The Health-Care Paper Trail
York, Byron
......................................... 1 The Health-Care Paper Trail As the Hillary crowd prepares to make another run at health-care reform, a newly released cache of confidential memos...
...Thanks to a lawsuit that forced the White House to give up at least some of its records, more than 250 boxes of proposals, memos, scribbles, and endless charts and tables are open for inspection at the National Archives in College Park, Maryland...
...Thus it was with some consternation that, upon being briefed for a meeting with the National Medical Association, the nation's largest organization of black physicians, one official learned that many of the African-American doctors were well-to-do specialists, and quite skeptical about the plan...
...The discussion was `should subsidies be directed to firms that have a lot of low wage workers?' In the course of that discussion, the President mentioned the kinds of low-wage firms that he was familiar with from the South, like furniture and chicken companies...
...The White House caved...
...Nixon went on to pitch an alleged cure for AIDS developed by a company with which he was working...
...They contain information about the critical role played by giant non-profit institutions like the Robert Wood Johnson Foundation...
...Now they seem almost archaic...
...Weeks passed, and the obstacles were not confronted...
...One participant's notes from an April 1993 meeting quote Magaziner as saying, "Likely no input back fr...
...There is the following letter, dated January 26, 1993, to the first lady's chief of staff Maggie Williams from one Donald A. Nixon: I am Richard Nixon's nephew...
...The new campaign comes as Americans get their first (limited) look into how Mrs...
...There couldn't have been any hidden agenda for Tyson...
...Officials assured workers that the group would not be subject to the Freedom of Information Act, so nobody would ever see their papers...
...They really believed they were 100 times smarter than the average American," says Dr...
...meeting w/CEO's in ITR...
...One member's notes from April 1993: Speaking Guidelines for HCTF Members (notes from meeting 4/15/93 9:00 AM) *Use the talking points *Stick to the GOALS of the task force *Talk about the process of the task force *Talk in generalities *Stay away from specifics Another member took notes during a June 1993 briefing by Bob Boorstin, press secretary for the task force: Building Public Support What real people want to know: not a massive new bureaucracy less like Ira & more like Roseanne add personal stories of experiences on task force, your family, etc...
...20 The American Spectator March 1995 many from outside groups...
...There are clear gaps in the material...
...The working groups hoped diversity in the nation's medical work force, even if it meant nationalizing the medical education system to achieve an "appropriate" racial mix of doctors...
...Working on cost controls, Ukockis wrote in late March that "every option has fatal flaws, which, although passed off as problems `still under examination,' are actually major roadblocks...
...ICM [Ira Magaziner] only one awake & cogent...
...There is one key player whose papers won't be found in the Archives...
...What he wanted was for someone to make the "best possible" case for a specific price control program...
...With responses like that, it was hopeless to tell Magaziner that there were fundamental problems with health-care reform...
...when it] is virtually certain that the opposite will be the case...
...diversity and...
...One member of the Ethics Group writes that it included "a Protestant minister, a Jesuit...
...It's not that the working groups didn't discover the intractable contradictions in Magaziner's approach: you couldn't create a vast new nationalized medical system and save billions of dollars at the same time...
...Only 10 chairs for 50+ people...
...A Task Force That Looks Like America Even as the task force discouraged diversity of ideas, it welcomed old-fashioned interest-group diversity...
...Although they are housed at the Archives now, the papers remain in the legal custody of the White House and could possibly be returned to the administration...
...Thousands and thousands of pages were tossed haphazardly into cardboard boxes and sent off to the Archives...
...The neglect is unfortunate, because the papers could give journalists a much fuller picture of the health-care debacle...
...The President's concern about chicken and furniture factories that pay between $7 and $8 an hour has set me thinking about potential opposition that he seems very concerned to avoid," Starr wrote...
...At issue was the 1972 Federal Advisory Commissions Act, which required that groups that included outsiders as well as federal government employees had to meet in public...
...Although nearly all of the top players were white, memo after memo is concerned with including the right racial and ethnic mix in the process...
...I came up with that entirely on my own," he said when asked recently about the memo...
...If that happens, the cloak of secrecy will return, likely to stay for years to come...
...Zelman was concerned about pressure from those on the left who believed the administration wasn't going far enough...
...Top-Secret Magaziner and the first lady brought more than 500 people into the health-care group and then swore them all to secrecy...
...According to one participant's hand written notes of an April meeting, somebody asked Magaziner, "Has Pres...
...Indeed, First Lady Hillary Rodham Clinton is rarely seen in the papers that have been released...
...For now, the papers provide no more than a peek into Mrs...
...Believe me, June, this is where the action is...
...Magaziner had an entirely different agenda...
