President of the U.S., 1993-2001; Former Democratic Governor (AR)
Helped provide antiretrovirals to developing nations
In 2002 the Clinton Foundation launched an HIV/AIDS initiative (CHAI), to help developing nations deal with AIDS by setting up effective health systems, including diagnosis, care, and treatment, and by providing vital antiretroviral me
testing at the lowest costs in the world.
Last year, in the Bahamas, the first country to participate in our effort, I had a reunion with 5-year-old twin girls who were desperately ill when I first met them but are healthy now because
medicine purchased through our project. I have held orphans in Cambodia who are receiving lifesaving medicine through our AIDS initiative. Our program now works in 25 countries to diagnose, test, and care for people with HIV/AIDS, and
able to buy low-cost drugs and testing materials under our contract. As of 2007, about 750,000 more people are receiving treatment purchased under CHAI agreements, representing about a third of all those in the developing world receiving
Citizen action on childhood obesity & overweight adults
One skill we often mistakenly assume people already have is the ability to take good care of themselves through proper eating, exercise, and sleep. The percentage of overweight Americans has increased dramatically in the last
20 years, as we eat more and exercise and sleep less. Too many people's habits are determined by consideration of convenience and immediate cost, and too few children learn how to live healthy lifestyles at home or in school. The United
United Kingdom, Ireland, and other nations are waging national campaigns against childhood obesity, the alarming rise in diabetes, and other health problems that undermine our physical, psychological, and economic well-being.
Governments, schools, and large organizations are becoming more involved, but there is still plenty of room and need for citizen action.
In May 2005, working with the American Heart Association, my foundation launched the Alliance for a Healthier Generation to halt the alarming rise of childhood obesity by 2010, then reverse it.
Today, 12.5 million American children are obese, an
additional 13 million are overweight, and more and more of them are developing problems normally found only in adults--high blood pressure, high cholesterol, and Type 2 diabetes, which can lead to heart attacks, strokes, blindness, and loss of limbs. If
childhood obesity continues to increase, this young generation could be the first in American history to have shorter lives than their parents. I asked Gov. Mike Huckabee (R-AR) to co-lead the effort with me because he was a great example: he lost
110 pounds, got off his diabetes medicine, and ran his first marathon at age 49. After Huckabee left office, Gov. Arnold Schwarzenegger (R-CA), who also has aggressively tackled the childhood obesity issue, became the Alliance co-leader.
2002: Signed on 69 nations to buy generic HIV/AIDS medicine
In 2002, to help the Caribbean nations establish systems for the prevention, care, and treatment of HIV/AIDS, we decided to buy generic antiretroviral medicines because they were so much less expensive, about $300 per person per year at the time. The
government of the Bahamas was already providing generics to a few hundred people. Unbelievably, they were paying $3,500 per person per year for the $300 medicine because it was passing through two middlemen.
We worked with ten major generic producers
to negotiate a price reduction from $300 to $139. The manufacturers and suppliers of essential ingredients agreed to shift from a low-volume, high margin, uncertain-payment business to a high-volume, low-margin, certain-payment one.
Today our
foundation's AIDS initiative includes 69 countries, which are now able to treat 2 to 3 times as many people with the same amount of money. As I write this, almost 750,000 people are receiving treatment with drugs purchased under our contract terms.
1993: Advisers urged scaling back Hillary’s healthcare role
In mid-August, with health care finally put on the calendar, though there was still no plan, Hillary & Bill took their first vacation in four years. Hillary used the vacation an opportunity to talk to Bill about her healthcare plans--without his economic
advisors present.
Ira Magaziner and his aides were well along in drafting the legislation, and he and Hillary had told the president that he had to make some final choices about the bill’s content so it could arrive on Capital Hill when Congress
returned after Labor Day. Before leaving, the president had been besieged by advisors who continued to warn that the deficit would be in danger of exploding if he listened to Hillary. They saw the plan she was developing as too big and too costly. The
Clinton presidency would historically succeed, they advised, only if he would scale back his wife’s grandiose ideas about reform and settle on a more manageable and incremental approach. Clinton had said he would make a final decision after his vacation.
