Health Security for All Americans

Speech

By: William Jefferson Clinton

Date: September 22, 1993

Source: Clinton, William Jefferson. "Health Security for All Americans." September 22, 1993. Available at <http://www.ibiblio.org/nhs/supporting/remarks.htm l> (accessed June 10, 2006).

About the Author: William Jefferson Clinton (1946–) was the forty-second president of the United States. He held office from 1993 to 2001. Early in his first term as president, he proposed the Health Security Act, which failed.

INTRODUCTION

In 1993, President Bill Clinton proposed a program of sweeping health-care reforms and suggested the creation of a system of universal health-care coverage for all people living in the United States of America. The plan was met with considerable public enthusiasm but little political approval. There was significant buzz in the political and health-care arenas suggesting that the time was right for major changes in the American third-party-payer system, notably making certain that all of the people in the country would have access to free or affordable health care coverage. Numerous public-interest and lobbying groups had suggested plans for health-care reform, and the concept of universal coverage (assuring free or affordable health-care coverage for every person in America) or mandated coverage (requiring that all persons be able to purchase affordable health-care insurance, no matter what their level of employment or degree of personal financial stability) was publicly endorsed by both the Health Insurance Association of America (HIAA) and the American Medical Association (AMA). Many of the country's largest employers and biggest businesses, as well as the U.S. Chamber of Commerce, voiced their support of employer-mandated insurance (all employers would have to provide health coverage to every employee, regardless of degree or level of employment).

During the early 1990s, a number of health-care reforms were suggested, and many bills were proposed, resulting in a level of tumult and confusion within both the political arena and the business world. The first major shake-up came when the U.S. Chamber of Commerce, in recovery from significant internal organizational reform, withdrew its prior support of employer-mandated health-care coverage. This development was followed shortly by a change in the previous stance taken by the American Medical Association, which stated that only larger employers, those with more than one hundred staff members, should be mandated to provide health-care coverage for all workers. Most of the health-care reform bills that were introduced for legislative consideration were withdrawn, and support for the president's massive reform campaign quickly cooled. There was considerable commentary made about the level of government intrusiveness that would be imposed upon private citizens with the advent of universal health-care plans. Within about a year of its official introduction and without ever having been substantially acted upon, the Health Security Act was shelved.

PRIMARY SOURCE

Mr. Speaker, Mr. President, Members of Congress, distinguished guests, my fellow Americans—

Tonight, we come together to write a new chapter in the American story.…

It is time for America to fix a health care system that is badly broken.

Despite the dedication of millions of talented health care professionals, our health care is too uncertain and too expensive; too bureaucratic and too wasteful. It has too much fraud and too much greed.

At long last, after decades of false starts, we must make this our most urgent priority: Giving every American health security—health care that's always there—health care that can never be taken away.

On this journey, as on all others of consequence, there will be rough stretches and honest disagreements about how to reach our destination. After all, this is a complicated issue.…

So tonight, I want to talk with you about the principles that must guide our reform of America's health care system: Security, simplicity, and savings; choice, quality and responsibility.…

Every one of us knows someone who has worked hard and played by the rules but has been hurt by this system that just doesn't work. Let me tell you about just one.

Kerry Kennedy owns a small furniture franchise that employs seven people in Titusville, Florida. Like most small business owners, Kerry has poured his sweat and blood into that company. But over the last few years, the cost of insuring his seven workers has skyrocketed, as did the cost of the coverage for himself, his wife, and his daughter. Last year, however, Kerry could no longer afford to provide coverage for all his workers because the insurance companies had labeled two of them high risk simply because of their age. But, you know what? Those two people are Kerry's Mother and Father who built the family business and now work in the store.

That story speaks for millions of others. And from them, we have learned a powerful truth: we have to preserve and strengthen what is right with our health care system and fix what is wrong with it.

This is what is right: We are blessed with the best health care professionals, the finest health care institutions, the most advanced research, and the most sophisticated medical technology on the face of the earth. My mother is a Nurse, and I grew up around hospitals. The first professional people I ever knew and looked up to were doctors and nurses. They represent what is right with our health care system.

