Bill Clinton: “This is a rather complex issue, but I'd like to talk about it in a little bit of detail, because it's so terribly…”

“This is a rather complex issue, but I'd like to talk about it in a little bit of detail, because it's so terribly important to New York, if I might. The academic health centers today are mostly, by accident of history, located in large cities. They treat, as part of their ongoing teaching functions, huge numbers of poor people. They also, historically, have treated huge numbers of professionals and others who have wanted to come to them because of the high quality of their care. They are now getting it coming and going, for the following reasons: The more poverty concentrates in areas where academic health care centers are, the more people they have to treat who basically have no compensation for their care. So that hurts them financially. And then, as you just heard, the more people--more employers put their employees in managed care networks, the more likely those networks are then, the people making those choices, to choose the lowest cost health care option available, which may steer income, again, and opportunity away from the academic health care centers, ultimately undermining quality, ultimately undermining the ability of the United States to train, educate, and provide the finest doctors in the world, as well as ongoing medical research. This is a huge deal, much bigger than it would appear at the moment. It goes way beyond the number of patients who stream in and out of Sloan-Kettering every year because it has implications for the entire United States and the whole quality and fabric of our health care system. We seek to do two things in our bill which I think would help. One is, while I strongly support the whole concept of managed competition and managed care, I believe that we should leave more choices, and I think economically we can leave more choices with the employees or the patients, if you will. So under our plan, each health alliance would have to offer every employee at least three choices, although we think that employees--people will be offered more choices. Under the Federal employee health insurance plan, for example, which is a pretty good model, we have probably more than 20 choices. But you would have a range of choices so that it wouldn't be the employer's decision alone. The employer's contribution would be constant, no matter what. The employer wouldn't have to pay more. But the employee would have the option, at least to enroll in a fee- for-service medicine or enroll in a Sloan-Kettering plan, for example, even if it were a little more expensive, because you could get a wider range of doctors or higher quality or whatever. So we'd have more choices there. The second thing that we do is to try to provide for a direct fund to the academic health centers in recognition of the fact that you won't get the--there won't be a Medicare disproportion of share payment anymore because everybody will be covered. There's going to have to be a direct fund. And it's sort of like the question this gentlemen asked about undocumented aliens. There will be a big argument about how much money should be in the fund, but plainly the United States has been supporting academic health care centers directly through medical education subsidies but indirectly through this undocumented--this Medicaid disproportion of share payment. And the time has come for us as a people, I think, to directly support the academic health care centers. And what I would just say to you, sir, I met with all your counterparts in the Boston area not very long ago, and I told them the same thing. We need to go into the Congress, work this out, figure out what the financial requirements are, and do it. The American people pay 40 percent more of their income for health care than any other people on Earth. A lot of it is due to the inefficiencies of the system. A part, a small part, is due to the excellence with which we educate doctors. And I think every American is willing to pay it, and we ought to pay it directly. And so I think if we do it right, this health care bill will make your existence more secure in the years ahead. And the one thing I think you would agree with, if we don't do anything your condition will grow more perilous. So we have to do something, and the right thing to do is to have a direct support mechanism for the academic health care centers. [A participant asked about people's fear of having to give up a familiar doctor for one chosen by an insurance company.]”