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Office of the Press Secretary

For Immediate Release September 22, 1993


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 the decade.

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


         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

         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 population.


         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

         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.

                           QUALITY THREATENED

         No one is accountable for the performance of the health care
         system -- not hospitals, physicians, other providers, or health

         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 

         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 expenses.  

         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.