But we cannot ignore what is wrong. Millions of Americans are just a pink slip away from losing their health coverage, and one serious illness away from losing their life savings. Millions more are locked into the wrong jobs, because they'd lose their coverage if they left their companies. And on any given day over 37 million of our fellow citizens, the vast majority of them children or hard working adults, have no health insurance at all. And despite all of this, our medical bills are growing at more than twice the rate of inflation.

Our health care system takes 35% more of our income than any other country, insures fewer people, requires more Americans to pay more and more for less and less, and gives them fewer choices. There is no excuse for that kind of system, and it's time to fix it.…

The first principle of health care reform—the most important—must be security. This principle speaks to the human misery and costs that we hear about every day when Americans lack or lose health care coverage.

Security means that those who do not have health care coverage will have it and, for those who have coverage, it will never be taken away. We must achieve that security as soon as possible.

Under our plan, every American will receive a health security card that will guarantee you a comprehensive package of benefits over the course of your lifetime that will equal benefits provided by most Fortune 500 corporations.

This card will guarantee you a comprehensive package of benefits that can never be taken away. And let us pledge tonight: Before this Congress adjourns next year, you will pass, and I will sign a new law to create health security for every American.

With this card, if you lose your job or switch jobs, you're covered.

If you leave your job to start a small business, you're covered.

If you are an early retiree, you're covered.

If you or someone in your family has a preexisting medical condition, you're covered.

If you get sick or a member of your family gets sick, even if it's a life-threatening illness, you're covered.

And if an insurance company tries to drop you for any reason, you'll still be covered—because that will be illegal.

This card will give you comprehensive coverage. You will be covered for hospital care, doctors visits, emergency and laboratory services, diagnostic services like Pap smears and mammograms, substance abuse and mental health treatment.

And our proposal will pay for regular check-ups, well-baby visits and other preventive care. It's just common sense. People will stay healthier and at affordable costs. You know how your mother told you that an ounce of prevention is worth a pound of cure? Well, your mother was right. And we've ignored that lesson for too long.

Security must also apply to older Americans. This is something I feel very strongly about: We will maintain the Medicare program. And for the first time, Medicare will cover the cost of prescription drugs. And over time our proposal will provide assistance in the home for the elderly and disabled who need long term care. As we proceed with health care, we must not break faith with our older Americans.

Simplicity

…Our health care system must be simpler for the patients and simpler for those who actually deliver health care: our physicians, our nurses, and our other medical professionals.…

Under our proposal, there will be one standard insurance form, not hundreds. We will simplify government rules and regulations so that a doctor doesn't have to check with a bureaucrat in an office thousands of miles away before ordering a simple blood test. And you won't have to worry about the fine print, because there won't be any fine print.

Savings

…Reform must produce savings in our health care system.

Today, rampant medical inflation is eating away at our wages, our savings, our investment capital, and our public treasury. It undermines America's economy, competitiveness, confidence, and living standards.…

Unless everyone is covered, we can never put the brakes on health care inflation. Because when people don't have insurance, they wait to see a doctor until their illness is more severe and more costly, and they often seek treatment in the most expensive settings—like emergency rooms. And when they can't pay their bills, because they aren't insured—who do you think picks up the tab?—the rest of us do: through higher hospital bills and higher insurance premiums.

We will also save money by simplifying the system and freeing health care providers from costly and unnecessary paperwork and administrative overload that now costs $100 billion a year. We will crack down on the fraud and abuse that drains billions per year.

This system will work. You don't have to take my word for it. Ask Dr. C. Everett Koop. He says we could spend $200 billion less every year without sacrificing the high quality of American medicine. Ask the public employees in California, who have held their own premiums down by adopting this very same approach. Ask Xerox, which saved an estimated $1,000 per worker. Ask the staff of the Mayo Clinic, who provide some of the finest care in the world, while holding their cost increases to less than half the national average. Ask the people of Hawaii, the only state that covers virtually all of their citizens, and whose costs are well below the national average.…

Choice

…Americans believe they should be able to choose their own health care plans and their own doctor. And under our plan they will have that right.

