    [Public Papers of the Presidents of the United States: William J. Clinton (1993, Book II)]
    [October 27, 1993]
    [Pages 1834-1836]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Letter to Congressional Leaders on Proposed Health Care Reform
    Legislation
    October 27, 1993

    Dear Gentlemen:
        The ``Health Security Act of 1993'' holds the promise of a new era
    of security for every American--an era in which our nation finally
    guarantees its citizens comprehensive health care benefits that can
    never be taken away.
        Today, America boasts the world's best health care professionals,
    the finest medical schools and hospitals, the most advanced research and
    the most sophisticated technology. No other health care system in the
    world exceeds ours in the level of scientific knowledge, skill and
    technical resources.
        And yet the American health care system is badly broken. Its
    hallmarks are insecurity and dangerously rising costs.
        For most Americans the fear of losing health benefits at some time
    has become very real. Our current health insurance system offers no
    protection for people who lose their jobs, move, decide to change jobs,
    get sick, or have a family member with an illness. One out of four
    Americans is expected to lose insurance coverage in the next two years,
    many never to be protected again. Altogether, more than 37 million
    Americans have no insurance and another 25 million have inadequate
    health coverage.
        Rising health care costs are threatening our standard of living. The
    average American worker would be making $1,000 a year more today if
    health care accounted for the same proportion of wages and benefits as
    in 1975. Unless we act, health care costs will lower real wages by
    almost $600 per year by the end of the decade and nearly one in every
    five dollars Americans spend will go to health care.
        Small businesses create most of the new jobs in America and while
    most want to cover their employees, more and more cannot. Under the
    current health care system, cost pressures are forcing a growing number
    of small business owners to scale back or drop health insurance for
    their employees. Small businesses spend 40 cents of every health
    insurance dollar for administration--eight times as much as large
    companies. And only one in every three companies with fewer than 500
    workers today offers its employees a choice of health plan.
        Our health care system frustrates those who deliver care. Doctors
    and nurses are drowning in paperwork, and hospitals are hiring
    administrators at four times the rate of health care professionals. The
    system places decisions that doctors should be making in the hands of
    distant bureaucrats. Its incentives are upside down; it focuses on
    treating people only after they get sick, and does not reward
    prevention.
        Clearly, our challenges are great. This legislation is sweeping in
    its ambition and simple in its intent: to preserve and strengthen what
    is right about our health care system, and fix what is wrong.
        Our needs are now urgent. A nation blessed with so much should not
    leave so many without health security.
        This legislation draws upon history. It reflects the best ideas
    distilled from decades of debate and experience.
        It reflects the sense of responsibility that President Franklin
    Roosevelt called for when he launched the Social Security program in
    1933 and recommended that health care be included.
        It reflects the vision of President Harry Truman, who in 1946 became
    the first President to introduce a plan for national health reform.
        It reflects the pragmatism of President Richard Nixon, who in 1972
    asked all American employers to take responsibility and contribute to
    their workers' health care.
        And it reflects the ideas and commitment of

