A Health Care Proposal by Bill Bradley 
   
    Our health is in many ways the most intimate part of our
    being - our most precious possession. When you talk
    about health and healthcare, everyone has a story to tell.
    Some have happy endings, some are tragic. I have
    listened to so many of them over the years. Here is one
    of mine. 

    My father's health was the
    family's number-one
    priority when I was growing
    up in Crystal City, Missouri.
    He lived with constant pain.
    He had calcified arthritis of
    the lower spine. He could
    not walk much further than
    the two blocks from our
    house to his office. I never
    saw him drive a car, throw
    a ball or tie his shoes. 

    I think about my father
    when I think about health
    care. And I think about all
    those other stories I've
    listened to along the road,
    of how illness can shape a
    life, and haunt it with the
    fear of losing everything to
    physical and emotional and
    financial catastrophe. How
    illness can create a prison
    of pain and disability and
    fear. And that's why one of
    the basic promises I make
    to the American people is
    health care for all Americans. 

    My father was a lucky man; he had helping hands to
    guide him out of that prison, and as a small-town banker
    he had the money to assure first-rate care. He deserved
    it, this hard-working and productive middle-class man.
    He had to quit school at 16 when his own father died of
    cancer. He worked his way up in our hometown bank
    from a job he called "shining pennies" to be the major
    shareholder. He created his own future, but he never lost
    his empathy for others. He was very proud that during
    the Great Depression he never foreclosed on a single
    homeowner. 

    I think about my father when I think about health care
    because I believe that every American deserves what
    my father got - the helping hands to a productive life,
    whether they are the hands of family members or the
    hands of that extended family of all Americans, helping
    each other. You can call that extended family
    government if you like, but government is, after all, just us
    - the people. 

    My father's life showed me that through self-reliance,
    discipline and determination, a person can overcome
    virtually any obstacle, achieve any goal. But I can also
    imagine forces beyond your control that can overwhelm
    you. I saw that at home, too. And in traveling across
    America for so many years I've seen it in a lot of other
    homes, as well. 

    This is why I know that health care - two wonderful words
    that have been beaten into a phrase as unappealing as
    the crinkly paper on a doctor's examining table - goes
    far beyond even such critical issues as curing or
    controlling disease, of research projects and prevention
    programs, of insurance coverage; we need to start
    thinking of those two words - health care - as the shiny
    pennies of America's future, the foundation of our lives,
    as individuals, as families, as communities and as a
    nation. 

    Health care - as appealing and intrinsic to our lives as a
    well baby's gurgle and a worker's muscle and a
    grandparent's smile. Health care is about assuring
    middle-class working people that they will not be locked
    into jobs they hate because of their insurance coverage,
    or economically ruined by catastrophic illness. 

    Health care is about assuring all Americans that their
    race or sex or class or address will not be the
    determining factor in whether they have a chance for a
    healthy start in life. Healthcare is about strengthening
    America, by strengthening each one of us - one person
    at a time. 

    In Iowa recently I talked with a man who described
    symptoms that implied colon cancer. "What does your
    doctor say," I asked. 

    "I haven't gone to one," he said. "I don't have any health
    insurance to pay for it." 

    When we talk about the 45 million uninsured Americans,
    we are not talking about the indolent or the negligent,
    we're talking about people you and I know. We're talking
    about the waiters and waitresses who bring our meals;
    we're talking about home care workers who sit with our
    aging parents; we're talking about the taxi-drivers, gas
    station attendants and department store clerks. We are
    talking about Americans who get up every day, do a full
    day's work, but who know that if they get sick or hurt, they
    have no back-up. These are our neighbors. In fact, they
    could easily be you tomorrow; and they may already be
    you today. 

    It is not right that uninsured Americans face illness alone.

    It's not right to force them to choose between proper
    healthcare and bankruptcy. It's not right that Americans
    should lose the insurance coverage that gives their
    children adequate healthcare just because they're
    caught in corporate downsizing. It's not right that just
    because you work for a small business or are starting
    one of your own you must live in fear that some medical
    emergency might undo everything you've worked for. Nor
    is it right that kings and dictators can come to this
    country to get the best medical care in the world, while
    Americans two blocks away may not be able to afford
    any care at all. 

    Health care is not a luxury.
    Americans have the right to
    life, liberty, and the pursuit
    of happiness. But Thomas
    Jefferson, who proclaimed
    those rights in our
    Declaration of
    Independence also said,
    "Without health, there is no
    happiness." We can't
    abolish sickness or deny
    mortality. But we can help
    care for the sick and ease
    the pain of the dying and
    ensure that children have a
    healthy start in life. We can commit ourselves to the
    proposition that when it comes to health care, everyone
    will have the American Dream - at last. 

