OHMYGOD -- DO YOU WANT TO READ SOME FAR-LEFT, COMMIE, SOCIALIST, MARXIST, RADICAL BULL*** ABOUT HEALTH CARE ???

This is a LONG article -- it's a radical leftwing, commie, Marxist,
socialist rant about initiating a guvmint-takeover of health
insurance.


-- quote
To the Congress of the United States:

One of the most cherished goals of our democracy is to assure every
American an equal opportunity to lead a full and productive life.


In the last quarter century, we have made remarkable progress toward
that goal, opening the doors to millions of our fellow countrymen who
were seeking equal opportunities in education, jobs and voting.

Now it is time that we move forward again in still another critical
area: health care.

Without adequate health care, no one can make full use of his or her
talents and opportunities. It is thus just as important that economic,
racial and social barriers not stand in the way of good health care as
it is to eliminate those barriers to a good education and a good job.

Three years ago, I proposed a major health insurance program to the
Congress, seeking to guarantee adequate financing of health care on a
nationwide basis. That proposal generated widespread discussion and
useful debate. But no legislation reached my desk.

Today the need is even more pressing because of the higher costs of
medical care. Efforts to control medical costs under the New Economic
Policy have been Inept with encouraging success, sharply reducing the
rate of inflation for health care. Nevertheless, the overall cost of
health care has still risen by more than 20 percent in the last two
and one-half years, so that more and more Americans face staggering
bills when they receive medical help today:

--Across the Nation, the average cost of a day of hospital care now
exceeds $110.
--The average cost of delivering a baby and providing postnatal care
approaches $1,000.
--The average cost of health care for terminal cancer now exceeds
$20,000.

For the average family, it is clear that without adequate insurance,
even normal care can 'be a financial burden while a catastrophic
illness can mean catastrophic debt.

Beyond the question of the prices of health care, our present system
of health care insurance suffers from two major flaws :

First, even though more Americans carry health insurance than ever
before, the 25 million Americans who remain uninsured often need it
the most and are most unlikely to obtain it. They include many who
work in seasonal or transient occupations, high-risk cases, and those
who are ineligible for Medicaid despite low incomes.

Second, those Americans who do carry health insurance often lack
coverage which is balanced, comprehensive and fully protective:

--Forty percent of those who are insured are not covered for visits to
physicians on an out-patient basis, a gap that creates powerful
incentives toward high cost care in hospitals;
--Few people have the option of selecting care through prepaid
arrangements offered by Health Maintenance Organizations so the system
at large does not benefit from the free choice and creative
competition this would offer;
--Very few private policies cover preventive services;
--Most health plans do not contain built-in incentives to reduce waste
and inefficiency. The extra costs of wasteful practices are passed on,
of course, to consumers; and
--Fewer than half of our citizens under 65--and almost none over 65--
have major medical coverage which pays for the cost of catastrophic
illness.

These gaps in health protection can have tragic consequences. They can
cause people to delay seeking medical attention until it is too late.
Then a medical crisis ensues, followed by huge medical bills--or
worse. Delays in treatment can end in death or lifelong disability.

COMPREHENSIVE HEALTH INSURANCE PLAN (CHIP)

Early last year, I directed the Secretary of Health, Education, and
Welfare to prepare a new and improved plan for comprehensive health
insurance. That plan, as I indicated in my State of the Union message,
has been developed and I am presenting it to the Congress today. I
urge its enactment as soon as possible.

The plan is organized around seven principles:

First, it offers every American an opportunity to obtain a balanced,
comprehensive range of health insurance benefits;

Second, it will cost no American more than he can afford to pay;
Third, it builds on the strength and diversity of our existing public
and private systems of health financing and harmonizes them into an
overall system;

Fourth, it uses public funds only where needed and requires no new
Federal taxes;

Fifth, it would maintain freedom of choice by patients and ensure that
doctors work for their patient, not for the Federal Government.

Sixth, it encourages more effective use of our health care resources;

And finally, it is organized so that all parties would have a direct
stake in making the system work--consumer, provider, insurer, State
governments and the Federal Government.

BROAD AND BALANCED PROTECTION FOR ALL AMERICANS

Upon adoption of appropriate Federal and State legislation, the
Comprehensive Health Insurance Plan would offer to every American the
same broad and balanced health protection through one of three major
programs:

--Employee Health Insurance, covering most Americans and offered at
their place of employment, with the cost to be shared by the employer
and employee on a basis which would prevent excessive burdens on
either;

--Assisted Health Insurance, covering low-income persons, and persons
who would be ineligible for the other two programs, with Federal and
State government paying those costs beyond the means of the individual
who is insured; and,

--An improved Medicare Plan, covering those 65 and over and offered
through a Medicare system that is modified to include additional,
needed benefits.
One of these three plans would be available to every American, but for
everyone, participation in the program would be voluntary.