Universal coverage would reduce bureaucratic costs
I was beginning to believe we [Hillary and Bill] might actually have honest debate that would produce something close to universal coverage.
The bureaucratic costs imposed by insurance companies were a big reason Americans paid more for health care but still didn’t have the universal coverage that citizens in
Source: My Life, by Bill Clinton, p.555
, Jun 21, 2004
Loosen eligibility for disability benefits
[As Arkansas Governor], I was upset with the Reagan administration. It had just dramatically tightened the eligibility rules for federal disability benefits. There had been abuses of the disability program, but the Reagan cure was worse than the problem.
The regulations were so strict they were ridiculous. In Arkansas, a truck driver with a ninth-grade education had lost his arm in an accident. He was denied disability benefits on the theory that he could get a desk job doing clerical work.
Source: My Life, by Bill Clinton, p.313
, Jun 21, 2004
I was scheduled to present the health-care plan to a joint session of Congress on Sep. 22. I explained the problem--that one system cost too much and covered too few--and outlined the basic principles of our plan: security, simplicity, savings, choice,
quality, and responsibility. Everyone would have coverage, through private insurers, that would not be lost when there was an illness or a job change; there would be far less paperwork because of a uniform minimum-benefit package; we would reap large
savings through lower administrative costs.
Under our plan, Americans would be able to choose their own health plan and keep their own doctors, choices that were vanishing for more and more Americans whose insurance was carried by health maintenance
organizations (HMOs).
If the system I had proposed had been adopted, it would have reduced inflation in health-care costs, spread the burden of paying for health care more fairly, and provided health security to millions of Americans who didn't have it
1992 campaign: “It’s the economy, stupid” but healthcare too
I don’t think that Bill expected that health care reform would become a cornerstone of his campaign. After all, James Carville’s famous war room slogan was “It’s the economy, stupid.” But the more Bill studied the problem, the clearer it became that
reforming health care and reining in costs were integral to fixing the economy, as well as taking care of people’s urgent medical needs.
Bill and expert advisers began developing ideas about how to tackle health care. Bill previewed those plans in a
campaign book entitled Putting People First and in a speech. The reforms he outlined included controlling spiraling health care costs, reducing paperwork and insurance industry red tape, making prescriptions more affordable to those in need, and, most
important, guaranteeing that all Americans had health insurance. We knew that trying to fix the health care system would be a huge political challenge. But we believed that if voters chose Bill Clinton on Nov. 3, it meant that change was what they wanted
Allowing patients to choose doctors is non-negotiable
Bill and other Democrats [in 1994] rejected the single-payer and Medicare models, preferring a quasi-private system called "managed competition" that relied on private market forces to drive down costs through competition. The government would have a
smaller role, including setting standards for benefit packages and helping to organize purchasing cooperatives.
The best model was the Federal Employees Health Benefit Plan, which covered nine million federal employees and offered an array of
insurance options to its members. Prices and quality were monitored by the plan's administrators.
Under managed competition, hospitals and doctors would no longer bear the expense of treating patients who weren't covered because everyone would be
insured through Medicare, Medicaid, the veterans and military health care plans or one of the purchasing groups.
Perhaps most important, the system would allow patients to choose their own doctors, a non-negotiable item in Bill's view.
Despite reform failure, smaller reforms helped millions
[After reform failure], Bill signed a series of bills, including laws ensuring that women be allowed to stay in the hospital for more than 24 hours after childbirth, promoting mammography and prostate screening, increasing research into diabetes and
improving childhood vaccination rates. None of these actions represented a seismic shift on the order of the Health Security Act. But collectively, these reforms of health care policy improved conditions for tens of millions of Americans.
On balance
I think we made the right decision to try to reform the whole system. By 2002, with the economy in trouble again and the financial savings of managed care in the 90s having leveled out, health insurance costs were again rising, the number of people
without insurance was going up and seniors on Medicare still didn't have prescription drug coverage. Someday we will fix the system. When we do it, it will be the result of more than 50 years of efforts by Richard Nixon, Jimmy Carter and Bill and me.