    When we talk about healthcare in this country, we often
    talk about it as if it were an end in itself. We forget that it
    is really a means to an end - and the end is the best
    possible health for Americans. 

    Good health, like education, is in all our interests. It has
    measureless benefits for all of us. It allows us to get up in
    the morning and go to work with a feeling of hope, not
    dread. Parents with good health can look after their
    children. Healthy communities are places where
    neighbors look after their neighbors. Good health begets
    good health. 

    In many ways, America has the best, most advanced
    medicine in the world. Our doctors and nurses are
    peerless; our hospitals matchless; our technology
    unequaled. Breakthroughs in genetic engineering in the
    next decade could dramatically extend life expectancy. 

    With all our skill and technology and innovative
    treatment, why aren't Americans the healthiest people in
    the world? Why don't we have the best health care
    system in the world? 

    I am here today to tell you - we are going to have the
    best health care system in the world. 

    Good health is a blessing; it is not a right. But good
    health care is a right. And it is up to us to ensure that
    right to every American. 

    First, we will do so by making certain that all children are
    insured. 

    Second, by giving adults a real choice of affordable
    health insurance plans. 

    Third, by expanding the concept of health care to include
    the idea of good health and by attacking the myriad of
    non-medical factors which determine health. 

    I am talking about a health
    care system that doesn't
    just swoop in during an
    emergency. I am talking
    about a system that
    emphasizes prevention
    and early intervention, a
    system that uses our
    scientific advances for the
    many who can benefit,
    rather than the few who can
    afford them. I'm talking
    about giving the joy of
    medicine back to doctors
    and nurses who see a
    decline in quality, and feel
    a sense of loss in a system
    that often erodes their
    professionalism and makes them feel they cannot do
    right by their patients. I am talking about healthcare that
    goes out to people where they live their lives - in their
    communities, in their schools, in their businesses, their
    places of worship - not healthcare that waits for people
    to show up when they have no other place to go. I am
    talking about a system of public health that truly ministers
    to the physical and mental health of the public.
    Throughout our history, leaders from both parties have
    looked upon the health of our citizens as a national
    responsibility. Over two hundred years ago, Congress
    established the Marine Hospital Service, offering care to
    seamen who contributed a small yearly premium. A
    century later, Teddy Roosevelt's Progressive Party
    called for a system of social insurance that would protect
    people against sickness and the ravages of old age.
    During the Depression, Franklin Roosevelt called for
    nationally supported health insurance, something his
    successor, Harry Truman, fought for after the war. 

    Almost forty years ago, John Kennedy, while
    campaigning for the presidency, saw that one out of two
    elderly Americans were living in the kind of poverty that
    prevented them from getting even the bare minimum of
    healthcare. Lyndon B. Johnson picked up the reins of
    reform and created Medicare, the most successful
    medical program in our history. Richard Nixon passed
    the HMO act of 1972. 

    In 1994, President Clinton sought to provide health
    insurance for all Americans. That attempt failed. But the
    problems that called forth that effort have not
    disappeared. And it is time to try again - but in a
    different way. 

    The lessons learned from the experience of the past,
    and the stories people have told me along the road are
    valuable guides today. 

    Americans do not want a health care system controlled
    from the center by a massive bureaucracy. 

    Americans do not want a health care system that seems
    indifferent to quality. 

    Americans do not want to be denied their right to
    choose their doctors or the direction of their treatment. 

    In 1986 everyone told me tax reform could never be
    achieved because there were too many opposing
    interests. I listened to all those interests, and eventually I
    understood their concerns. A short while later, the
    common ground we established turned into the tax
    reform that everyone said was unachievable. Improving
    our healthcare system will require a similar process. 

    Before sending a program to Congress, we will consult
    the concerns and ideas of all participants in the
    enterprise of American health. We will address their
    objections and draw upon their experience, knowing that
    no one has all the answers. And, above all, we will listen
    to prospective patients. The contours of this proposal
    will change as the voices of others are heard. It should
    be viewed as a starting point, not a final plan. I know that
    making healthcare available to all will not be easy. But
    the difficulty is a challenge, not a reason to avoid
    engagement. 

    The riddle of the ancient oracle at Delphi was, "What
    goes on four legs at dawn, two legs at noon, and three
    legs at sunset?" The answer, of course, is all of us. We
    crawl at birth, we walk as adults, and sometimes we use
    a cane as we age. 

    The proposal I will offer today deals with Americans at
    these three critical stages of life: at dawn, at noon, and
    at sunset. 