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    generations of Congressional leaders who have fought to build a health
    care system that honors our nation's commitments to all its citizens.
        Today America stands ready for reform. For the first time, members
    of both parties have agreed that every American must be guaranteed
    health care. An opportunity has been placed before us. We must not let
    it pass us by.
        This legislation builds on what's best about the American health
    care system. It maintains and strengthens America's private health care.
    It extends the current system of employer-based coverage that works so
    well for so many. It protects our cherished right to choose how we are
    cared for and who provides that care. It invests in improving the
    quality of our care.
        This legislation recognizes that America cannot, and need not, adopt
    one model of health care reform. It allows each state to tailor health
    reform to its unique needs and characteristics, as long as it meets
    national guarantees for comprehensive benefits, affordability and
    quality standards. It establishes a national framework for reform, but
    leaves the decisions about care where they belong--between patients and
    the health care professionals they trust.
        Under this legislation, every citizen and legal resident will
    receive a Health Security card that guarantees the comprehensive
    benefits package. People will be able to follow their doctor into a
    traditional fee-for-service plan, join a network of doctors and
    hospitals, or become members of a Health Maintenance Organization. Like
    today, almost everyone will be able to sign up for a health plan where
    they work. Unlike today, changes in employment or family status will not
    necessarily force a change in health coverage.
        The self-employed and the unemployed will receive their health
    coverage through the regional health alliance, a group run by consumers
    and business leaders, that will contract with and pay health plans,
    provide information to help consumers choose plans, and collect
    premiums. The largest corporations--those employing 5,000 workers or
    more--will have the option of continuing to self-insure their employees
    or joining a regional alliance.
        The legislation is financed by three sources: requiring every
    employer and individual to contribute to paying the cost of health care;
    raising excise taxes on tobacco and requiring small contributions from
    large corporations which form their own health alliance; and slowing the
    growth in spending on federal health care programs. Enormous efforts
    have been made to ensure that the financing is sound and responsible.
        The Health Security Act is based upon six principles: security,
    simplicity, savings, quality, choice and responsibility.
        Security. First and foremost, this legislation guarantees security
    by providing every American and legal resident with a comprehensive
    package of health care benefits that can never be taken away. That
    package of benefits, defined by law, includes a new emphasis on
    preventive care and offers all Americans prescription drug benefits.
        Under this legislation, insurers will no longer be able to deny
    anyone coverage, impose lifetime limits, or charge people based on their
    health status or age. The legislation also limits annual increases in
    health care premiums, and sets maximum amounts that families will spend
    out-of-pocket each year, regardless of how much or how often they
    receive medical care.
        The legislation will preserve and strengthen Medicare, adding new
    coverage for prescription drugs. To meet the growing needs of older
    Americans and people with disabilities, a new long-term care initiative
    will expand coverage of home and community-based care.
        The legislation also provides residents of underserved rural and
    urban areas with better access to quality care. It also offers
    incentives for health professionals to practice in these areas, builds
    urban-rural health care networks, and protects those doctors, hospitals,
    clinics and others who care for people in underserved areas.
        Simplicity. To relieve consumers, business and health professionals
    of the burdens of excess paperwork and bureaucracy, this legislation
    simplifies our health care system. It requires all health plans to adopt
    a standard claim form; creates a uniform, comprehensive benefits
    package; and standardizes billing and coding procedures.
        Savings. The legislation promotes true competition in the health
    care marketplace. It increases the buying power of consumers and
    businesses by bringing them together in health alliances. Health plans
    will no longer succeed by trying to pick only healthy people to insure;
    they will have to compete on price and quality. This competition will be
    backed up by enforceable premium caps.
        This legislation also criminalizes health fraud, imposing stiff
    penalties on those who cheat the system. And it takes steps to reduce
    ``defensive

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    medicine'' and discourage frivolous medical malpractice lawsuits by
    requiring patients and doctors to try to settle disputes before they end
    up in court, and by limiting lawyers' fees.
        Quality. The legislation empowers consumers and health care
    professionals by providing information on quality standards and
    treatment results. It calls for new investments in medical research,
    including heart disease, bone and joint disease, Alzheimer's disease,
    cancer, AIDS, birth defects, mental disorders, substance abuse and
    nutrition. To help keep people healthy, rather than only treating them
    after they get sick, the legislation pays fully for a wide range of
    preventive services and offers new incentives to educate primary care
    doctors, nurses and other family practitioners.
        Choice. Through comprehensive reform, the legislation gives
    Americans a new level of control over their health care choices. It
    ensures that people can follow their doctor and his or her team into any
    plan they choose to join. It transfers the choice of health plan from
    the employer to the individual, and guarantees a choice of health plans,
    including at least one traditional fee-for-service plan. Doctors and
    health professionals may participate in multiple health plans if they
    wish.
        Responsibility. Under this legislation, every employer and
    individual will be required to pay for health coverage, even if that
    contribution is small. It extends the current employer-based system for
    financing health coverage--a system that now serves nine of every ten
    Americans who now have health insurance. To ensure affordability, small
    businesses, low-wage employers and low-income individuals and families
    will get substantial discounts.
        This legislation will strengthen our economy. Our current system is
    so much more costly than any other system in the world, and the American
    people should not be asked to pay huge new taxes in order to afford
    health care reform. This plan raises no new broad-based taxes, but
    spends our health care dollars more wisely. It levels the playing field
    for small businesses, making it possible for them to insure their
    families and employees. It eases the tremendous burden of rising health
    costs on big business, helping them to compete for global markets. And
    by bringing the explosive growth in health costs under control, it sets
    us in the right direction of reducing our national debt.
        The legislation restores common sense to American health care. It
    borrows from what works today, letting us phase in change at a
    reasonable pace and adjust our course if needed. It builds on what works
    best--and makes it work for everyone. Our task now is to work together,
    to leave behind decades of false starts and agree on health care reform
    that guarantees true security. The time for action is now. I urge the
    prompt and favorable consideration of this legislative proposal by the
    Congress.
        Sincerely,

                                                                Bill Clinton

    Note: Identical letters were sent to Thomas S. Foley, Speaker of the
    House of Representatives, and George J. Mitchell, majority leader of the
    Senate. This letter was made available by the Office of the Press
    Secretary on October 27 but was not issued as a White House press
    release.