THE NEED FOR REFORM
The United States is a world leader in developing new medical
technologies and probing the mysteries of disease through basic and
clinical research. People from all over the world come to the United
States for specialized training and treatment.
...As we undertake this journey of change, we clearly must
preserve what's right with our health care system -- the close
patient-doctor relationship, the best doctors and nurses, the
best academic research, the best advanced technology in the
--President Clinton, September 20th, 1993
But the health care system, as a whole, is in deep crisis.
Health care spending now consumes 14% of GDP, up from 9.1% in 1980.
If nothing is done, by the year 2000, nearly 19% of America's GDP will
go towards health care alone.
Some say that is acceptable, because that's what it costs to keep
our population healthy. But this means accepting that rising health
care costs should consume over 100% of the projected increase in
wages, produce 60% of the projected growth in the federal budget, and
eat away two-thirds of our projected economic growth for the rest of
But in fact, we would be spending that money without getting the
security, simplicity, and value that would help bring health and
expanded opportunity to all Americans.
Because we cannot control health care costs and become further
and further behind in our efforts to do so, we find our economy,
and particularly the federal budget, under increasing pressure.
Just as it would be irresponsible, therefore, to change what is
working in the health care system, it is equally irresponsible
for us not to fix what we know is no longer working.
--Hillary Rodham Clinton, June 13, 1993
...The ethical imperative is perhaps the most important thing.
We have to decide that the costs, not just the financial costs,
but the human costs, the social costs of all of us continuing to
conduct ourselves within the framework in which we are now
operating is far higher than risk of responsible change.
--President Clinton, September 20th, 1993
In short, today's American health care system falls short of
providing high quality care and choices for all Americans.
Some things, like universal access, are not negotiable. And
that's exactly the way it should be.
--C. Everett Koop, 20 September 1993
A LACK OF SECURITY
* Every month, 2 million Americans lose their insurance. One
out of four -- 63 million -- Americans will lose their health
insurance coverage for some period during the next two years.
* 37 million Americans have no insurance and another 22
million have inadequate coverage.
* Losing or changing a job often means losing insurance.
Becoming ill or living with a chronic medical condition can
mean losing insurance coverage or not being able to obtain it.
* Long-term care coverage is inadequate. Many elderly and
disabled Americans enter nursing homes and other institutions
when they would prefer to remain at home. Families exhaust
their savings trying to provide for disabled relatives.
* Many Americans in inner cities and rural areas do not have
access to quality care, due to poor distribution of doctors,
nurses, hospitals, clinics and support services.
* Public health services are not well integrated and
coordinated with the personal care delivery system. Many
serious health problems -- such as lead poisoning and drug-
resistant tuberculosis -- are handled inefficiently or not at
all, and thus potentially threaten the health of the entire
* Rising health costs mean lower wages, higher prices for
goods and services, and higher taxes. The average worker today
would be earning at least $1,000 more a year if health
insurance costs had not risen faster than wages over the
previous 15 years.
* If the cost of health care continues at the current pace,
wages will be held down by an additional $650 by the year 2000.
* More and more Americans have had to give up insurance
altogether because the premiums have become prohibitively
* Many small firms either cannot afford insurance at all in
the current system, or have had to cut benefits or profits in
order to provide insurance to their employees.
* Only one other industrialized country (Canada) spends more
than 10% of their GDP on health care. Japan, France and
Germany spend 9% of GDP or less, and their costs have not risen
nearly as rapidly as ours.
* No one is accountable for the performance of the health
care system -- not hospitals, physicians, other providers, or
* Quality care means promoting good health. Yet, our system
waits until people are sick before it starts to work. It is
biased towards specialty care and gives inadequate attention to
cost-effective primary and preventive care.
* Consumers cannot compare doctors and hospitals because
reliable quality information is not available to them.
* Health care providers often don't have enough information
on which treatments work best and are most cost-effective.
* Health care treatment patterns vary widely without
detectable effects on health status.
* Some insurers now compete to insure the healthy and avoid
the sick by determining "insurability profiles". They should
compete on quality, value, and service.
* The average doctor's office spends 80 hours a month pushing
paper. Nurses often have to fill out as many as 19 forms to
account for one person's hospital stay. This is time that
could be better spent caring for patients.
* Insurance company red tape has created a nightmare for
providers -- with mountains of forms and numerous levels of
review that wastes money and does nothing to improve the
quality of care.
* We have the best doctors who can provide the most advanced
treatments in the world. Yet people often can't get treated
when they need care.
* Our medical malpractice system does little to promote
quality. Fear of litigation forces providers to practice
defensive medicine -- ordering inappropriate tests and
procedures to protect against lawsuits. Truly negligent
providers often are not disciplined, and many victims of real
malpractice are not compensated for their injuries.
* Purchasing insurance can be overwhelming for consumers.
With different levels of benefits, co-payments, deductibles and
a variety of limitations, trying to compare policies is
confusing and objective information on quality and service is
hard for consumers to find. As a result, consumers are
vulnerable to unfair and abusive practices.
* Insurers have responded to rising health costs by imposing
restriction on what doctors and hospitals do. A system that
was complicated to begin with has become incomprehensible, even
to experts. Each health insurance plan includes different
exclusions and limitations. Even the terms used in health
policies do not have standard definitions.
* Small business owners -- who cannot afford big benefits
departments -- have to spend time and money working through the
insurance maze. For firms with fewer than five workers, 40
percent of health care premiums go to pay administrative
* Administrative costs add to the cost of each hospital stay
with the number of health care administrators increasing four
times faster than the number of doctors.
* Health claim forms and the related paperwork are confusing
for consumers, and time-consuming to fill out.
* Insurance coverage for most Americans is not a matter of
choice at all. In most cases, they are limited to whatever
policy their employer offers. Only 29% of companies with fewer
than 500 employees offer any choice of plans.
* With a growing number of insurers using exclusions for pre-
existing conditions, arbitrary cancellations and hidden benefit
limitations, consumers have few choices for affordable policies
that provide real protection.