Clinton Health Care Reform Research Articles

Change and Reform

Within the health care community, the first quarter of 1995 seems so much quieter than did the first quarter of 1994. The distant thunder of impending health care reform that preoccupied so many of us seems like a faint echo, a Kohutek of sorts. We all remember the comet Kohutek that was supposed to light up the nighttime sky, and we all remember the fireworks that never were, but we would be mistaken to view the failure of the Clinton health care reform package as a political Kohutek. Nothing in my memory has so fundamentally caused a rethinking of health care as did the specter of government-driven health care reform. Similarly, nothing in my memory has so catalyzed change in health care delivery and reimbursement as did the fear of government-mandated change. I only wish I could view these as positive events.…

The Clinton presidency and health care reform.

The Clinton presidency and health care reform.

Nativism, Hollow Corporations, and Managed Competition: Why the Clinton Health Care Reform Failed

Nativism, Hollow Corporations, and Managed Competition: Why the Clinton Health Care Reform Failed

Preparing and presenting testimony. Guidelines for the health care practitioner.

Whether presenting to Hillary Rodham Clinton's Health Care Reform Task Force, or as citizens presenting to a Board of Selectmen on issues affecting the Council on Aging, health providers possess a unique and valuable perspective that few policymakers or politicians have. The health practitioner's role as a direct provider of health services, advocate, educator, role model, policymaker, clinician, researcher, consultant, collaborator, administrator, and counselor [1] can be combined to influence policy and policymakers through formal testimony preparation and presentation. Presenting testimony for public hearings is an effort to influence public policy. The purpose of this article is to provide guidelines which will encourage increased legislative involvement on the part of health providers. Those willing to be involved in local, regional, state, or national government activities by providing testimony may effect needed change.

Managed Competition and Managed Care: What are the Ethical Issues?

Managed competition and managed care, two hallmarks of President Clinton's health care reform proposal, would significantly change the way that health care in the United States is structured and delivered. This article presents ethical debates about managed care in historical perspective, reviews ethical arguments for and against managed care systems, and concludes with a set of practical guidelines to govern existing managed care arrangements. Throughout the paper, special attention is devoted to the impact of managed care on the elderly population and on physician-patient relationships.

What CMHCs can learn from two states' efforts to capitate Medicaid benefits.

If the Clinton health care reform package becomes law, community mental health centers will face challenges similar to those recently encountered by centers in several states under new Medicaid initiatives to capitate payments for mental health care. The authors summarize experiences and research findings from centers in two states using two different models: in Minnesota, a mainstreaming model in which Medicaid contracted with health maintenance organizations (HMOs) to provide all physical and mental health care for its beneficiaries, and in Utah, a mental health HMO model in which community mental health centers signed contracts to serve as mental health HMOs for Medicaid beneficiaries. Several implications for CMHCs under managed competition are discussed, including the need for centers to play a strong, proactive role in the establishment of benefit alternatives and enrollment processes and the need to implement aggressive policies to manage service utilization.

Letter from California--health care reform.

Despite all the publicity, it appears that President Clinton's health care reform may turn out to be much less than people were expecting. It is still going to be a private system with health insurance coming from the employer for those who have a job, and via the state or federal government for those who do not.

How physicians will benefit under Clinton's plan.

President Clinton's healthcare reform plan will be good for primary care physicians, according to Judith Feder, one of the administration's top health policy advisers. During a 20-minute phone interview recently, she told postgraduate medicine that the goal is to reduce governmental and other kinds of hassles for practitioners while holding them accountable for results. Her responses to other concerns of physicians follow.

Changing national priorities regarding substance abuse: détente comes to the war on drugs.

The drug issue is about the responsibility of to its citizens and the kind of society we aspire to be. President Bill Clinton, 1993 The White House Office of National Drug Control Policy (ONDCP), the former command post of the War on Drugs and the drug czar, is orchestrating a subtle but distinctive course change in national drug policy, articulating its own priorities, timetables, and approaches. On November 1, 1992, the new director, Lee P. Brown, the former police commissioner of New York City, announced his agency's Interim National Drug Control Strategy (White House Office of National Drug Control Policy, 1993). Although it contains neither detailed nor quantifiable goals and objectives yet, it provides a sneak preview of the comprehensive strategy President Clinton will submit to Congress on February 1, 1994. Social workers in every line of practice will appreciate the urgency behind these new priorities and are likely to find the direction for change clear and refreshing. INTERIM NATIONAL DRUG CONTROL STRATEGY Brown deliberately eschews the warfare and militarism motifs that drug czar William Bennett so heartily embraced a few years ago. Like the Clinton health care reform proposal, the drug control policy is multifaceted, intertwined with other major policy initiatives, and deliberate. As with health care reform, this proposal strives to embrace both prevention and treatment. Its key domestic objective is to reduce drug use and demand. The Interim National Drug Control Strategy spells out four main priorities: reducing demand, preventing crime, streamlining activities, and cooperating with countries where drug supplies originate. The first priority is to concentrate the government's efforts to reduce the demand for illegal drugs. The concerted efforts of the criminal justice and health care systems will focus on the treatment of addicts and heavy users. Government agencies will also work together to promote drug treatment, convey skills and values to prevent relapses and recidivism, include drug treatment in all health insurance plans, promote drug-free workplaces to enhance safety and productivity, and help youngsters be resistant to drugs through education and service programs in their own schools and communities. The second priority is to reduce drug-related activities and violence by controlling and preventing crime and strengthening neighborhood structures, involving law enforcement personnel, educators, substance abuse treatment specialists, and religious and community leaders both in and outside of communities. The administration will emphasize innovative efforts, such as community policing in neighborhoods, schools, and public housing, to strengthen and maintain social structures and lay the foundation for constructive involvement by government, the private sector, and neighborhood residents. Educational benefits will be given to students willing to serve their communities as police officers and public safety volunteers. Clinton has already made $150 million available to put additional police on the streets and urged Congress to enact the Brady Bill and legislation to ban the domestic manufacture of assault weapons. Congress has also been urged to pass the Safe Schools Act of 1993, with its initiatives to lessen the impact of drugs and violence on youths by teaching conflict resolution skills. Further, the administration will seek sentencing policies to ensure swift, fair, and appropriate punishment for convicted drug offenders. The third priority, in line with the administration's reinventing government emphasis, is to empower communities by streamlining government's activities. This priority entails activating communities to combat drug trafficking and use; focusing federal efforts to eliminate duplication by agencies; and reviewing the appropriate roles of federal, state, and local governments in controlling and interdicting drugs. …