    I am suggesting a different approach to health care - one
    for each stage of life - from infancy to old age. For as we
    know, the problems at each stage are different, and
    solutions must fit the problems. 

    Let's begin with - healthcare for children. There is no
    more serious indictment of a society than that it lets its
    children languish in pain or illness. Yet in the midst of our
    great prosperity, there are 11 million children who go
    without medical care because their parents cannot
    afford it. 

    No devotion to the principle of personal responsibility
    allows us to blame the child whose parents cannot
    provide medical care. Even the harshest calculus of
    costs and benefits teaches that by diminishing the
    present lives of our children, we are dimming the future
    prospects of the nation. It is not just a metaphor to say
    that our children are our future. It is the literal truth. They
    are the citizens, the workers, the dreamers of America's
    tomorrow. 

    Nearly 35 years ago, we made that kind of commitment
    to our senior citizens when we enacted Medicare. That
    commitment was simple: healthcare for the elderly was a
    national responsibility. 

    Now we need to make a similar commitment to our
    children. That commitment is also simple: no child in this
    country will be without health insurance. Because our
    children are our national future, their healthcare must be
    a federal responsibility. And to those who say we can't
    afford to do this, I answer: We can't afford not to. 

    I propose that we enroll every child in a health insurance
    program from the moment of birth. Enrollment will be the
    responsibility of the parent. Just as proud new parents
    must fill out a birth certificate and a social security card
    before leaving the hospital, these parents must also
    enroll their new child in a health care plan. 

    I don't think this is onerous or difficult. In most states, we
    can't drive a new car home from an auto dealership
    without signing up for insurance. Should we have a
    lesser requirement for the most valuable and cherished
    addition to our lives? 

    Under this proposal parents would be able to choose the
    form of protection they want for their children by keeping
    the insurance coverage they already have, or by joining
    one of the private insurance plans for children that will be
    developed through the healthcare system that serves all
    federal employees. 

    Since we require insurance for every child, we must
    make it possible for every family to afford it. I suggest we
    do so through refundable tax credits for the poor and
    middle class and by excluding premium payments from
    income for all Americans. The reason we help all
    parents, is because all children are important to the
    future. 

    For Americans between the ages of 19 and 64, I
    propose to make it easier for them to find insurance and
    to purchase it. For those who are now insured and
    satisfied with their plans, nothing should change. But not
    all Americans are so lucky. Many small employers
    cannot afford health insurance for themselves or their
    employees. Many people, who were once employees,
    find themselves classified as independent contractors
    without health benefits. Others can't pay the cost of
    insurance, even though they're above the federal poverty
    line. 

    For these uninsured adults, I suggest we make
    insurance more accessible by allowing them to enroll in
    one of the many private plans now available only to
    members of Congress and other federal employees. 

    Those who can't afford a plan will be helped by a
    refundable tax credit, scaled to income, and all citizens
    will be able to exclude insurance premium costs from
    their federal taxes. Whether they join a new plan or
    decide to stay with what they now have, this simply
    extends to all individuals those tax benefits which are
    part of the employment-based system. 

    With this approach, healthcare will become portable,
    which means you will be able to take it from job to job,
    from city to city. You won't have to stay in a job you don't
    want in order to guarantee your health insurance. 

    No matter what plan you choose, it should come with a
    Patients Bill of Rights and a Consumer Right to Know
    provision. And if you don't like your insurance company,
    you can fire them, and you don't have to worry about
    them firing you. 

    Just as we must fortify our future by helping the youngest
    among us, we must honor our past by keeping our
    commitments to our oldest citizens. We have already
    done so through Medicare, the most successful public
    health insurance program in American history. But we
    need to make this program better by expanding it to
    include costs of prescription drugs, with generic drugs
    being the first choice of medication whenever possible. 

    In addition we should encourage the elderly, through
    Medicare payments, to join health plans that will not only
    provide healthcare but allow them to remain
    independent in their homes. This will reduce the
    economic and psychological burden on family members,
    eliminate the costs of institutional care, and give our
    older citizens the opportunity to spend their remaining
    years among the people and places they know and love,
    and among those who know and love them. 

    Healthcare is something we get from professionals. But
    caring for your health is something we must all do for
    ourselves as individuals and communities. If the first rule
    of medicine is to do no harm, the first rule of health is to
    care for yourself. Good health is not just about
    recovering from an illness, it is the knowledge and the
    practice that prevents that illness from occurring in the
    first place. 

    Let's be realistic. You can't smoke two packs a day for
    thirty years and be surprised by lung cancer. Seat belts
    and helmets, proper nutrition, safe sexual practices and
    exercise must be the responsibility of individuals. But we
    can all help each other in meeting our responsibilities. 

