From: skywalke@dino.qci.bioch.bcm.tmc.edu (Timothy B. Reynolds)
Newsgroups: alt.politics.clinton
Subject: Re: Clinton's health care plan
Date: 17 Nov 1992 14:38:51 GMT
Organization: X-Ray Crystallography / Howard Hughes Medical Institute
NNTP-Posting-Host: dino.qci.bioch.bcm.tmc.edu



 September 24, 1992

              Controlling Costs and Guaranteeing Care for All
                   The Clinton/Gore Health Care Plan

      Governor Bill Clinton today detailed his health care reform plan
 and laid out the fundamental differences between his comprehensive
 plan and George Bush's piecemeal approach to the health care crisis.

      "We'll never revive our economy or cope with the deficit until
 we get health care costs under control," said Clinton.

      The Clinton/Gore plan will tightly contain costs so that they
 rise no faster than wages, saving Americans $700 billion by the end
 of the decade.  The plan will also guarantee coverage for all
 Americans, and preserve the private health system's quality and
 choice.  Highlights of the plan include --

 Controlling costs:

   *    Fence in national health costs by setting a national health
        budget to limit what consumers pay for health coverage.

   *    Take on the insurance companies to restore competition,
        driving costs below the budget and protecting consumers.  We
        will ban "pre-existing condition" exclusions, require policies
        to offer full benefits, and set up purchasing groups that give
        individuals and companies real buying power and make insurers
        compete for their business.

   *    Stop drug price gouging by ending special tax breaks for
        companies that raise drug prices faster than inflation.

   *    Take other steps to control costs: reform medical malpractice
        laws, reduce duplicative technology and streamline paperwork.

 Covering all Americans:

   *    Require employers to insure their workers, either directly or
        through a purchasing group; phase in requirements, with small
        businesses coming last, and provide tax credits to protect
        businesses.

   *    Guarantee private coverage for nonworkers, starting with
        nonworking pregnant women and children.

   *    Dedicate federal savings from cost controls to paying for
        expansions in coverage.

      Governor Clinton said that he would put his plan before Congress
 in the first hundred days of his administration.

      "I have a plan for fundamental change and real reform," said
 Governor Clinton.  "George Bush has a last minute political
 proposal."

      "Mr. Bush has done next to nothing to solve the health care
 crisis," Clinton added.  "I will make sure health care costs don't
 rise faster than your income.  He won't.  I will take on
 irresponsible drug companies and insurance companies.  He won't."

      George Bush's inaction has let health care costs climb to $800
 billion in 1992.  They now add $1,230 to the price of an American
 car.  Over the next five years, they'll account for more than half
 the growth of the federal deficit.

      The health care reform plan Clinton detailed today is central to
 Putting People First, Governor Clinton's national economic strategy
 for America.

 SUMMARY OF THE CLINTON/GORE PLAN  FOR AFFORDABLE, QUALITY HEALTH CARE

      America has the finest health care in the world, but it costs
 too much and leaves millions without coverage.

      The Clinton/Gore plan calls for fundamental change.  It will
 make sure that no American is bankrupted by illness, ensure that all
 Americans have affordable, high quality health coverage, and create a
 health care system that is much simpler and more secure than the one
 today.

      To make a health care system that works, the Clinton/Gore plan
 meets three goals:

 1.   Cost control so that health care costs do not increase faster
      than Americans' wages.

 2.   Guaranteed universal coverage.  Every American will be
      guaranteed affordable, quality coverage.

 3.   Preserves what's best in our system.  Quality private care and
      personal choice of the world's best doctors and hospitals.

 COST CONTROL: RESTORING COMPETITION WITHIN A BUDGET

      It's time to get health care costs under control.  Because of
 Republican inaction, we will spend $809 billion on health care this
 year, and we'll waste as much as $200 billion of that on a bloated
 bureaucracy and unnecessary tests and services.  Only the insurance
 companies benefit.  They have written the rules to prevent real
 competition and rational planning, and they profit mainly by avoiding
 "risk" -- the people who need help most.

      The Clinton/Gore plan will improve quality, expand choice, and
 control costs through a strategy of competition within a budget.
 This strategy is supported by leading consumer groups, including the
 American College of Physicians, the American Academy of Family
 Physicians, the American Nurses Association, and businesses from
 Bethlehem Steel to Xerox that belong to the National Leadership
 Coalition on Health Care.