...Ukockis called it "a massive case of policy constipation...
...If asked about membership on various groups," read another instructional memo, "you need to indicate that this is yet another thing that you cannot talk about...
...According to one memo, "The health care work force must achieve sufficient racial, ethnic, gender, geographic, and cultural diversity to be representative of the people it serves...
...The papers suggest he did it by simply throttling anybody who didn't see things his way...
...1 pm-Midnight Presentations continued, ending w/shortterm cost controls...
...In a "Dear Ira" letter dated March 23, 1993, Alan Dugan, managing director of Towers Perrin, offered Magaziner his firm's services free of charge and added that Towers Perrin "is excited and honored to have the opportunity to assist the administration to develop its national health reform proposal...
...The president was "making directed comments during briefings...
...There are examples of the sort of wonk-to-wonk mutual admiration that could only exist among the most committed bureaucrats: "As you requested," reads one memo, "I am sending you some notes for your consideration as you spin the old magic on your current infrastructure draft...
...They've always contended that Hillary Clinton was not on the working groups," says Thomas Spencer, attorney for the doctors' group...
...knowledgeable but fresh eyes...
...from a relatively small num ber of the estimated 500,000 pages in the Archives...
...His proposal: a policy that would allow companies like Tyson to avoid a big hit...
...Then there is Paul Starr's worry that imposing new taxes to pay for health care might set off a storm that would sink the reform effort...
...attorney in Washington to investigate whether criminal charges should be brought against Magaziner...
...to be its greatest 21 The American Spectator March 1995 Perrin and ran their strategy operation and have very good relations with their senior management, many of whom also supported Bill...
...So far no newspaper or magazine has published a serious examination of the health-care papers...
...The document raises the question of whether the president personally intervened on behalf of a major supporter...
...They are as disorganized as the task force itself...
...a Rabbi...
...The working groups were the hundreds of White House-chosen experts who actually put the proposals together...
...It's easy to see why...
...Dated September 5, 1993, it is addressed to Magaziner and follows up on a meeting with the president in which they talked about whether large companies that have mostly low-wage workers should be given subsidies to provide health insurance for their employees...
...Officially, the task force was a small group of top officials-among them the first lady, six cabinet secretaries, and Magaziner-who supervised the process...
...The White House gave up the materials only after an ugly legal fight...
...I probably mentioned Tyson because I knew it was an Arkansas firm...
...made any of those 700 decisions yet...
...Magaziner then began an impassioned presentation of his own...
...Treasury official Mike Springer wrote in a March memo that he was disturbed by "the implicit assumption that an increasingly bureaucratized delivery system under constant pressure to cut costs will be somehow more benign and responsive than our current system...
...Regional 23 The American Spectator March 1995 moment with the First Lady to try to underline the key importance of the purchasing cooperatives...
...Tyson) have more than 5,000 employees...
...what could be more adventurous than health care reform in America...
...And there is the blow-up of a "Rex Morgan, M.D...
...The health bureaucracy would also have unchallenged power to enforce its agenda: Federal law would specify that funding for health professions education would be conditioned on meeting requirements established by a federal body, with the identity of that body, the process for establishing requirements and the total amount of funding to be determined by the Task Force...
...In response to a presentation covering cost savings options possible under Medicare, he became impatient when informed they involved savings of only tens or hundreds of millions of dollars...
...The problem was getting Magaziner to lis ten...
...They came up with a plan to establish Health Professions Educational Consortia, which would be given wide-ranging authority to set standards for "geographical distribution, primary and specialty care mix...
...And in the final plan, the bottom line, there was no subsidy whatsoever...
...How would firms with lots of low-wage workers fare under these different approaches...
...Although task force press releases often described the group as "inclusive," a look at the papers shows it included few people who disagreed with Magaziner, because disagreeing with Ira Magaziner could be a very unpleasant experience...
...People outside process...
...The biggest of these companies (e.g...
...Last night's meeting was to consist of a series of short presentations to Ira Magaziner outlining the options our group is evaluating for short-term cost containment," wrote Treasury Department official James Ukockis in a memo to his boss the day after the meeting: A short time into the meeting it became clear Mr...
...For all their importance, the papers have been virtually ignored by the press, which has paid more attention to the custody battle than to the documents themselves...
...Whether or not he had Tyson in mind is impossible to tell from the papers that have been released...
...On February 22, 1993, Magaziner met with the Cluster Group on Short Term Cost Controls...
...I didn't know about commodity trading...
...Emphasis in the original.] The Clinton players apparently thought this would earn them the unwavering loyalty of minority doctors...
...In the end, Magaziner's approach worked not to correct problems in the plan but to silence dissent...
...it wasn't reported until March 1994...
