Hillary Clinton, head of her husband's task force on health care reform, took her message to US academic researchers for the first time last week, at the centennial celebration of the Johns Hopkins University School of Medicine. Mrs Clinton declared that what the country needs most is a larger corps of general primary care doctors to work in small towns and inner cities, attending to routine medical needs. While praising Hopkins for its accomplishments in research and successful high-technology mediciene, Mrs Clinton warned academic hospitals that they must find ways of extending their expertise more broadly into the community. She closed with an admonition to doctors of all stripes to spend more time talking to their patients about diet, nutrition and exercise. [Nature, June 17, 1993] ------------------------------------------------------- For Immediate Release September 16, 1993 STATEMENT BY DR. ARTHUR FLEMMING As the former Secretary of Health, Education and Welfare in the Eisenhower Administration, I would like to express my strong support for President Clinton's health care reform proposal. The proposal he is about to present to the nation is comprehensive, thoughtful, workable and fair - - a proposal that will lead us on the road to a nation where health security with quality care is guaranteed for all Americans and health care costs are brought under control. I have worked for health care reform for the better part of four decades, and I have seen other health care reform efforts start with high hopes and fail. But I believe this is different. The President has presented us with a historic opportunity, and we must seize the moment. Let us get a plan on the books and begin to learn from experience, instead of engaging in endless rhetoric. As a former U.S. Commissioner of Aging, I am particularly enthusiastic about the plan: because this proposal will mean a stregthened Medicare program -- providing greater security and expanded benefits for older Americans. Under the President's proposal, older Americans will receive all the benefits they do today. In addition, Medicare will be expanded to cover prescription drug benefits, and there will be a new long-term care program to cover home- and community-based care. Nearly all Americans will still have to pay only 25% of the total cost of the Part B benefits they receive -- including the new drug benefit. Any increase in the premium will be consistent with the increase in benefits. Only the wealthiest Americans -- those people earning $100,000 or more -- will pay the full actuarial value of the benefits they receive. Finally, Medicare funds now being wasted to cover fraud and overcharges will be used to pay for these new benefits. Over the next several months, there will be likely many attempts by those opposed to reform to scare Americans about the effect of the President's plan. But older Americans should know that President Clinton's proposal will mean greater security and expanded benefits. And I hope that older Americans -- and Americans of all ages -- will join in getting this plan on the books." *** Dr. Flemming was Secretary of Health, Education and Welfare from 1958 through 1961. He was Chair of the White House Conference on Aging in 1971 and U.S. Commissioner on Aging at HEW from 1973 to 1978. Currently, he is Chair of the National Citizens' Board of Inquiry into Health in America, Co-Chair of Save our Security Coalition. ------------------------------------------------------- For Immediate Release September 16 , 1993 Statement from the White House SENATOR PRYOR'S PHARMACEUTICAL RESTRAINT AGREEMENTS The White House today indicated its support of Senator David Pryor's (D-AR) call for pharmaceutical manufacturers to sign voluntary commitments to restrain prescription drug price increases: "While we are still evaluating the specifics of Senator Pryor's proposal, we applaud him for his vision, dedication and leadership in doing all he can to help make prescription drugs affordable and accessible for the American public. His challenge to the industry is precisely the type of initiative which must be met by pharmaceutical manufacturers and others in the health care industry if we are going to work together to put the brakes on health care inflation. Under Senator Pryor's proposal, the makers of prescription drugs would commit to limiting retail price increases to the annual inflation rate. By taking this action, manufacturers would protect the American consumer from escalation of drug prices. This is important because drug price inflation has been particularly significant at the consumer level over the last twelve years. Based on the many thousands of letters that the White House has received over the past eight months on health care reform, the cost of prescription medications is among the top concerns of Americans. Senator Pryor's approach appears to provide a realistic way to deal with medication costs during the period of transition to the new system. The pharmaceutical industry has repeatedly stated that they are committed to keeping price increases for their products at or below the general inflation rate. Recently the President called on the industry to keep to their pledge. Senator Pryor's proposal represents a golden opportunity for the industry to make good on that pledge to the American public." ------------------------------------------------------- The White House Health Care Reform Today September 16, 1993 * Today, President and the First Lady will begin the discussion about health care with the American people. From throughout the country , people who have written letters to the President will have an opportunity to tell their stories firsthand about the need for health care reform. The event will be broadcast live on C-Span beginning