The benefits offered by the three plans would be identical for all
Americans, regardless of age or income. Benefits would be provided
for:
--hospital care;
--physicians' care in and out of the hospital;
--prescription and life-saving drugs;
--laboratory tests and X-rays;
--medical devices;
--ambulance services; and,
--other ancillary health care.

There would be no exclusions of coverage based on the nature of the
illness. For example, a person with heart disease would qualify for
benefits as would a person with kidney disease.

In addition, CHIP would cover treatment for mental illness, alcoholism
and drug addiction, whether that treatment were provided in hospitals
and physicians' offices or in community based settings.

Certain nursing home services and other convalescent services would
also be covered. For example, home health services would be covered so
that long and costly stays in nursing homes could be averted where
possible.

The health needs of children would come in for special attention,
since many conditions, if detected in childhood, can be prevented from
causing lifelong disability and learning handicaps. Included in these
services for children would be:
--preventive care up to age six;
--eye examinations;
--hearing examinations; and,
--regular dental care up to age 13.

Under the Comprehensive Health Insurance Plan, a doctor's decisions
could be based on the health care needs of his patients, not on health
insurance coverage. This difference is essential for quality care.

Every American participating in the program would be insured for
catastrophic illnesses that can eat away savings and plunge
individuals and families into hopeless debt for years. No family would
ever have annual out-of-pocket expenses for covered health services in
excess of $1,500, and low-income families would face substantially
smaller expenses.

As part of this program, every American who participates in the
program would receive a Health-card when the plan goes into effect in
his State. This card, similar to a credit card, would be honored by
hospitals, nursing homes, emergency rooms, doctors, and clinics across
the country. This card could also be used to identify information on
blood type and .sensitivity to particular drugs-information which
might be important in an emergency.

Bills for the services paid for with the Health-card would be sent to
the insurance carrier who would reimburse the provider of the care for
covered services, then bill the patient for his share, if any.

The entire program would become effective in 1976, assuming that the
plan is promptly enacted by the Congress.

HOW EMPLOYEE HEALTH INSURANCE WOULD WORK

Every employer would be required to offer all full-time employees the
Comprehensive Health Insurance Plan. Additional benefits could then be
added by mutual agreement. The insurance plan would be jointly
financed, with employers paying 65 percent of the premium for the
first three years of the plan, and 75 percent thereafter. Employees
would pay the balance of the premiums. Temporary Federal subsidies
would be used to ease the initial burden on employers who face
significant cost increases.

Individuals covered by the plan would pay the first $150 in annual
medical expenses. A separate $50 deductible provision would apply for
out-patient drugs. There would be a maximum of three medical
deductibles per family.

After satisfying this deductible limit, an enrollee would then pay for
25 percent of additional bills. However, $1,500 per year would be the
absolute dollar limit on any family's medical expenses for covered
services in any one year.

As an interim measure, the Medicaid program would be continued to meet
certain needs, primarily long-term institutional care. I do not
consider our current approach to long-term care desirable because it
can lead to overemphasis on institutional as opposed to home care. The
Secretary of Health, Education, and Welfare has undertaken a thorough
study of the appropriate institutional services which should be
included in health insurance and other programs and will report his
findings to me.

IMPROVING MEDICARE

The Medicare program now provides medical protection for over 23
million older Americans. Medicare, however, does not cover outpatient
drugs, nor does it limit total out-of-pocket costs. It is still
possible for an elderly person to be financially devastated by a
lengthy illness even with Medicare coverage.
I therefore propose that Medicare's benefits be improved so that
Medicare would provide the same benefits offered to other Americans
under Employee Health Insurance and Assisted Health Insurance.

Any person 65 or over, eligible to receive Medicare payments, would
ordinarily, under my modified Medicare plan, pay the first $100 for
care received during a year, and the first $50 toward outpatient
drugs. He or she would also pay 20 percent of any bills above the
deductible limit. But in no case would any Medicare beneficiary have
to pay more than $750 in out-of-pocket costs. The premiums and cost
sharing for those with low incomes would be reduced, with public funds
making up the difference.

The current program of Medicare for the disabled would be replaced.
Those now in the Medicare for the disabled plan would be eligible for
Assisted Health Insurance, which would provide better coverage for
those with high medical costs and low incomes.

Premiums for most people under the new Medicare program would be
roughly equal to that which is now payable under Part B of Medicare--
the Supplementary Medical Insurance program.

