First lady cites risk of no reforms Health crisis hurts middle class, too

May 27, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- Sharpening her sales pitch for health reform, an impassioned Hillary Rodham Clinton warned yesterday that even well-insured Americans "no longer can take for granted" their medical coverage.

Mrs. Clinton's remarks revealed the administration's latest thinking on how to win the support of the pivotal middle class for a health reform plan now nearing completion.

Raising her voice to drive home her points, Mrs. Clinton told a labor union audience that everyone is at risk because they could lose their jobs, their employers could cut back on insurance or they could be dropped because of a particular health problem.

'Security' the theme

"Security is what the health care debate is all about," she told a meeting of 500 officials of the Service Employees International Union. "Can your family find peace of mind? Can you or your child get the quality of care when you need it the most?"

Mrs. Clinton heads the president's task force on health care reform, which is putting the final touches on a plan that would guarantee health care for all Americans and control costs.

"Security" is the major theme of the administration's sales campaign for its plan, but the first lady also stressed four other ideas: assuring that Americans have freedom to choose their doctors and health plans, getting rising health costs under control, guaranteeing high quality care and reducing burdensome paperwork for the medical industry and patients.

Mrs. Clinton sought to defuse fears that the reform plan might force Americans to give up their current doctors and join large group health organizations.

An "absolute bedrock principle" of reform is as much "consumer choice" as possible within the health care system," she said. Consumers who want "fee for service" plans, in which they pick their own doctors, can have them.

Mrs. Clinton never mentioned -- as her task force staff experts have acknowledged -- that Americans who pick fee for service plans almost certainly will pay more.

Nor did she bring up another controversial component of the health reform plan: the higher taxes needed to help finance coverage for those Americans who currently don't have any.

Fear of losing coverage

The nation should "no longer stand alone among its competitors in the industrialized world and not provide health security for every single American," Mrs. Clinton said, asserting that one in four Americans will lose insurance coverage in the next two years.

That figure is extrapolated from U.S. Census data showing that at any given point, 35 million Americans lack health insurance. It's a changing pool of people, a number of whom lose coverage for a short time while between jobs or waiting for coverage to begin at a new employer.

Even those who don't lose insurance are worried. Not only are costs increasing but employers are cutting back on benefits or requiring greater employee contributions. These concerns are driving Americans' interest in reform, says Robert J. Blendon, a Harvard University professor who has informally advised the task force on public attitudes toward health issues.

"They are insecure and what [Mrs. Clinton] is saying to them is: 'If you support my plan, you'll never lose your insurance ever,' " he said.

Standing ovation

The first lady's speech drew a standing ovation from the labor audience. The Service Employees union, which represents many health care workers, is expected to be an ally of the administration on health reform. "Give 'em hell, Hillary," one woman called out as she entered the room.

Consumers for the first time would be given adequate information about their doctors, hospitals and health plans so they can "comparison shop" and ensure accountability among those running the plans, Mrs. Clinton said.

Urging the union's members to campaign for health reform, Mrs. Clinton advised them to tell their friends and neighbors about the "price-gouging, cost-shifting, unconscionable profiteering" that, she said, health care workers see every day. Mrs. Clinton did not name any individuals or groups.

"Explain how you see the system that is being gamed and ripped off because it has no real discipline, no budget, no controls," she said. "Too many people have made too much money off of eliminating opportunities for caring for people instead of expanding them."

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