Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, April 10, 1993 TAG: 9304100116
SECTION: NATIONAL/INTERNATIONAL PAGE: A1 EDITION: METRO
SOURCE: Knight-Ridder/Tribune
DATELINE: WASHINGTON LENGTH: Medium
ADMINISTRATION OUTLINES PROPOSALS FOR HEALTH SYSTEM
Providing their first public outline of President Clinton's health-care package, senior administration officials Friday described a system that would guarantee treatment for every American and allow people to choose a private doctor if they wish.Whether a person chose a health maintenance organization or another network of private doctors, care would be guaranteed under an umbrella "health alliance" established in each state.
The proposal would provide every American with a national "health security card," signifying universal coverage. An estimated 37 million Americans lack insurance.
The guarantee of treatment would be portable from job to job, and patients could not be dropped or denied coverage because of pre-existing medical conditions, the officials said.
Most of the elements of the plan have been discussed previously. Friday's briefing was aimed at gaining early public approval for the package.
Under the program, which would take years to implement fully, people would be able to change from one plan to another at least once a year or if they move to another state or coverage area.
Employers and individuals would be required to pay an undetermined amount for the comprehensive coverage, although the government would subsidize the poor. The payment scale would not be determined on the basis of current health but perhaps on age. The reasoning: Older people tend to need more health care.
"The two key features are security and choice," a senior policy-maker said as he presented elements of the plan considered most attractive to consumers, including "quality report cards" on the health-care networks and mechanisms to handle complaints and disputes.
The program still is being developed and no final decisions have been made by Clinton, the official noted, "but directionally, we think this is the way things will go."
The administration officials, speaking on condition of anonymity, would not discuss the critical question of how to pay for the program, however. When prodded, one said he would not rule out any financing method, including a controversial suggestion to create a national value-added tax, in effect a national sales tax.
Shying away from any money questions, one White House policy-maker said "no decision has been made on whether there will be short-term controls" on prices and doctors' fees. Officials would not predict the costs or detail the size of the basic benefit package, saying those decisions are still to come.
Employers would be expected to provide at least the minimum national health-care guarantee; and officials said large, self-insured companies would have to offer employees "a degree of choice" on their health-care plans. Smaller employers "of a certain size" would have to go into the state's health alliance to provide that choice.
Many other critical issues, such as the size of the individual network budgets and how to prevent the system from dividing into rich and poor networks, especially in the large cities and rural areas, still are being thrashed out.
This week the president began a series of briefings on the final shape of the reform proposals. The three senior officials who spoke with journalists Friday said those presidential briefings would continue for the next several weeks to work out questions of how long it would take to phase in all the elements of the health-care program and its anticipated costs.