HOW ASSISTED HEALTH INSURANCE WOULD WORK

The program of Assisted Health Insurance is designed to cover everyone
not offered coverage under Employee Health Insurance or Medicare,
including the unemployed, the disabled, the self-employed, and those
with low incomes. In addition, persons with higher incomes could also
obtain Assisted Health Insurance if they cannot otherwise get coverage
at reasonable rates. Included in this latter group might be persons
whose health status or type of work puts them in high-risk insurance
categories.

Assisted Health Insurance would thus fill many of the gaps in our
present health insurance system and would ensure that for the first
time in our Nation's history, all Americans would have financial
access to health protection regardless of income or circumstances.

A principal feature of Assisted Health Insurance is that it relates
premiums and out-of-pocket expenses to the income of the person or
family enrolled. Working families with incomes of up to $5,000, for
instance, would pay no premiums at all. Deductibles, co-insurance, and
maximum liability would all be pegged to income levels.

Assisted Health Insurance would replace State-run Medicaid for most
services. Unlike Medicaid, where benefits vary in each State, this
plan would establish uniform benefit and eligibility standards for all
low-income persons. It would also eliminate artificial barriers to
enrollment or access to health care.

COSTS OF COMPREHENSIVE HEALTH INSURANCE

When fully effective, the total new costs of CHIP to the Federal and
State governments would be about $6.9 billion with an additional small
amount for transitional assistance for small and low wage employers:

--The Federal Government would add about $5.9 billion over the cost of
continuing existing programs to finance health care for low-income or
high risk persons.

--State governments would add about $1.0 billion over existing
Medicaid spending for the same purpose, though these added costs would
be largely, if not wholly offset by reduced State and local budgets
for direct provision of services.

--The Federal Government would provide assistance to small and low
wage employers which would initially cost about $450 million but be
phased out over five years.

For the average American family, what all of these figures reduce to
is simply this:

--The national average family cost for health insurance premiums each
year under Employee Health Insurance would be about $150; the employer
would pay approximately $450 for each employee who participates in the
plan.

--Additional family costs for medical care would vary according to
need and use, but in no case would a family have to pay more than
$1,500 in any one year for covered services.

--No additional taxes would be needed to pay for the cost of CHIP. The
Federal funds needed to pay for this plan could all be drawn from
revenues that would be generated by the present tax structure. I am
opposed to any comprehensive health plan which requires new taxes.

MAKING THE HEALTH CARE SYSTEM WORK BETTER

Any program to finance health care for the Nation must take close
account of two critical and related problems--cost and quality.

When Medicare and Medicaid went into effect, medical prices jumped
almost twice as fast as living costs in general in the next five
years. These programs increased demand without increasing supply
proportionately and higher costs resulted.

This escalation of medical prices must not recur when the
Comprehensive Health Insurance Plan goes into effect. One way to
prevent an escalation is to increase the supply of physicians, which
is now taking place at a rapid rate. Since 1965, the number of first-
year enrollments in medical schools has increased 55 percent. By 1980,
the Nation should have over 440,000 physicians, or roughly one-third
more than today. We are also taking steps to train persons in allied
health occupations, who can extend the services of the physician.

With these and other efforts already underway, the Nation's health
manpower supply will be able to meet the additional demands that will
be placed on it.

Other measures have also been taken to contain medical prices. Under
the New Economic Policy, hospital cost increases have been cut almost
in half from their post-Medicare highs, and the rate of increase in
physician fees has slowed substantially. It is extremely important
that these successes be continued as we move toward our goal of
comprehensive health insurance protection for all Americans. I will,
therefore, recommend to the Congress that the Cost of Living Council's
authority to control medical care costs be extended.

To contain medical costs effectively over the long-haul, however,
basic reforms in the financing and delivery of care are also needed.
We need a system with built-in incentives that operates more
efficiently and reduces the losses from waste and duplication of
effort. Everyone pays for this inefficiency through their health
premiums and medical bills.

The measure I am recommending today therefore contains a number of
proposals designed to contain costs, improve the efficiency of the
system and assure quality health care. These proposals include:

1. HEALTH MAINTENANCE ORGANIZATIONS (HMO'S)

On December 29, 1973, I signed into law legislation designed to
stimulate, through Federal aid, the establishment of prepaid
comprehensive care organizations. HMO's have proved an effective means
for delivering health care and the CHIP plan requires that they be
offered as an option for the individual and the family as soon as they
become available. This would encourage more freedom of choice for both
patients and providers, while fostering diversity in our medical care
delivery system.

2. PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS (PSRO'S)

I also contemplate in my proposal a provision that would place health
services provided under CHIP under the review of Professional
Standards Review Organizations. These PSRO's would be charged with
maintaining high standards of care and reducing needless
hospitalization. Operated 'by groups of private physicians,
professional review organizations can do much to ensure quality care
while helping to bring about significant savings in health costs.

