By Barr, Dorothea
The National Public Accountant , Vol. 38, No. 7
Since January, Americans across the country have been writing to President Clinton regarding his health care reform interests. In fact, the Health Care Task Force headed by the First Lady Hillary Rodham Clinton has received over 100,000 letters, many relaying health care atrocities and making recommendations for change.
The Health Care Task Force, comprised of approximately 500 public and private sector representatives, has developed its final health care reform proposal, which now awaits its debut before Congress. Despite the long hours, enormous amount of public input and vast number of task force agents, Americans have only been able to catch a faint picture of the form the reform proposal will take.
How will health care reform provide and pay for the coverage which will be offered to approximately 37 million uninsured Americans? What benefits will the minimum package include? How will reform affect the bottom line of businesses, large and small? How will it affect employees? Will reform be a simple modification of our existing system or a comprehensive overhaul complete with government mandates, subsidies and taxes?
No one knows!
What we do know is that the introduction of the president's health care reform plan will represent only Act I, Scene I of a long, complicated and highly controversial play. As a constituent you will have an opportunity to communicate with your representatives as the proposal moves through the Congress. The play's directors, Dan Rostenkowski (D-IL), Chairman of the House Ways and Means Committee, and Senator Daniel Moynihan (D-NY), Chairman of the Senate Finance Committee, will set the stage for the 535 congressional actors and try to complete the production on time and under budget.
An Issue Fraught With Controversy
While many in Congress and the Clinton Administration firmly believe that health care reform is necessary, they do not necessarily believe that this is the correct time for reform. Rostenkowski and Leon Panetta, Director of the Office of Management and Budget, are among the strongest opponents of President Clinton's health care reform timing. Each continues to express considerable concern and apprehension over implementing health care reform while the nation's economic climate remains tenuous and while Congress considers the largest tax increase in the history of the United States.
The president is committed to a late May-early June presentation and seeks 1993 passage. To ensure that congressional committees are not wrestling with a major spending cut and a tax package simultaneously, the actual introduction of the legislation will not be sent to Congress until House committees have completed consideration of budget reconciliation legislation.
Clinton's Plan Combines Several Proposals
The health care task force has considered and reconsidered several variations of the following health care themes--finally coming to rest with the concept of managed care, a hybrid of each of the following approaches.
A "single-payer" system--every American is automatically covered and the Federal government uses tax dollars to pay all medical bills. This is the system used in Canada, where a lower percentage of GDP is spent on health care than in the United States.
An individual mandate--each person would be required to have insurance for themselves and their dependents. This approach would remove employer responsibility for providing health coverage. By limiting the amount of insurance that could be paid for with pre-tax dollars, it would make health care "consumers" acutely conscious of cost, discouraging too-rich insurance plans.
An employer mandate--employers would be responsible for finding and paying for insurance for all employees and their dependents. An employer mandate fails to address the problems of the unemployed. This proposal includes those businesses not currently offering health insurance.
Managed competition--considered the most viable concept, this program seeks to provide coverage to every individual, mandating that all employers provide no less than the minimum coverage established by the Federal government. …