Clinton Directs Health Treatise at Governors

Preparing to formally launch his much-delayed campaign for health care reform, President Clinton on Sunday called for a bipartisan effort to enact “fundamental” changes, saying that the current system is so “out of control” that Americans can ill-afford “incremental” actions.

In a message directed at the nation’s governors, who are meeting here, Clinton vowed to make health care reform “topic No. 1 in America--at our dinner tables, in our offices and in the halls of Congress.”

Responding to an invitation by the Tulsa World, the President composed a treatise that, along with several charts, took up a full page of the newspaper’s Sunday edition. In it, he said he will outline his rationale for health care reform in a speech to governors today and then unveil his agenda next month.

The President’s appeal to his former colleagues underscores a paradox he faces in attempting to overhaul the complex health care system: Strapped by steeply rising health care costs in their own states, the governors potentially are among Clinton’s strongest allies, but they also could become his staunchest opponents.

Most of the governors have already initiated significant reforms in their own states and now fear that federal actions may preempt those efforts. The governors want Washington to grant them the necessary authorizations that would allow the state programs to flourish even as Congress debates the President’s plan.

Administration officials have said the President intends to do just that, but they have not offered details. As a result, the extent to which the governors will back Clinton’s agenda may depend largely on how much flexibility the President will grant the states.

As if to underscore that point, the governors Sunday afternoon adopted a resolution offered by California Gov. Pete Wilson saying that states must be allowed to proceed on “a parallel track of change” while the debate in Washington continues. The resolution urged the President to recognize “the importance of states as laboratories for federal policy.”

“We all fear that something will be imposed on us out of Washington that we can’t pay for,” said South Carolina’s Republican Gov. Carroll A. Campbell Jr., co-chairman of the National Governors’ Assn. health care task force.

But Vermont’s Democratic Gov. Howard Dean, the other co-chairman, predicted that most governors, including Republicans, “are going to be some of the President’s strongest allies” on health care reform.

The states want, above all, exemptions from a 1974 federal law known as ERISA (Employee Retirement Income Security Act) that, among other things, bars states from requiring businesses to offer health coverage.

The law’s complexities are such that “without an ERISA waiver, we can’t even create standard (insurance) forms for billing,” said Minnesota Gov. Arne Carlson, a Republican.

Like most governors, Carlson urged the President and Congress to proceed quickly with health care reform. “The public is growing increasingly impatient.”

Dr. James Todd, executive vice president of the American Medical Assn., is also circulating at the conference, spreading the same message. “We’re so tired of waiting,” he said in an interview. “We don’t want to see the process slow down.”

When Clinton formed the White House Task Force on National Health Care Reform in late January, naming First Lady Hillary Rodham Clinton as its chief, he said his overhaul agenda would be ready by early May. But the plan has been delayed by, among other things, the death of Mrs. Clinton’s father last spring and by the Administration’s focus on the prolonged budget battle this summer.

After his speech today, the President will have a working lunch with the governors. Clinton is next expected to address the need for health care reform in late September, perhaps before a joint session of Congress.

On Sunday, Vice President Al Gore addressed the governors, making a pitch for their support for his current assignment: the national performance review, a six-month effort to improve and streamline the federal government.

Gore won hearty applause from the governors when he disclosed that his initiative to “reinvent government”--to be unveiled in early September--will for the first time formally allow state and local governments to review federal regulations before implementation.

In his Sunday newspaper message to the governors, the President said his recently passed five-year economic plan was “only a first step,” adding: “We cannot truly strengthen our economy, or ensure the well-being of every American family, until we reform our health care system.”

Clinton said his overriding goals in launching “this great national debate” are guaranteeing that no American ever loses medical insurance and controlling “skyrocketing” health care costs.

Directing himself to congressional Republicans, who all voted against his economic package, the President said he hopes the health care debate will not “fall victim to partisan bickering.”

And in arguing against incremental reform, Clinton said less-than-comprehensive efforts will “doom our children to face these same questions a generation from now.”

Clinton also hit on a likely theme of his campaign: providing security to all. “If someone in your family gets sick, if you lose or change jobs, your health protection can disappear overnight,” he said in the newspaper piece.

The centerpiece of the President’s reform agenda is the regional consumer insurance-purchasing alliance, composed of large groups of consumers banded together to buy insurance at low rates. The alliances would offer members a variety of plans from which to choose.

This, Clinton said, will grant people “something that we all value”--choice of doctors.

Under the Clinton plan, insurance companies would be forced to take all customers and not drop a person after he or she develops an expensive illness.

The Clinton plan is also expected to require all businesses to provide at least 80% of a full-time worker’s health insurance premiums, while all employees would be required to pay the remainder. Small businesses and low-wage earners would receive as yet unspecified “discounts” or subsidies to help purchase their insurance.

Clinton’s plan would gradually provide medical coverage to the tens of millions of uninsured Americans. This so-called universal coverage would be financed largely by the savings expected to accrue as a result of comprehensive health care reform, plus a “sin tax” on cigarettes.

In the Tulsa World, the President blamed rising medical costs for depriving workers of pay raises, inflating costs of higher-priced goods and services and raising taxes.

“The average worker today would be earning $1,000 more a year if the cost of health insurance had not risen faster than wages over the previous 15 years.

“Health care costs add $1,100 to the price of every car made in America--double the cost added to Japanese imports. If our products are to be competitive in the world market, we must control health costs.”