3. MORE BALANCED GROWTH IN HEALTH FACILITIES

Another provision of this legislation would call on the States to
review building plans for hospitals, nursing homes and other health
facilities. Existing health insurance has overemphasized the placement
of patients in hospitals and nursing homes. Under this artificial
stimulus, institutions have felt impelled to keep adding bed space.
This has produced a growth of almost 75 percent in the number of
hospital beds in the last twenty years, so that now we have a surplus
of beds in many places and a poor mix of facilities in others. Under
the legislation I am submitting, States can begin remedying this
costly imbalance.

4. STATE ROLE

Another important provision of this legislation calls on the States to
review the operation of health insurance carriers within their
jurisdiction. The States would approve specific plans, oversee rates,
ensure adequate disclosure, require an annual audit and take other
appropriate measures. For health care providers, the States would
assure fair reimbursement for physician services, drugs and
institutional services, including a prospective reimbursement system
for hospitals.

A number of States have shown that an effective job can be done in
containing costs. Under my proposal all States would have an incentive
to do the same. Only with effective cost control measures can States
ensure that the citizens receive the increased health care they need
and at rates they can afford. Failure on the part of States to enact
the necessary authorities would prevent them from receiving any
Federal support of their State-administered health assistance plan.

MAINTAINING A PRIVATE ENTERPRISE APPROACH

My proposed plan differs sharply with several of the other health
insurance plans which have been prominently discussed. The primary
difference is that my proposal would rely extensively on private
insurers.

Any insurance company which could offer those benefits would be a
potential supplier. Because private employers would have to provide
certain basic benefits to their employees, they would have an
incentive to seek out the best insurance company proposals and
insurance companies would have an incentive to offer their plans at
the lowest possible prices. If, on the other hand, the Government were
to act as the insurer, there would be no competition and little
incentive to hold down costs.

There is a huge reservoir of talent and skill in administering and
designing health plans within the private sector. That pool of talent
should be put to work.

It is also important to understand that the CHIP plan preserves basic
freedoms for both the patient and doctor. The patient would continue
to have a freedom of choice between doctors. The doctors would
continue to work for their patients, not the Federal Government. By
contrast, some of the national health plans that have been proposed in
the Congress would place the entire health system under the heavy hand
of the Federal Government, would add considerably to our tax burdens,
and would threaten to destroy the entire system of medical care that
has been so carefully built in America.

I firmly believe we should capitalize on the skills and facilities
already in place, not replace them and start from scratch with a huge
Federal bureaucracy to add to the ones we already have.

COMPREHENSIVE HEALTH INSURANCE PLAN--A PARTNERSHIP EFFORT

No program will work unless people want it to work. Everyone must have
a stake in the process.

This Comprehensive Health Insurance Plan has been designed so that
everyone involved would have both a stake in making it work and a role
to play in the process consumer, provider, health insurance carrier,
the States and the Federal Government. It is a partnership program in
every sense.

By sharing costs, consumers would have a direct economic stake in
choosing and using their community's health resources wisely and
prudently. They would be assisted by requirements that physicians and
other providers of care make available to patients full information on
fees, hours of operation and other matters affecting the
qualifications of providers. But they would not have to go it alone
either: doctors, hospitals and other providers of care would also have
a direct stake in making the Comprehensive Health Insurance Plan work.
This program has been designed to relieve them of much of the red
tape, confusion and delays in reimbursement that plague them under the
bewildering assortment of public and private financing systems that
now exist. Health-cards would relieve them of troublesome bookkeeping.
Hospitals could be hospitals, not bill collecting agencies.

CONCLUSION

Comprehensive health insurance is an idea whose time has come in
America.

There has long been a need to assure every American financial access
to high quality health care. As medical costs go up, that need grows
more pressing.

Now, for the first time, we have not just the need but the will to get
this job done. There is widespread support in the Congress and in the
Nation for some form of comprehensive health insurance.

Surely if we have the will, 1974 should also be the year that we find
the way.

The plan that I am proposing today is, I believe, the very best way.
Improvements can be made in it, of course, and the Administration
stands ready to work with the Congress, the medical profession, and
others in making those changes.

But let us not be led to an extreme program that would place the
entire health care system under the dominion of social planners in
Washington.

Let us continue to have doctors who work for their patients, not for
the Federal Government. Let us build upon the strengths of the medical
system we have now, not destroy it.

Indeed, let us act sensibly. And let us act now--in 1974--to assure
all Americans financial access to high quality medical care.

-- end quote

OH, *** -- I forget to include the heading -- here it is:

President Richard Nixon's Special Message to the Congress Proposing a
Comprehensive Health Insurance Plan

February 6, 1974

And it's signed:

RICHARD NIXON
The White House,
February 6, 1974.

.

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