      The Clinton/Gore plan will further cut costs by eliminating drug
 price gouging, cutting bureaucracy and fraud, and reforming medical
 malpractice laws.  We will also protect consumers by making sure
 insurers end their discriminatory practices and turn no one away.
 These are the specific steps:

  Set a National Health Budget -- an overall limit on costs.

      It is time that we decide as a nation how much we want to spend
 on health care.  The Clinton/Gore plan will establish a national
 health care board made up of consumers, providers, business, labor
 and government.  Together, they will set national and state health
 care budgets to limit public and private health care costs.

   >    The budget and managed care networks:

        Consumers will have access to a variety of local health
        networks -- organized systems of insurers, hospitals, clinics
        and doctors.  These managed care networks will receive a fixed
        amount of money (a "capitation fee") for meeting a consumer's
        full health needs.  States will set an upper limit on these
        "capitation fees" so as to meet the budget.  By limiting their
        total spending without interfering with their practices, the
        budget creates incentives for hospitals, clinics and doctors
        to reduce bureaucracy, eliminate duplicative technology, and
        stop waste.

   >    The budget and other insurers:

        For services covered by other (non-managed care) insurers,
        states will establish fee schedules applicable to all payers
        in order to meet the global budget targets.

   >    The budget and Medicare:

        We will protect Medicare benefits for the elderly.  Our
        fundamental reforms will reduce bureaucracy and unnecessary
        care, generating savings for Medicare and the private sector.
        Medicare payments to providers, like non-managed care
        insurance payments, will be subject to budgetary limits.

  Set new rules for insurance companies -- to create competition.

      The Clinton/Gore plan will fundamentally change the rules for
 insurance companies.  We will ban the anti-competitive practices that
 increase red tape and force up prices.  We will restore consumer
 choice, end job lock, and give businesses greater bargaining power.
 These steps will restore real competition, drive costs below budget
 limits and ensure that health costs rise no faster than Americans'
 wages.

      We will make insurance companies play by a new set of rules:

   >    Open enrollment.

        We will ban "pre-existing condition" exclusions.  Insurers
        will have to take all comers, freeing workers locked into
        their jobs because they fear losing their insurance.

   >    Equitable pricing.

        Insurers will have to use "community rates," which stop
        insurers from charging consumers more based on such factors as
        size of employer, health condition or gender.

   >    Comprehensive benefits package.

        We will require insurers to offer a comprehensive benefits
        package, as detailed by the National Health Care Board.  This
        package will cover the preventive and primary care Americans
        need to stay healthy -- including pre-natal care, well-child
        care, mammograms and routine health screenings.  It will also
        include full protection in case of illness -- including
        physician visits, hospital care, prescription drugs, and basic
        mental health care -- and allow consumers to choose where to
        receive care.

   >    Purchasing groups to drive competition.

        We will establish publicly-sponsored purchasing groups that
        band together small businesses and individuals to buy private
        coverage.  Health networks will have to compete -- at lower
        costs, with more choices and higher quality -- to win the
        business of the companies and individuals in these groups.

     Eliminate drug price gouging.

      To protect American consumers and bring down prescription drug
 prices, the Clinton/Gore plan will eliminate special tax breaks for
 pharmaceutical companies that raise their drug prices faster than the
 rate of inflation.  We must stop drug companies from charging more in
 the United States than they do in other advanced nations.

     Reduce paperwork and fraud.

      To control costs and trim the "paper hospital," the Clinton/Gore
 plan will replace expensive and complex financial forms and
 accounting procedures.  We will implement a single claims form,
 standardized billing codes, electronic processing, and other steps
 that will reduce the paperwork now consuming as much as 80 hours a
 month of a physician's time.  We will also crack down on billing
 fraud and remove incentives that invite abuse.

     Reform medical malpractice law.

      We will reform medical malpractice laws to reduce the cost of
 "defensive medicine" -- doctors' practice of ordering unnecessary
 tests to protect themselves against malpractice lawsuits.  We will
 make alternative dispute resolution mechanisms available in every
 state -- mechanisms that take disputes out of the court system and
 effectively and fairly address the concerns of patients and
 physicians.  We will also encourage the development of medical
 practice guidelines to eliminate improper care and to help physicians
 defend against charges of negligence.

  Reduce duplicative technology.

      To reduce the proliferation of duplicative technology, the
 National Health Board will develop recommendations and incentives for
 the shared use of new forms of technology.

 UNIVERSAL COVERAGE:  PRIVATELY PROVIDED, PUBLICLY GUARANTEED

      The Clinton/Gore health reform plan will guarantee coverage for
 all Americans by building on our system of coverage through
 employment.  All workers and their families will receive coverage
 through the workplace.  Government will guarantee coverage for
 nonworkers.