at 8:00 a.m. EDT. * Following that, President Clinton will participate in a small business roundtable with SBA administrator Erskine Bowles. * We were greatly encouraged by the Republican plans for health care reform that were introduced yesterday. We see many areas of agreement and look forward to discussing further they areas that need more work. The consultation process is working .... for both sides. * The need for health care reform was even more evident yesterday. Families USA released a report showing that two million Americans a month lose their health insurance coverage at least temporarily. First Lady Hillary Rodham Clinton said after receiving the report: "What we have is a situation in which American's lose health insurance for a variety of reasons. The number one goal for the president in proposing health care reform is ensuring health care security for every single American." * Yesterday, the First Lady helped unveil the government's new anti-trust proposals for the health care industry. Saying it would lower costs, maintain high quality and knock down barriers to collaboration, she said the guidelines will allow joint purchasing ventures, more mergers and more physician networks. Health Care Reform Today * The White House ------------------------------------------------------- The White House Health Care Reform Today September 17, 1993 * A great start to the dialogue on health care. The President and the First Lady, the Vice-President and Mrs. Gore listened to people put faces to the problems of health care. They heard from 15 of the more than 700,000 who wrote to the White House about the need for health care reform. The President said: "In the weeks and months ahead, health care will often be topic number one at dinner tables, at offices, at medical clinics, and in the halls of Congress. If you read some of these letters as I have, the picture very quickly becomes clear. Even the millions of Americans who enjoy health care coverage are afraid it won't be there for them next month or next year. They want us to take action to give them the security that all Americans deserve." * Former Secretary of Health, Education and Welfare in the Eisenhower Administration, Dr. Arthur Flemming has expressed his strong support for President Clinton's health care reform proposal. He said: "The President has presented us with a historic opportunity, and we must seize the moment. Let us get a plan on the books and begin to learn from experience, instead of engaging in endless rhetoric. As a former U.S. Commissioner of Aging, I am particularly enthusiastic about the plan: because this proposal will mean a straightened Medicare program -- providing greater security and expanded benefits for older Americans. Under the President's proposal, older Americans will receive all the benefits they do today. In addition, Medicare will be expanded to cover prescription drug benefits, and there will be a new long-term care program to cover home- and community-based care. Nearly all Americans will still have to pay only 25% of the total cost of the Part B benefits they receive -- including the new drug benefit. Any increase in the premium will be consistent with the increase in benefits. Only the wealthiest Americans -- those people earning $100,000 or more -- will pay the full actuarial value of the benefits they receive. Finally, Medicare funds now being wasted to cover fraud and overcharges will be used to pay for these new benefits." Health Care Reform Today * The White House ------------------------------------------------------- REMARKS BY THE PRESIDENT TO DOCTORS, NURSES, AND SOCIAL WORKERS Children's National Medical Center Washington, D.C. 10:20 A.M. EDT THE PRESIDENT: Thank you. Well, Dr. Beard, I promise to free you of the paperwork if you will promise not to use your free time to run for president.(Laughter and applause.) Mr. Brown and Ms. Frieberg, Dr. Beard, to all of you who helped to make our visit here so wonderful today.I want to thank this Children's Hospital for bringing us together this morning, for giving us a chance to see some of your patients and their parents and their friends, and to witness the miracles you are working. I want to thank Ben Bradley and Sally Quinn for calling Al and me and telling us to hustle more money for the hospital. (Applause.) In my former life, when I was a governor, my wife and I worked very hard for the Arkansas Children's Hospital.Some of you know it's one of the 10 biggest hospitals in the country, and every year we finished first or second in the telethon, even though we come from a small state.There's a lot of grass-roots support for people who are doing what you're doing. We built a tertiary care nursery at our hospital with state funds for -- the first time anything like that had been done. And I have spent countless hours in our Children's Hospital at home with my own daughter, with the children of my friends.Sometimes their last day, sometimes their best day.And I am profoundly grateful to you. I think the people in the press and maybe some others might have wondered today why in the wide world we would come to a children's hospital, with all of its gripping, wonderful, personal stories, to have an event about bureaucracy and paperwork.After you listen to a nurse say why she couldn't care for a sick child, and a doctor plead for more time to be a doctor, maybe you know.There is an intensely human element behind the need to reform the system we have. When we were upstairs and Dr. Grizzard and Ms. Mann were showing us some forms, we looked at four case files that they said had $14,000 worth of work in them that were absolutely unrelated to the care of the patient.The doctor said he estimated that each doctor practicing in this hospital, 200 in total, spent