
like to believe that the national movement for health reform is
dead and buried.  After all, special interest groups spent more
than $60 million on an advertising blitz that left many Americans
dazed and more than a little confused.  And, according to
Newsweek magazine, those opponents spent more than $300 million
to defeat health care reform in 1994.

     But wishing reform dead won't make it so because there are
important reasons why this effort will continue.  So, in the
tradition of the sage political pundit David Letterman, let me
offer "Donna Shalala's Top Ten Reasons Why We Should Keep Health
Care Reform Alive."

     Number 10.  Health spending is multiplying faster than TV
talk shows.  Americans will spend $982 billion on health care
services in 1994, or nearly 14 percent of our gross domestic
product.  If prices keep rising as they have, we'll spend $2.1
trillion on health care in 2003, or 20 percent of our GDP.  In
other words, one in every five dollars we spend will be on health
care.

     Number 9.  There are more Americans living without health
insurance than there are Elvis sightings.  Today, an estimated 39
million Americans have no health insurance at all, or 14.7
percent of our total population.  In the last five years, five
million Americans have lost their insurance.  If we do nothing,
by the year 2003 the total will grow to 43 million, or 15.7
percent of the total.

     Number 8.  Employer-paid health insurance is disappearing
faster than the Statue of Liberty at a David Copperfield magic
show.  Today, an estimated 58.5 percent of working Americans get
health insurance from their employers.  By 2003, that will drop
to 55.8 percent of workers.

     Number 7.  Did you hear the one about the $24 aspirin?      
Well, maybe not $24, but the price is going up quickly.  Under
our current system, hospitals must care for anyone in need.  So,
when must care for an increasing number of uninsured patients,
hospitals shift those costs to those of us who have insurance. 
In 1980, that cost shift averaged 20 percent. By 1992, it was up
to 31 percent.

     Number 6.  Numbers don't lie.  Much has been made in the
last year about the alleged slowing of health care inflation. 
Some have gone so far as to say that health care reform isn't
needed because the market will correct itself.  A closer look at
these trends tells a very different story.  Between 1980 and
1993, the average difference between medical prices and overall
prices was 3 percentage points.  In 1993, the difference was 2.9
percentage points.  That's progress, but not much.

     Number 5.  The jawbone isn't mightier than the pen.  History
requires us to wonder how much of this moderation in prices is
real and how much of it is a result of the "jawboning effect" of
the national debate over reform.  Three times in the last 20
years, medical spending has taken a similar dip during periods of
intense national debate.  Each time, as soon as the debate was
over, and the special interests had won, prices went right back
to their former pace.  Can Americans and their employers afford
another riverboat gamble?  I don't think so.

     Number 4.  What goes down, must stay down.  In 1993,
President Clinton and the Congress enacted the most far-reaching
deficit reduction package in our nation's history.  As a result,
the federal budget deficit has declined in each of the last three
years.  And the deficit has been reduced by half as a percentage
of the gross national product.  By putting the deficit on the
decline, the President has led our economy to its strongest
growth in 20 years.  Yet, the one area of the federal budget that
is not under control is health care costs.  And if we fail to
control those costs the deficit will begin to explode again.

     Number 3.  Because life is a pre-existing condition.  When
insurance companies deny coverage to a person or a group of
people simply because they are considered to be at risk of
getting sick, they call it redlining.  I call it discrimination. 
An estimated 81 million Americans have some form of pre-existing
medical condition that makes it hard or impossible for them to
get coverage.  None of these practices have stopped; in fact,
they're likely to become even more commonplace if we don't change
the rules.

     Number 2.  An ounce of prevention is worth a pound of cure. 
As Secretary of Health and Human Services, I speak out frequently
about the need for Americans to take responsibility for their
health by preventing disease instead of simply treating its
symptoms.  But how can we ask people to take greater
responsibility if our system continues to be skewed toward "sick
care" instead of "health care."  Nearly every health reform
proposal puts prevention first by paying for such things as
mammograms, Pap smears, physicals, and immunizations.

     Number 1.  Despite Harry and Louise, the American people
still want reform.  For nearly two years, special interests have
thrown everything they've got at health care reform.  It's not
surprising, then, that we reached an impasse this year.  But the
one thing the status quo crowd could not accomplish was to change
Americans' belief that we need to reform our health care system. 
The latest public opinion polls still show seven out of 10
Americans favoring a health care system that provides every
person with a rock-solid guarantee of health care coverage that
can never be taken away.  A similar majority favors a system that
keeps health costs within people's reach.

     Several years after his "death," Mark Twain offered
policymakers one piece of advice that holds true today.  "Always
do right," he said.  "This will gratify some and astonish the
rest."

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