OpEd: Opposition to reform are "theologically-held" opinions
Pres. Nixon recognized the draining effects of health costs on the economy and proposed a system of universal health care as an "employer mandate." Presidents Ford and Carter also pursued reform in the 1970s, but they ran into the same political obstacle
that had blocked change for most of the 20th century. Over several decades, the health insurance industry had grown increasingly powerful.
The historical odds were against Bill because attitudes about health care reform were diverse, even among
Democrats. As one expert put it, opinions are "theologically held"--this impervious to reason, evidence or argument. But Bill felt he had to show the public and the Congress that he had the political will to move forward and make good
on his campaign promise to take immediate action on health care. Reform was not only good public policy that would help millions of Americans. It also was inextricably tied to reducing the deficit.
The President later admitted, during one of our conversations, that a more elegant, Third Way solution would have been to simply give health care tax credits (or vouchers, in effect) to those who needed them, mostly the working poor
(the very poorest receive health care coverage through Medicaid). This was, essentially, the proposal first made by Stuart Butler of the Heritage Foundation and resurrected, in modified form, by former senator
Bill Bradley in the 2000 Democratic presidential primary campaign. "That's what you're going to have to do eventually," the President conceded, "and if I could do it now, that's what
I would offer. The problem was, I couldn't do it in '94, with the deficits the way they were, without a tax increase."
On May 18, 1997, the President challenged the nation to develop an AIDS vaccine within the next ten years. He also announced a number of initiatives to help meet that goal, including high-level international collaboration, a dedicated research center for
AIDS vaccine research at NIH, and outreach to scientists, pharmaceutical companies, and patient advocates to maximize the involvement of both private and public sectors in the development of an AIDS vaccine. In June 1999 the President dedicated the
Dale and Betty Bumpers Vaccine Research Center at the NIH and announced that the primary work of this new center will be HIV vaccine research. NIH has increased funding for AIDS vaccine research by 100 percent since the President’s challenge.
As of June 1998, researchers have evaluated 27 vaccine candidates. And in February 1999, NIH-supported investigators initiated the first AIDS vaccine trial in Africa.
Source: WhiteHouse.gov web site
, May 1, 2000
Do more for health insurance
While Medicare takes care of Americans over the age of 65, we’re the only Western industrial nation that doesn’t provide a system of health insurance for all working people under 65. We worked hard to create comprehensive
health care reform early in my administration. And while that larger challenge remains unmet, we now have, thanks to bipartisan efforts, a new law that ensures that people won’t automatically lose their health insurance
when they change jobs or when somebody in the family gets sick.
But we have to do more. First, we should provide assistance to unemployed workers to help them keep their health insurance until they find a new job.
We also need to make it easier for small businesses to buy into insurance risk pools that are large enough to make it possible to offer coverage at a reasonable cost.
Clinton adopted the manifesto, "A New Agenda for the New Decade":
Promote Universal Access and Quality in Health Care That more than 40 million Americans lack health insurance is one of our society’s most glaring inequities. Lack of insurance jeopardizes the health of disadvantaged Americans and also imposes high costs on everyone else when the uninsured lack preventive care and get treatment from emergency rooms. Washington provides a tax subsidy for insurance for Americans who get coverage from their employers but offers nothing to workers who don’t have job-based coverage.
Markets alone cannot assure universal access to health coverage. Government should enable all low-income families to buy health insurance. Individuals must take responsibility for insuring themselves and their families whether or not they qualify for public assistance.
Finally, to help promote higher quality in health care for all Americans, we need reliable information on the quality of health care delivered by health plans and providers; a “patient’s bill of rights” that ensures access to medically necessary care; and a system in which private health plans compete on the basis of quality as well as cost.
Goals for 2010
Reduce the number of uninsured Americans by two-thirds through tax credits, purchasing pools, and other means.
Create a system of reliable “report cards” on the quality of care delivered by health plans and providers.
Source: The Hyde Park Declaration 00-DLC5 on Aug 1, 2000
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