  Guaranteed coverage for working families.

   >    Affordable coverage.

        The Clinton/Gore plan to control costs will make sure health
        benefits are affordable for employers and employees.

   >    Employer responsibilities.

        85% of workers and their families get coverage through jobs.
        We will make sure that all do.  We will require companies to
        insure their employees, and provide tax credits to offset
        costs for companies that need help.

   >    Employer options.

        Employers will purchase benefits directly from insurers or
        through the publicly sponsored purchasing groups.

   >    Protection for business.

        The Clinton/Gore plan will provide assistance to make sure
        that small businesses and their workers are not jeopardized by
        the new responsibilities.  We will take a number of steps in
        addition to the small group market reforms already described:

 --   Provide assistance through tax credits to protect businesses.

 --   Phase in employer requirements with the smallest businesses
      coming in last.  We will not throw businesses into today's
      broken health insurance system.

 --   Require employees to pay a share of the costs of new health
      benefits.

 --   Raise the health insurance tax deduction for the self-employed
      from 25% to 100%.

     Guaranteed coverage for nonworkers.

      The Clinton/Gore plan guarantees nonworkers and their families
 private coverage through the publicly sponsored purchasing groups.
 They will pay a sliding scale premium based on income.  We will fold
 Medicaid into this program for private coverage.

     Savings dedicated to expanding coverage.

      We will dedicate federal savings from cost controls to expanding
 coverage to all.  Once universal coverage is achieved, savings will
 be used to reduce the deficit.

 OTHER STEPS FOR NATIONAL HEALTH REFORM

     Expand Health Education and Demand Personal Responsibility
 The Clinton/Gore plan gives Americans the ability to help themselves.
 We will make an intensive health education effort in the workplace
 and in schools to educate Americans about behavior that causes ill
 health and high costs.  We will make sure adequate information for
 finding high quality, cost-effective coverage is available.  The
 right to affordable health care must be accompanied by the
 responsibility to maintain our own health and to use the system
 wisely.

     Expand School-based, Rural and Urban Health Clinics

 Simply providing health insurance coverage is not enough.  Too many
 Americans in underserved rural and urban communities, and too many
 school children across the country, lack access to the health care
 they need, even when they have excellent insurance coverage.

      The Clinton/Gore plan will expand the number of community health
 clinics in rural and inner-city areas.  In Arkansas, school-based
 clinics have been highly effective in reaching children and families
 on issues like teen pregnancy and early childhood care.  We want to
 see these clinics expanded across the country.

      We will expand the National Health Service Corps which pays for
 the education of health care professionals in return for service in
 underserved communities.  And we will carry out the recommendations
 of the National Governors' Association to provide incentives for
 students and mid-career health professionals to serve in primary care
 professions in underserved areas.

     Emphasize Preventive and Primary Care

 Failure to obtain preventive and primary care -- such as prenatal
 care, immunizations, check-ups, and routine screenings -- is costing
 billions of dollars in avoidable health care.  The Clinton/Gore plan
 will guarantee preventive coverage for all Americans.  We will also
 reform our medical education system to prepare more physicians to
 practice preventive and primary care.  We will expand support for
 graduate training for mid-level health professionals, such as
 certified nurse-midwives and nurse practitioners.

     Expand long-term care

 No Americans should have to impoverish themselves to qualify for
 long-term health care, and no family should have to choose between
 long-term care for grandparents and education for children.

      We can provide more services to the elderly and disabled by
 expanding Medicare.  We will phase in long-term care benefits,
 starting with diversified coverage of home-based and community-based
 care.  In Arkansas, we've launched a popular pilot program called
 ElderChoices, which gives the elderly the right to take money
 previously available only for nursing home care and spend it instead
 on home health care, personal care, transportation to senior centers,
 nurses' services, or attendance at an adult day care center.

