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- <text id=93TT1760>
- <title>
- May 24, 1993: "I'm Having Nightmares"
- </title>
- <history>
- TIME--The Weekly Newsmagazine--1993
- May 24, 1993 Kids, Sex & Values
- </history>
- <article>
- <source>Time Magazine</source>
- <hdr>
- HEALTH CARE, Page 38
- "I'm Having Nightmares"
- </hdr>
- <body>
- <p>Michael Duffy, Dick Thompson and Ira Magaziner.
- </p>
- <p> In a rare interview, White House health-care adviser Ira Magaziner
- met with TIME correspondents Michael Duffy and Dick Thompson
- for an hour last week to discuss his proposals. Some excerpts:
- </p>
- <p> Q. What will be most different about life in America if Bill
- Clinton's program is enacted?
- </p>
- <p> A. There's going to be much greater security. Regardless of
- whether Americans change jobs or lose their jobs or move to
- another state, they are guaranteed health insurance. That is
- the biggest difference.
- </p>
- <p> Q. Are Americans going to have to pay more for this security?
- </p>
- <p> A. It depends. People who are not now insured, and the companies
- they work for, are going to pay a lot more. That's a matter
- of equity.
- </p>
- <p> Q. How quickly will the uninsured be covered?
- </p>
- <p> A. We haven't really made that decision. If you say to a company
- you've got to go from zero to [full coverage] overnight, you're
- going to drive a lot of companies out of business. You can't
- do this overnight, even if you had all the money in the world.
- The fundamental part of this reform that is often overlooked
- is that in 10 years from now almost no one is going to remember
- what you did up front to pay for this. What they're going to
- remember is that we expanded access to doctors, improved the
- quality of care, increased competition and so on--those are
- really the guts of what is going to make a difference on this
- long term.
- </p>
- <p> Q. Will every American be going to an HMO?
- </p>
- <p> A. Our job is not to determine who's going to win, whether it's
- an HMO, a fee-for-service network or whatever. It's just to
- set a groundwork for who's going to compete and provide choice
- to all consumers. A lot of people think HMOs are going to win
- out, but I think Americans like a fee-for-service [option].
- </p>
- <p> Q. Can doctors work outside the alliance?
- </p>
- <p> A. If doctors want to be out on their own, they can't be paid
- through the insurance network. If doctors in Beverly Hills want
- to get together and do whatever they do, that's fine as long
- as taxpayers don't pay for it. Even in Sweden, where you have
- a completely government-run system, private people go to private
- doctors. You're not going to stop that, and you shouldn't.
- </p>
- <p> Q. Will there be price controls?
- </p>
- <p> A. What we're moving to is a budgeted system, not controls.
- With controls, you're trying to regulate every transaction,
- which means you have to set up an enormous regulatory structure,
- and it's a nightmare for the providers. But with a budgeted
- system, you give providers a fixed amount of money. You figure
- out how you want to handle things.
- </p>
- <p> Q. How can you cap what Americans need to spend on health care?
- </p>
- <p> A. You can. Most other countries have proved that you can.
- </p>
- <p> Q. What about short-term price controls on drugs, providers
- and insurers?
- </p>
- <p> A. You may need to put in some regulation in the short term
- to make sure the insurance market doesn't go haywire.
- </p>
- <p> Q. How do you feel about the process so far?
- </p>
- <p> A. Every day and every night, I'm having nightmares that something
- will go wrong. It's a big responsibility. But if we can get
- comprehensive health-care reform that's really decent, you'll
- feel like you've really contributed something.
- </p>
-
- </body>
- </article>
- </text>
-
-