But, today, under our broken health care system, that power to choose is slipping away. Now it is usually the employer—and not the employee—who makes the choice of what health care plan will be provided. If your employer only offers one plan, as do nearly three-quarters of small and medium-sized businesses, you're stuck with that plan and the doctors it covers.

We propose to give every American a choice among high quality plans. You can stay with your current doctor, join a network of doctors and hospitals, or join a Health Maintenance Organization. If you don't like your plan, every year you'll have the chance to choose a new one.

The choice will be left to you—not your boss—and not some bureaucrat.

And we also believe that doctors should have a choice as to what plans they practice in. We want to end the discrimination that is now growing against doctors and permit them to practice in several different plans. Choice is important for doctors, and critical for consumers.

Quality

…Quality is something that cannot be left to chance. When you board an airplane, you feel better knowing that plane had to meet standards designed to protect your safety. We must ask no less of our health care system.

We don't propose a government-run health care system. We propose that government sets standards to ensure health care quality.…

Our plan will guarantee that quality health care is available in even the most remote areas of our nation, linking rural doctors and hospitals with high-tech urban medical centers. And our plan will ensure quality by speeding research on effective prevention and treatment measures for cancer, for AIDS, for Alzheimers, for heart disease and for other chronic diseases. Our plan safeguards the finest medical research establishment in the world, and makes it even better.

Responsibility

…We need to restore a sense that we are all in this together, and we all have a responsibility to be a part of the solution.

Responsibility must start with those who have profited from the current health care system. Responsibility means insurance companies will no longer be allowed to cast people aside when they get sick. It must also apply to laboratories that submit fraudulent bills; to lawyers who abuse the malpractice system; to doctors who order unnecessary procedures. It means drug companies will no longer be allowed to charge three times more for prescription drugs here in the United States than they charge overseas. Responsibility must apply to anyone who abuses our system and drives up costs for honest, hardworking citizens and health care providers.

Responsibility also means changing the behavior in this country that drive up our health care costs and cause untold suffering. It's the outrageous costs of violence from far too many handguns, especially among the young. It's high rates of AIDS, smoking and excessive drinking; it's teenage pregnancy, low-birth-weight babies, and not enough vaccinations for the most vulnerable.

But let me also say this. And I hope you will listen, because it is a hard thing to hear. Responsibility in our health care system isn't about "them." It's about you. It's about me. It's about each of us.

Too many Americans have not taken responsibility for their health. Too many Americans use this health care system but don't pay a penny for their health care. I believe those who do not have health insurance should be responsible for paying something. There can be no more something for nothing.…

Let us write that new chapter in America's story, and guarantee every American comprehensive health benefits that can never be taken away.

Some people have said that it would be a miracle if we passed health care reform. But, my fellow Americans, I believe we live in a time of great change when miracles do happen.…

I believe that forty years from now, our grandchildren will also find it unthinkable that there was a time in our country when hardworking families lost their homes and savings simply because their child fell ill, or lost their health coverage when they changed jobs. Yet, our grandchildren will only find such things unthinkable tomorrow, if we have the courage to change today.

This is our chance. This is our journey. And, when our work is done, we will know that we have answered the call of history and met the challenge of our times.

Thank you. And God bless America.

SIGNIFICANCE

There was much speculation as to what caused the defeat of the Clinton health-care reform bill; many expressed public sentiment that the plan was too involved, too cumbersome, and too government-heavy to appeal to the masses. Essentially, the plan, as it was ultimately structured, advocated what is called a managed competition program. In this type of program, a limited pool of potential health care insurers compete for the individual's or family's business, within a range of acceptable plan options for comprehensive health-care coverage, thereby driving prices for coverage down while frequently increasing the available menu of services and programs available to the consumer. In this way, the consumer is offered significant free choice in plan selection. Significant enhancements were built into the system, in part as a means of seeking buy-in from growing population segments, such as prescription coverage and early retirement benefits for elders. Caps were built into the roll-out of the program, limiting premium cost increase over the first several years of the plan. The health-care reform plan also included such high-cost items as home-based long-term care and services for elders and those with disabilities. A somewhat controversial issue was coverage for abortions, a proposal that had the effect of galvanizing conservative and religious groups to voice their very strong opposition to the plan.