    When it comes to the needs of our communities, one
    size does not fit all, but the goal will be the same: to
    promote a healthy lifestyle. 

    The public health system will be about a shared
    responsibility - helping people take care of themselves.
    For health is not just about being alive, it is about being
    well. 

    This life stage proposal will allow the three parts of our
    society to do what they do best. The private sector will
    do what it does best - provide healthcare insurance for
    Americans. Community organizations and communities
    will do what they do best - help build the strong networks
    locally to provide good health for Americans. And
    government will do what it has a fundamental
    responsibility to do - protect the well being of its citizens.

    That's the proposal. 

    I believe it is irresponsible to commit to new programs
    without also laying the costs before the public so that we
    can decide together how to pay for them. The healthcare
    specialists I have consulted estimate that my proposals
    will cost $35 - $45 billion for children and adults, $10
    billion for drug benefits for the elderly, $6.5 billion for tax
    exclusions, $2 billion for public health initiatives. That is
    a great deal of money, but a campaign proposal without
    a price tag is just another politician's promise. 

    With the imaginative use of new technologies, we are
    already finding new cost savings within the system. We
    must step out of the old box that says either we raise
    taxes or cut benefits in order to control costs. Instead,
    we need to think most creatively about how to use our
    resources. Understand that of the roughly $1 trillion
    spent on healthcare in 1998, $250 billion are related to
    the delivery of unnecessary care, redundant tests, and
    the excessive administrative costs. Imagine a world
    where the Internet replaces all the filing cabinets and
    paper forms. 

    Imagine a world where the cost of retrieving information
    is near zero. 

    Imagine a world where doctors have good data, and
    make decisions that are both economically prudent and
    clinically valuable. 

    Imagine the future - where health care costs will be much
    lower. 

    In 1996, hospitals and doctors spent $30-$50 billion
    trying to get paid and insurance companies spent
    another $30-$50 billion trying not to pay. Many doctors
    are spending 2 to 3 hours a day on the phone, looking
    for approval to provide care, explaining a decision, or
    inquiring about reimbursement. It is ridiculous to spend
    so much time and money on personnel and equipment
    just to stay on top of all the different insurance
    requirements. Common sense and technology can
    change this. 

    Together, this waste and these administrative costs all
    add up to around $300 billion. Our program would cost
    between $50 and $65 billion to make sure 95% of all
    Americans have health insurance. 

    We can get this right. 

    I think of healthcare as a good investment - in our
    productivity and our growth. But I do not justify it as only
    an investment. I ask for it as a fulfillment of the nation's
    responsibility to its people; in the belief that in this
    country of such great power and unexampled wealth, no
    citizens should be denied the chance to seek help for
    illness - not as long as we have help to give. 

    I've talked in this campaign about the importance of
    government doing a few big things well. When it comes
    to America's health, this is not the time to be timid. It
    requires bold action and a national commitment, from
    the President on down, to make certain that every
    American has what should be a basic birthright. It is
    about who we are as a people and a nation, and what
    we can become. 

    During the Great Depression, when the people of my
    home town in Missouri were anxious about the health of
    the banking system, my father - the small town banker -
    would stack up piles of cash in the bank's glass window
    to reassure the people of the town that the bank had
    protected their deposits. We must reassure people
    today that healthcare will be there for them when they
    need it. And like my father, who never foreclosed on a
    mortgage during the depression, I want to assure
    Americans that their dreams of a better life for
    themselves and their children will not be foreclosed
    simply because they can't afford healthcare. That is my
    common sense dream for the America of the new
    millennium. It can happen. 

    Abraham Lincoln taught us that "the legitimate object of
    government is to do for a community of people whatever
    they need to have done, but cannot do at all, or cannot
    so well do, for themselves in their separate and
    individual capacities." Care for health is a legitimate and
    a necessary task for the government which has been
    designed to serve the people. By undertaking this task
    we have the opportunity to strike down barriers to that
    "pursuit of happiness" which is the unalienable right of
    every human being. 

    When Thomas Jefferson wrote those words into the
    Declaration of Independence, neither he nor those who
    gathered with him in that Pennsylvania summer could
    envision that their handful of sparse and isolated
    colonies would become the repository of almost
    unimaginable power and wealth. Yet no change in our
    circumstances has altered one phrase of those enduring
    principles, nor relieved us of the obligation they impose.
    Time has only expanded our capacity to protect those
    rights to which they dedicated a newborn nation. What
    we can now do, we should do now, so that we, like those
    [who] came before, can extend and enlarge the content
    of American liberty.


