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
world.
--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
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 population.
RISING COSTS
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.
[OMB]
More and more Americans have had to give up insurance
altogether because the premiums have become prohibitively
expensive.
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
insurers.
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.
GROWING COMPLEXITY
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
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.
DECLINING CHOICES
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.