enough time on paperwork unrelated to patient care every year to see another 500 patients for primary preventive care -- times 200.You don't have to be a mathematical genius to figure out that's another 10,000 kids who could have been cared for, whose lives could be better. People say to me, how in the world do you expect to finance universal coverage and cut Medicare and Medicaid?Let me say, first of all, nobody's talking about cutting Medicare and Medicaid, we're talking about whether it doesn't need to increase at 16 percent or 12 percent or 15 percent a year anymore.And it wouldn't if we had some simplification so people could spend the time they have already got on this Earth doing what they were trained to do. I've got a friend who is a doctor that I grew up with who happens to live in the area, who calls me about once every three months to tell me another horror story.And the other day, he called me and he said, "You had better hurry up and get this done."He said, "You know, I'm in practice with this other guy.We've got all of these people doing paperwork.Now we've hired somebody who doesn't even fill out any forms.She spends all day on the telephone beating up on the insurance companies to pay for the forms we've already sent in.We actually had to hire somebody to do nothing but call on the phone."He said, "I'm lost in a funhouse here." (Laughter.)He said, "I went to medical school to try to practice medicine.Now I've got to hire somebody who does nothing but call people on the phone to pay the bills they're supposed to pay, after I've spent all this time filling out these forms?" People complain about doctor fees going up.I'll give you one interesting statistic.In 1980, the average physician in America took home 75 percent of the revenues that were generated in a clinic.By 1990, that number had dropped from $.75 on the dollar to $.52.Where did the rest of it go?Right there.Most of it went to forms. Now, you know, when we were up in that medical records room, we saw all these forms.We knew that by the time they -- we were told that by the time the room was done the room was already too small because the paper kept coming faster than you could make space for it in this hospital.A lot of you are nodding about that. (Laughter.)Now they have records flowing on into a room that is beneath us in the garage, and these files are still growing at the rate of 6.5 feet a week. We know, of course, from what Dr. Beard and Ms. Frieberg said that that's just some of the story.There are departments in this hospital that spend all their time trying to satisfy hundreds of different insurers.There are 1,500 in America, by the way; no other country has that many.This hospital I think deals with over 300. Each of them want a slightly different piece of information and in slightly different way, so that even if you try to have a uniform form it's not uniform by the time you finish customizing it. How did this happen?Hospitals like this one treat people who are most vulnerable, weak, ailing and in pain.To make sure that sick patients were getting the best care, government regulators and private insurers created rules and regulations, and with them came forms to make sure you were following the rules and regulations.To make sure doctors and nurses then didn't see the patients that were getting the best care too often, keep them in the hospital too long, or charge them too much, there were more rules and regulations, and along with them, more forms. As more and more insurance agencies and private companies got into the business of selling health insurance -- and as I said, there are now more than 1,500 insurers in this country; no other country in the world has anything like that many -- each of them had their own forms and their own different list of what they would cover. And so what are you left with?Instead of all this paper and all these medical forms assuring that the rules are followed and people get healthy, we're stuck in a system where we're ruled by the forms and have less time to make children and adults healthy. When doctors and nurses are forced to write out the same information six different times in seven different ways just to satisfy some distant company or agency, it wastes their time and patients' money and, in the end, undermines the integrity of a system that leaves you spending more and carrying for fewer people. Just think about the patients.I don't know if you've read the stories in the morning paper about the people we invited to the Rose Garden at the White House yesterday.We invited about 100 people and let -- who had written us letters.We let 15 of them read their letters.They are part of the 700,000 letters that my wife and her group have received since we started this health care project. And they were all saying more or less the same thing:we want coverage, we don't want to be locked into our jobs, preexisting conditions shouldn't bankrupt families. But there was one gentleman there from Florida, Jim Heffernan, who told us that he is a retiree on Medicare who spends his time working in hospice programs with people who are much sicker than he is.And he talked about how all the regulations, the reimbursement forms, all the complexities sap the energy and the morale and the vitality of the people that he was trying to help.He describes mountains of paperwork that older Americans face.He told how he now volunteers his time helping these patients to decipher their forms instead of helping them to feel better about their lives and think of something interesting to do every day to make every day count. The biggest problem with all this, of course, is the waste and inefficiency.We spend more than $.20 of every health care dollar on paperwork.And after about four years of studying this