The Clinton Health Care Reform Plan: Who Will Pay More, Who Will Pay Less?

The Clinton Health Care Reform Plan: Who Will Pay More, Who Will Pay Less?

Mental Health and Substance Abuse Coverage Under Health Reform

President Clinton's health care reform proposal articulates a complete vision for the mental health and substance abuse care system that includes a place for those traditionally served by both the public and the private sectors. Mental health and substance abuse services are to be fully integrated into health alliances under the president's proposal. If this is to occur, we must come to grips with both the history and the insurance-related problems of financing mental health/substance abuse care: (1) the ability of health plans to manage the benefit so as to alter patterns of use; (2) a payment system for health plans that addresses biased selection; and (3) preservation of the existing public investment while accommodating in a fair manner differences in funding across the fifty states.

The Pharmaceutical Industry and Health Care Reform

While the goals of President Clinton's health care reform plan--to expand access to health care by the underserved and reduce the unacceptably high cost of care--are important, his proposed mechanisms for doing so include provisions that are counterproductive. Blacklisting certain drugs from the Medicare program, imposing red tape on physicians who participate in Medicare, and establishing a Medicare rebate tax will hurt the pharmaceutical industry's ability to conduct research on new medications. In the end, the Administration's plan will injure the very population--the elderly, the poor, and minorities--that needs health care reform the most.

Meeting the Needs of the Poor and Underserved Under Health Care Reform

President Clinton's health care reform plan is premised on six principles: security, simplicity, savings, choice, quality, and responsibility. To the extent that negotiations with Congress and others to arrive at the final reform package respects the primary of these principles, the President's plan will meet the needs of America's poor and underserved.

The cost of providing health care benefits to early retirees.

Subsidized health care benefits would be guaranteed for early retirees ages fifty-five to sixty-four under President Bill Clinton's health care reform proposal. This is an important policy issue because persons in this age group are the least likely age cohort of the nonelderly population to be working. They are also the most likely to face high and uncertain health care costs. Previous research has shown that access to continuation of health insurance coverage encourages retirement before age sixty-five. These retirement effects can add substantially to the federal government's cost of providing health care benefits to early retirees. Based upon various assumptions for premium levels, the induced retirement effects of current workers, and the number of nonworkers qualifying for subsidized benefits, we present total annual cost estimates to the federal government, based on 1994 figures, ranging from $9.1 billion to $19.6 billion, to provide subsidized benefits to the nonworking population between the ages of fifty-five and sixty-four.

Implications of national health care for dentistry.

Despite the impact of dental health on oral health, general health, and emotional health, the dental-health provisions of President Clinton's health care reform proposal are meager. To better serve the Americans who need better dental care, dentistry should establish influence, develop an impassioned constituency, and provide special information to federal policymakers.

Economic Analyses of the Clinton Health Care Reform Proposal

Economic Analyses of the Clinton Health Care Reform Proposal

The Clinton Health Care Reform Plan

By removing employers' incentives to use health promotion programs to cut their health care costs, the Clinton health care reform plan may cripple one of the nation's most promising and effective cost control avenues.

Clinton health reform plan vexes drug firms

Hearings began last week on President Clinton's health care reform plan, with leadoff witness Hillary Rodham Clinton testifying before House and Senate committees. Pharmaceutical companies are reacting to the plan with some praise, but considerably more concern. recognize that by the time the plan passes months of Congressional hearings and negotiations, it may bear little resemblance to the initial proposals. But many core concepts endorsed by the President are likely to remain, and drug firms don't welcome all of them. The Pharmaceutical Manufacturers Association (PMA), which represents about 120 drug companies, supports the President's goal of reforming health care, especially expanding coverage to pay for prescription medicines. Drugs not only prevent disease and save lives—they save money, notes PMA president Gerald J. Mossinghoff. They keep patients out of hospitals, out of nursing homes, out of emergency rooms, out of doctors' offices, and out of surgery. PMA says it looks forward to work...