Clinton senior adviser speaks to AICPA Health Care Industry Conference.

Addressing the American Institute of CPAs Health Care Industry Conference in Las Vegas, Ira Magaziner, senior adviser to President Clinton for policy development, called on CPAs to examine health care reform bills closely as they are introduced and to "try to work with us to make them as good as possible."

Magaziner, the architect of the Clinton health care reform plan, stressed the basic principles that would have to be a part of any plan the president would accept. "First and foremost," said Magaziner, "we have got to get everybody insured in this country."

Magaziner stopped short of defining "everybody" as 100% of the population. "As is the case with Social Security and compulsory education," he said, "some people slip betwen the cracks, so you in fact will wind up with approximately 98% coverage."

The price of reform. To finance the White House plan, Magaziner called for a "system of shared responsibility" in which both employers and individuals would contribute to the costs of health insurance. Magaziner did not go into detail on a proposed employer mandate, but one formula outlined in bills approved by the House Ways and Means Committee, the House Education and Labor Committee and the Senate Labor and Human Resources Committee would require employers to pay at least 80% of the cost of employees' health insurance.

Another key to financing universal coverage, Magaziner said, was cost containment. He told the conference the key to containing costs was findig a middle ground between a pure market and a bureaucratic system of price control. "That middle ground is a captitation system of payment," Magaziner said, arguing such a system would change the incentives for physicians and make consumers more cost conscious.

The president's plan calls for a system of caps on premiums aimed at poorer areas of the country. "In some areas, competition isn't going to make much sense because you'll be lucky to have one integrated health care network," Magaziner said. "In those areas, we think having some kind of cap on the rate of growth of premiums will be useful."

The senior adviser admitted cost containment was an area "where our ideology sometimes gets in the way of practicality," but he emphasized its essential role in health care reform. "Health care costs are out of control in this country," said Magaziner. "They've gone up to 14.5% of our total economy and are headed to 19% by the end of the decade. They're choking the rest of the economy."

Freedom of choice. Magaziner also stressed in his address that consumers must be able to choose their own doctors and health plans. He cited a Henry J. Kaiser Family Foundation study that found over two-thirds of the nation's employers did not offer their employees any choice of health plans. Magaziner said the president's plan would not only provide a choice but also allow consumers to pay more to go outside their health plans if they wanted to "see a specialist across town."

Other proposals. While not going into specifics on health care benefits, a subject receiving much scrutiny in the current congressional deliberations, Magazine introduced primary preventive care as a key to the plan's goal of "promoting better health and saving money in the long term." He suggested a direct surcharge on premiums to finance efforts by the National Institutes of Health and by academic centers that performed biomedical research and trained health care professionals.

Also proposed in the plan, said Magaziner, was a comprehensive long-term-care program that promoted home- and communitybased care, modified nursing home regulations and established programs to assist community caregivers such as adult day-care programs. "The financing package for such a program ultimately will involve some type of individual requirement in paying for health care, a tobacco tax and a cut in the growth of Medicaid and Medicare," Magaziner said.

Quelling concerns that the president was giving in to congressional pressure to change key details of his health care reform plan, Magaziner said the administration had planned for, and welcomed, negotiations with congressional leaders. "We knew even if we came down from the mountain with the tablets that Congress would rewrite them," he said. "Even though we've been criticized for doing it, we thought it was important to address the specifics up front so we could spark a national debate about them."