system, long before I even thought of running for President, I got interested in this at home, and I've tried to honestly compare our system with systems in other countries.And it appears to me that we spend about a dime on the dollar more than any other country in the world on bureaucracy and paperwork. In a medical system that costs $880 billion, you don't have to be a mathematical genius to figure out what that is.What could we do in this country with that money?How many people could we cover?How many things could we do?How much more preventive care could we do to lower the long-term cost of the system?How many more children could we care for? In the last 10 years, our medical providers have been hiring clerical help at four times the rate of direct health care providers.That is a stunning statistic.They spend resources that should go into care on other things. What we want to do with this health security plan is to do away with all of that, to streamline the rules, reduce the paperwork, make the system make sense and do nothing to interfere with the private delivery of care system that we have now.And we believe we can do it.We think we can do away with the different claims forms, with all the confusing policies, and put the responsibility for measuring quality where it belongs -- with you on the front lines and not with examiners that work for government or the insurance company thousands of miles away. Here's how we propose to do it.First, we want to create a single claim form -- one piece of paper that everyone will use and all plans will accept.We've already started moving in this direction now.There are some standard forms used by Medicare and others that are aimed at cutting back on all this craziness.But as you know here at Children's, a single form is no good if every insurer uses it differently.You might as well have different forms. So we will now introduce a single form which we have a prototype of here today.I've got one here or you can see one here. A single form which would go to every hospital, every doctor's office in the country, which would deal with the basic benefits package and which would replace that -- and worse.Think of what that will do. Think of how many hours it will free up for all of you.(Applause.) Now, when we do this, that won't be enough.We'll have to standardize how the forms are used -- building on what has been done in other contexts in private industry, building on what we know from the professional associations in health care.We'll ask doctors and nurses and health care plans to decide together on what information absolutely has to be given to guarantee the highest quality and most cost-effective care. Secondly, in order to make this form work, we'll have to create a single comprehensive benefit package for all Americans. We'll allow consumers of the health care -- the employees and others in our country -- to make some choices between the packages.But it will essentially be one comprehensive package.No longer will hospitals and doctors have to keep track of thousands of different policies.No longer will they have to chase down who has which insurance and what's covered under what circumstances.If it's covered, it's covered no matter who you are or what plan you're in, no matter whether you have a job or whether you don't.It will simply be covered. It will simplify your life.And it will also provide security to the American people who worry that if they switch jobs, they'll lose their health care coverage or it will be so different it will take them six months to figure out what's covered and what isn't.They won't have to know -- the American people won't --enough jargon to fill a phone book just to come down here and see you.It will mean that more of the money we all pay for health care will go for health care and not bureaucracy. And finally, the government will try as hard as we can -- and I say that because I've found as President I have to work extra hard to change the culture of the government when I want to get something done.But our rules are going to be that we are going to rebuild the trust between doctors and hospitals and patients and the government that is funding some, but by no means all, of the health care. Federal programs, let's face it, are a big part of the paperwork problem.We will simplify and streamline Medicare reimbursement and claims processes,and we'll refocus clinical laboratory regulations to emphasize quality protection.And we will reduce a lot of the unnecessary administrative burden that the national government has put on them now. If we do this right, those of you on the front lines will spend less time and money meeting the paperwork requirements, and more time and energy treating patients.You'll face fewer crazy rules and regulations, worry less about which insurers cover what, have better tools and information to help actually protect people and promote quality, rather than constantly having to prove you've done nothing wrong. You'll hear a lot more about this proposal in the weeks ahead.As the debate evolves, I want to tell the people about these children, these brave children I met upstairs, about the wonderful people who are caring for them, and about how they deserve the opportunity to care more and spend less time with paper and forms. I value what you do here at this hospital and what people like you do all over America.If the American people really knew what nurses and doctors have to go through today just to treat people, they would be up in arms, they would be marching on Congress, demanding that we do something to solve this problem. I hope that, by our coming here today, we have made a very real and human connection between these magnificent children and all of the wonderful people who care for them and this awful