By: Bill Clinton
Date: October 15, 1992
Source: Presidential Debate. October 15, 1992. Transcripts from the Commission on Presidential Debates. Available online at (accessed February 2, 2003).
About the Author: Bill Clinton (1946–) was born in Hope, Arkansas. After earning an international relations degree from Georgetown University, Clinton received a Yale law degree. In 1978, at the age of thirty-two, Clinton was elected governor of Arkansas. After losing his reelection bid, he was elected again and maintained the position until becoming president (served 1993–2001) of the United States. He was the first Democrat since Franklin D. Roosevelt (served 1933–1945) to be reelected to a second presidential term.
In the 1992 presidential campaign, Democratic candidate Bill Clinton, then governor of Arkansas, and independent candidate H. Ross Perot challenged Republican incumbent George H. W. Bush. All three candidates addressed the health care issue. Ensuring that all Americans have access to adequate health care has been an issue for U.S. presidents for decades. But in the early 1990s, health care in the United States was in crisis. Tens of millions of Americans had no health insurance, prices for medical procedures, doctor visits, medical accessories, and pharmaceuticals were exorbitant, "unnecessary" treatments and procedures were performed at alarming rates, and malpractice claims were rising.
President Bush's solutions to the health care crisis included capping malpractice awards, providing insurance vouchers for low-income persons, and pooling individual insurance policies to bring the costs of insurance down. Bush firmly believed in keeping the government out of the industry as much as possible. Perot did not have a clearly defined plan. He blamed the influence of insurance, pharmaceutical, and health care lobbyists on the government for keeping health care costs high.
Clinton made health care reform a centerpiece of his campaign. He promised that if elected he would give the nation a health care plan within his first hundred days in office. Clinton identified six problems with the health care system. First, the entire system was insecure. More Americans than ever were uninsured, and millions more were one catastrophe away from financial ruin. Second, the system was too complex. Administrative costs were high, and there was too much paperwork and bureaucracy. Third, costs were steadily rising. Each year from 1980 to 1992, the proportion of American dollars spent on health care was getting larger and larger. Fourth, the quality of health care was decreasing. Americans were getting less and less for their health care dollars. Fifth, choices were eroding. Health care plans continually restricted which doctors and what kinds of doctors its members could visit. Sixth, insurance and pharmaceutical companies were acting irresponsibly. Insurance companies only insured "healthy individuals," and pharmaceutical companies charged Americans outrageous prices for their products. Clinton's reform plan intended to counteract these problems by offering security, simplicity, savings, quality, choice, and responsibility.
As president, Bill Clinton had the opportunity to put his plan to work. He immediately appointed his wife, Hillary Rodham Clinton, to head a special task force to address the health care crisis. The two presented the Health Security Plan to the nation nine months later.
With the details of the plan worked out, the president needed to gain the support of Congress before the plan could become law. Congressional members were lobbied hard by groups that opposed the Clinton plan. They were particularly averse to the plan's complexity (ironically, because simplicity was one of the six principles upon which the plan was supposed to have been based), its reliance on government administration, and employer mandates. Additionally, the plan was too complicated for the public to understand. As a result, congressional support for Clinton's plan collapsed and it never became law.
Clinton's plan promoted the concept of "universal coverage," meaning health insurance for everyone. It declared health care to be a right, not a privilege. The concept is not new. In 1976, Jimmy Carter also promised to offer universal and mandatory health coverage for all Americans. The concept returned in the speeches of presidential hopefuls in 2003 and policy statements from such groups as the American Public Health Association and the American College of Physicians.
Primary Source: Presidential Debate, October 15, 1992 [excerpt]
SYNOPSIS: Democratic presidential candidate Bill Clinton responds to a question about the rising costs of health care.
Simpson: Thank you very much. We have a question over here.
Audience Member: I'd like to ask Governor Clinton, do you attribute the rising costs of health care to the medical profession itself, or do you think the problem lies elsewhere? And what specific proposals do you have to tackle this problem?
Clinton: I've had more people talk to me about their health care problems I guess than anything else, all across America—you know, people who've lost their jobs, lost their businesses, had to give up their jobs because of sick children. So let me try to answer you in this way. Let's start with a premise. We spend 30% more of our income than any nation on earth on health care, and yet we insure fewer people. We have 35 million people without any insurance at all—and I see them all the time. A hundred thousand Americans a month have lost their health insurance just in the last 4 years.
So if you analyze where we're out of line with other countries, you come up with the following conclusions. Number one, we spend at least $60 billion a year on insurance, administrative cost, bureaucracy, and government regulation that wouldn't be spent in any other nation. So we have to have, in my judgment, a drastic simplification of the basic health insurance policies of this country, be very comprehensive for everybody.
Employers would cover their employees, government would cover the unemployed.
Number 2, I think you have to take on specifically the insurance companies and require them to make some significant change in the way they rate people in the big community pools. I think you have to tell the pharmaceutical companies they can't keep raising drug prices at three times the rate of inflation. I think you have to take on medical fraud. I think you have to help doctors stop practicing defensive medicine. I've recommended that our doctors be given a set of national practice guidelines and that if they follow those guidelines that raises the presumption that they didn't do anything wrong.
I think you have to have a system of primary and preventive clinics in our inner cities and our rural areas so people can have access to health care.
The key is to control the cost and maintain the quality. To do that you need a system of managed competition where all of us are covered in big groups and we can choose our doctors and our hospitals, a wide range, but there is an incentive to control costs. And I think there has to be—I think Mr. Perot and I agree on this, there has to be a national commission of health care providers and health care consumers that set ceilings to keep health costs in line with inflation, plus population growth.
Now, let me say, some people say we can't do this but Hawaii does it. They cover 98% of their people and their insurance premiums are much cheaper than the rest of America, and so does Rochester, New York. They now have a plan to cover everybody and their premiums are two-thirds of the rest of the country.
This is very important. It's a big human problem and a devastating economic problem for America, and I'm going to send a plan to do this within the first 100 days of my presidency. It's terribly important.
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