Jan. 29, 1994
First lady defends health reform

By Jan Greene
First lady Hillary Rodham Clinton came to Las Vegas on Friday ready to dispute criticism that the president's health care reform plan is too cumbersome and too bureaucratic.

"These are just desperate attempts to try to undermine the real need to get decent health care reform," Clinton said in an interview with the Review-Journal. "We have the most bureaucratic system in the world right now."

The first lady said she though "it was just kind of funny" when, during the Republican respons to President Clinton's State of the Union speech Tuesday, Senate Minority Leader Bob Dole, R-Kan, pulled out a chart displaying the complex system of dozens of boards, commissions and other governmental bodies that would deliver universal health insurance coverage to every American.

"He knows better than that," said Clinton, who led a presidential task force to craft the health care plan. "Have you ever seen a chart of what the existing system looks like?"

She argued that the approach being advocated by the Clintons would not only be simpler than the current system but would save money.

During his State of the Union address, the president promised to veto any health care reform bill that did not guarantee coverage for every American.

Asked whether that meant the president would reject any of the other options being considered by Congress - such as one propsed by Rep. Jim Cooper, D-Tenn. - Clinton was circumspect.

"We don't know what the final legislation will be, so I don't think anyone is speculating about it," Clinton said.

She said she supported her husband's decision to promise a veto, something that some worried would back him into a political corner during the coming congressional debate over reform.

"This was nothing new," she said. "When he took the legislation to Capitol Hill and gave his health care speech, he said everything is negotiable, all the details about how we get where we're going, but that's not negotiable is getting everybody covered."

Clinton also plugged her plan as an answer to Nevada's health care problems, such as the lack of doctors or other medical professionals in rural areas.

State health officials have worried that the national plan would make that problem even worse by emphasizing managed care organizations that tend to consolidate health care rather than spreading it out into rural areas that need it.

"The health care plan will make a big positive impact on rural areas," Clinton argued.

She said that by drawing rural dwellers - who are often uninsured or using state Medicaid benefits - into a universal insurance plan, their payments into the system would generate economic activity in rural places and draw doctors.

She took her stump speeches from the halls of the county hospital - where the stories of several uninsured people were used as ammunition for the need for universal coverage - to a gathering of about 120 health care professionals and political dignitaries at the Thomas & Mack Center.

Some of those asking Clinton questions appeared to tone down their previous criticism of national health care reform.

For instance, Dr. Frank Nemec, past president of the Clark County Medical Society, had choice words last month with Clinton backer Sen. Jay Rockefeller, D-W. Va., when he was in Las Vegas to push the plan.

But Nemec politely thanked the first lady for coming to Las Vegas before telling of his "concern" about the Clinton plan's concept of "global budgeting" - the idea that each alliance would have a set amount of money to work with and would have to work within it.

Nemec asked: Wouldn't that mean doctors would have to withhold care at times because there wasn't enough money in the system to pay for it?

Clinton responded that the current system withholds care to people without insurance, and that doctors make decisions every day that limit care.

"We have to have some kind of budget backstop," she said. "We have to have a way to put some budget cost consciousness without telling you what to do."

Nemec pressed on, asking what would happen if the alliance exceeds its budget, what would get cut.

"The local community would make that decision," Clinton said, adding that she believes there's enough waste in the system now that would be pared once hospitals, doctors and other providers were competing for business.

State Sen. Ray Rawson, R-Las Vegas, said the forum audience "went out of its way not to offend and not to be too critical, and she didn't answer all their questions."

Dr. Robert Shreck, a local family physician, asked whether the Clinton plan would simply accelerate the current cost-cutting trend among employers, which often results in patients being transferred from doctor to doctor as the company finds cheaper health plans each year.

"Now we have this totally disorganized system out there that drives really hard bargains with doctors and puts them in really bad positions," Clinton said.

The Clinton plan would change that "survival of the fittest" system, she said, by putting everyone in the same pool for health care.

"If everybody's in the purchasing cooperative ... you eliminate the kind of advantages for the big guys," she said.