During the period that the Health Security Act was under discussion, there were several health-care reform packages and bills circulating. Generally, the most popular among them contained at least some level of consumer choice and advocated the creation of managed competition among the pool of potential insurers. They also contained a proposal for purchasing cooperatives for health insurance and standard benefit packages—as is the case for most commercial insurance plans, health maintenance organizations, managed care organizations, and federally funded health care coverage providers such as Medicaid. All advocated the establishment of subsidies in order to make the payment of insurance premiums affordable for low-income individuals and families, as well as for those living in poverty.

Critics of the plans, and of the Clinton plan in particular, felt that they were excessively cumbersome (the proposed Health Security Act legislation was well in excess of one thousand pages in length) and overly restrictive. The Clinton plan called for limited choice of health-care providers; many individuals and families feared that they would lose established relationships with health-care professionals. Many others reported that they were well satisfied with their current type and level of health-care coverage and would object to any mandated changes, despite the reported fact that the health care coverage costs in America are the highest in the world. There was a public perception that everyone who wanted or needed health care coverage could get it, and many believed that few people were either uninsured or underinsured. In a time of economic prosperity, the public seemed to feel that all was universally well and failed to recognize the substantial percentage of the population that earned too much to be eligible for publicly paid health care but not enough to be able to afford private insurers. Also overlooked were those who were too ill or disenfranchised to have the wherewithal to seek federally funded coverage, those who continually resorted to the use of emergency medical services as a means of obtaining health care.

In the end, the ponderousness of the plan, as well as the timing of its launch—when the majority of the voting population expressed comfort with their health-care coverage—led to its demise. Universal health-care coverage would be a boon to the poorer segments of the population, to the underemployed, to the chronically ill, to the homeless and disenfranchised populations, and to those who simply do not have the means or the ability to navigate the administrative systems necessary to obtain federally funded health care. Anything that drives costs down while maintaining or improving the level of health-care provision and stabilizing or broadening the menu of available services benefits everyone, particularly if it can be accomplished universally.

FURTHER RESOURCES

Books

Chapman, Audrey R., ed.Health Care Reform: A HumanRights Approach. Washington, D.C.: Georgetown University Press, 1994.

Epstein, Richard A.Mortal Peril: Our Inalienable Right toHealth Care?. Cambridge, Mass.: Perseus Books, 1999.

Ginzberg, Eli, ed.Critical Issues in U.S. Health Reform. Boulder, Colo.: Westview Press, 1994.

Laham, Nicholas.A Lost Cause: Bill Clinton's Campaign for National Health Insurance. Westport, Conn.: Praeger, 1996.

Patel, Kant and Mark Rushefsky.Health Care Politics and Policy in America. Armonk, N.Y.: M.E. Sharpe, 1995.

Rosenthal, Marilynn and Max Heirich, eds.Health Policy:Understanding Our Choices from National Reform to Market Choices. Boulder, Colo.: Westview Press, 1998.

Rushefsky, Mark and Kant Patel.Politics, Power and Policy-Making: The Case of Health Care Reform in the 1990s. Armonk, N.Y.: M. E. Sharpe, 1998.

Shelton, Michael W.Talk of Power, Power of Talk: The 1994 Health Care Reform Debate and Beyond. Westport, Conn.: Praeger, 2000.

Periodicals

"The Beginning of Health Care Reform: The Clinton Plan."The New England Journal of Medicine329 (21) (November 18, 1993): 1569–1570.

Web sites

The Health Security Act of 1993. "Health Care That's Always There—Executive Summary." <http://www.ibiblio.org/ nhs/executive/X-Summary-toc.html> (accessed May 20, 2006).

The White House. "William J. Clinton." <http://www. whitehouse.gov/history/presidents/bc42.html> (accessed May 31, 2006).