problem represented by this board up here. If we move here, it means more for them. And that's why we came here. Thank you very much. (Applause.) ------------------------------------------------------- The White House Health Care Reform Today September 20, 1993 * Today, President Clinton and the First Lady will join more than 100 doctors to talk about the Health Security Act. Joining them and speaking will be the former Surgeon General, Dr. C. Everett Koop. * This week, as we head towards the President's speech on Wednesday night, we'll be giving you our suggestions on how to talk about health care. The basics of how what we say centers around these six principles: Security, Savings, Simplicity ... Quality, Responsibility and Choice. * Guaranteeing comprehensive benefits that can never be taken away. Controlling health care costs for consumers, business and our nation. Improving the quality of American health care. Increasing choices for consumers. Reducing paperwork and simplifying the system. Making everyone responsible for health care. * In America, rights and responsibilities go hand-in-hand. We will ask everybody to pay something, even if your contribution is small. Everyone must assume responsibility. No one should get a free ride. Most important, we're going to offer new opportunities and new incentives for people to stay healthy -- and to treat small problems before they become big ones. Our goal should be to keep people healthy, not treat them after they become sick. * While others are not drawing any lines in the sand on the details of the plan, the NFIB sure did. NFIB head Jack Faris made that clear in Friday's New York Times. He said: "We checked the Constitution, and we don't see where it gives you the right to universal health insurance." Basically, the NFIB is saying to everyone who currently does not have health care or is at risk of losing their health care to drop dead. But then again, the NFIB has been predicting the end of the world as they know it since at least 1962. ------------------------------------------------------- The White House Health Care Reform Today September 21, 1993 * Here's what the White House will be saying today: The unprecedented bi-partisanship will continue with a set of workshops for members of Congress. Republicans and Democrats alike are being given an opportunity to hear from Administration officials about the Health Security Act of 1993. Speaking yesterday at the opening session, First Lady Hillary Rodham Clinton said: "Heath care reform goes beyond politics as usual. It is not a partisan issue..." * For the first time ever, Republicans and Democrats agree that every American must have health security...that universal coverage is not negotiable by either side. Health care for every American is agreed upon and will stand and no naysayer or partisan can drive a wedge between the parties on this critical principle. * Dr. C. Everett Koop, former Surgeon General, on supporting the Clinton plan: "A few weeks ago, I told the President that without passing a single law or issuing a single regulation, he had accomplished more in health care reform in the past four months than all of his living predecessors put together. And he did that with a special kind of leadership that is willing to take on an enormous task. This kind of leadership also takes courage because it's a daunting task to face runaway health care costs, the vexing issue of universal access, the malpractice mess, the mounting problems of Medicare and Medicaid, the application of outcomes research, a sweeping reassessment of medical ethics, to say nothing of rooting out fraud and waste and abuse and greed." * The National Association of Private Enterprise, in surveying it's 38,662 members, found that 73% of small business owners support reforming our health care system. ------------------------------------------------------- The White House Health Care Reform Today September 22, 1993 * Tonight the President will bring health care to the front of the public debate. He will talk about the goals of health care: Security, Savings, Simplicity, Quality, Choice and Responsibility. Here's how to talk about the President's speech tonight: Security of guaranteed, comprehensive benefits. Health care costs that are under control. Improved quality of care. Increased choices for consumers. Less paperwork and a simpler system. Responsibility from everyone. Here's how to talk about the problem: Over the next two years, one out of four of us will be without health coverage at some point. Change jobs, lose your job, or move -- and your insurance company is currently allowed to drop you. Today's system is rigged against families and small businesses. Insurance companies pick and choose whom they cover. Then they drop you when you get sick. If you have a pre-existing condition, you usually can't get any insurance at all. Insurance companies charge small businesses as much as 35% more than the big guys. Only 3 of every 10 employers with fewer than 500 employees offer any choice of health plan. Millions of Americans have almost no choice today. Twenty-five cents out of every dollar on a hospital bill goes to bureaucracy and paperwork -- not patient care. Fraud and abuse are exploding, costing us at least $80 billion a year. That's a dime of every dollar we spend on health care. Our nation's health costs have nearly quadrupled since 1980. Without reform, by the year 2000, one of every five dollars we spend will go to health care. * Thursday afternoon, more than 1,000 people are expected on the White House south lawn to show support for the President's plan. We don't have room to put in the whole list...but there'll be a few surprises! Stay tuned and join us tonight! -------------------------------------------------------