 THE BUSH RECORD: A HEALTH CARE NIGHTMARE

 DOING NOTHING WHILE COSTS EXPLODE AND MILLIONS LOSE INSURANCE

 Since 1980, health care costs have tripled, going from $2500 to $7500
 for an American family.  [Health Care Finance Authority, Office of
 the Actuary]

     Annual national health care spending increased from $249 billion
 in 1980 to more than $800 billion today.  [HCFA, Office of the
 Actuary]

     In 1990, 35 million Americans were uninsured.  Each month under
 George Bush, 100,000 people have lost their insurance -- mostly
 workers who lose their jobs or benefits.  [Current Population
 Reports, Bureau of the Census]

 WATCHING WHILE COSTS HIT BUSINESSES, WORKERS, AND THE ECONOMY

 For the first time in American history, health care costs now exceed
 business after-tax profits.  [Health Care Finance Review, Winter
 1991]

     1 million jobs have been lost since 1980 due to rising health
 care spending for business -- 200,000 under Bush alone.  [Kenneth E.
 Thorpe, UNC Working Paper, 8/31/92]

     Health benefits consume 8% of payroll today.  By the end of the
 decade, they will cost as much as 20% if nothing is done.  [Karen
 Davis, Commonwealth Fund]

     Health care costs are hurting American competitiveness.  They add
 $1,230 to the price of cars built in America [Chrysler Corp.]

     Bush's own advisory commission found that workers lost 58% of
 potential wage increases because employers had to spend it on health
 care costs.  [Social Security Advisory Commission, Dec. 1991]

     Medicare and Medicaid have grown from 8% of the federal budget in
 1980 to close to 14% today.  Over the next five years, they will
 account for more than half the growth of the federal deficit.  [CBO]

 PROTECTING THE INSURANCE AND DRUG COMPANIES

 Insurance companies have given over $2 million to the Bush/Quayle
 re-election effort.  [National Library on Money and Politics]

     Drug and health product interests have given another $1 million.
 [Center for Responsible Politics, National Library on Money and
 Politics]

     When Bush convened his 'Health Care Summit' on health care costs,
 Bush effectively barred groups of consumers and businesses who pay
 the bills.  40 representatives of health insurers and providers were
 invited.  [Medicine and Health, 11/4/92]


 THE BUSH PIECEMEAL POLITICAL HEALTH CARE NO-PLAN

 NOTHING BUT POLITICS

 "Mr. Bush expressed no sense of urgency about the health care crisis
 until last November when the voters of Pennsylvania spoke out loud
 and clear for a national health plan and elected Harris Wofford to
 the Senate."  [NYT, 8/2/92]

     George Bush has not introduced in Congress the key to his health
 plan -- his $36 billion a year health care tax credit and deduction
 scheme.

 RAISE COSTS AND COST JOBS

 Bush would increase national health expenditures by 2 percent over
 current levels -- $18 billion next year alone.  It would increase
 federal tax expenditures by 39% or $36 billion a year.  [R.D.
 Reischauer, CBO Director, Senate Finance Committee hearing, 5/6/92]

     "Bush's health proposals will drive up private sector costs at a
 loss of 1.5 million jobs in the next five years.  [Kenneth E. Thorpe,
 UNC Working Paper, 8/31/92]

 SEND MORE MONEY TO INSURANCE, DRUG COMPANIES

 "The large inducements for insurers... would increase the already
 horrendous administrative costs of the current system."  [Henry
 Aaron, Brookings Institute, House Energy and Commerce testimony,
 7/29/92]

     "[Bush's reforms] leave in place some of the worst
 anticompetitive features of the present failed market.  [Alain
 Enthoven, New England Journal of Medicine, 9/10/92]

     Bush won't control drug prices -- increasing at three times the
 inflation rate.  [Families USA]

 LEAVE MILLIONS UNINSURED

 No more than 7 million of the 37 million uninsured would be able to
 purchase health insurance under the Bush proposal.  [Employee
 Benefits Research Institute]

 CREATE 'HEALTH STAMPS' -- WELFARE FOR HEALTH CARE

 Bush would provide a full tax credit or voucher only for those
 earning less than $10,000.  The value falls to just $125 for an
 individual earning just $15,000.

     Bush's proposal allows middle class families to deduct only $563
 out of an average cost of $6,500 -- about 1 month worth of coverage.
 [DPC, 2/28/92; Families USA]

 BUSH PROPOSALS WOULD GUT MEDICARE AND COST JOBS

 In his 1992 Mid-session Review, Bush proposed raising Medicare taxes
 and cutting Medicare benefits by a combined total of $127 billion
 over the next five years, increasing the average elderly American's
 medical bill by $2000.  [OMB]

 The Medicare cuts required by Bush's proposals would increase private
 sector health costs -- and cost 2.2 million jobs.  [Kenneth E.
 Thorpe, UNC Working Paper, 8/31/92]


Timothy B. Reynolds
CLINTON/GORE volunteer
Transition '92
Newsgroups: alt.politics.clinton