...But the president knew...
...Comic Relief The health-care papers have their lighter moments...
...And the occasional memo documents an encounter with her, as did Paul Starr's plaint of February 7, 1993: "After the meeting last evening," he wrote Magaziner, "I talked for a no to mandate that sort of are For all its importance, racial and ethnic diversity sometimes took a back seat to political diversity, especially when it came to including people from states with large numbers of electoral votes, or those represented by powerful Democrats...
...District Judge Royce C. Lamberth called those statements "misleading at best...
...That same month, Pete Welch, a working group member, prefaced one memo by saying, "The goal of this model is to quickly establish Health Insurance Purchasing Cooperatives in some form before changes in political conditions could undermine them...
...After months of meetings followed by consultation with so-called "contrarians" who would criticize the plan, he arranged to have auditors review the final product...
...Starr says no...
...The task force was, with the arguable exception of the first lady, composed entirely of government officials, and thus not required to give up its documents...
...The papers show he just kept pushing the contradictions asidesometimes by stifling adversaries, often by saying that no decisions had been made on a huge number of critical issues...
...As recently as six months ago, the buzz words of health-care reform dominated the agenda in the White House and on Capitol Hill...
...We also contacted a woman who teaches medical ethics and is herself unsighted...
...In depositions, chief health-care aide Ira Magaziner told the court that the secrecy was proper because all members of the reform effort were government employees...
...Another note carries the handwritten addition: "Bea: there persons of color in this group...
...A document in Magaziner's papers lists members of the Health Professional Review Group, which was created to look over the final plan...
...and you made it...
...beside each member's vital statistics are his truly vital statistics...
...The White House makes a distinction between the Health Care Task Force and its working groups...
...The one group that has combed them extensively is the Association of American Physicians and Surgeons, but its researchers focused mostly on finding information to address the specific issues of the lawsuit...
...Reporters should hurry to take a look, because the documents might soon disappear back into the White House...
...He gave the Clinton administration a choice: make the papers public or defend the secrecy in court...
...Magaziner claimed his system would identify and remove such flaws...
...Taxes," he wrote in a memo to Magaziner, "are not a subject about which Americans are entirely rational...
...No overhead because Dave Alexander couldn't get act together...
...A few staffers' handwritten notes mention comments from HRC...
...How did he design a system that allowed so many terrible ideas to go so far...
...polls, focus grps.-because hi security...
...Orient of the Association of American Physicians and Surgeons...
...Jane Orient, executive director of the Association of American Physicians and Surgeons...
...It was designed to prevent interest groups from exercising undue influence in secret...
...The first lady hopes to use her original work to overhaul smaller portions of the health-care system, beginning with a plan to mandate insurance for all children...
...Certain of Magaziner's papers have now been released because he was considered a member of both teams...
...four African-Americans, one of whom is also a woman...
...Tyson" is, of course, Tyson Foods, the Arkansas chicken giant that has backed Bill Clinton financially and politically over the years-and was connected to the $100,000 made by Hillary Rodham Clinton in the risky commodities trading market...
...The company has been rewarded with favorable treatment from both Arkansas and, later, federal regulatory agencies...
...Eventually the time came to recruit members to speak to the public about the emerging plan...
...Thus her health-care papers remain secret...
...doing what in the task force...
...Here are task force guidelines from February 1993: The White House does not wish any information about the Task Force to be shared outside of the working groups, including with friends, colleagues, other governmental agencies not represented on the Task Force or any nongovernmental entity...
...And the boxes arrived at the National Archives...
...At a dinner in March 1993, deputy White House legal counsel Walter Dellinger suggested a plan to pre-write federal regulations enforcing the Health Security Act, so that it would be instantly enforceable upon passage by Congress...
...From day one there seemed to be a standard opening to any meeting involving top task force officials: don't say anything to anybody...
...Adjourned to HRC's conf room #100...
...The White House has indicated its intent to solicit broad input to the process but only when it decides to do so...
...They believe our direction is somehow fundamentally different from the `single payer' approach they favor," he wrote...
...that letter is sent down the chain with the notation "To Ira and Maggie Per HRC...
...In another memo, a Treasury Department official complains that his proposal was "captured," that is, confiscated by the task force for fear it would leak...
...It was his position "the President must do something, there is no choice...
...And by the way, there were now 1,100 decisions to be made...
...Clinton's Health Reform Task Force worked...
...Health insurance cooperatives...
...Later, Lamberth asked the U.S...
...Take the issue of price controls, which Magaziner favored and the president's economic team opposed...
...With "fresh eyes" like that, it was unlikely that the plan would be subjected to a serious critique...
...comic strip in Paul Starr's papers: a woman asks the dashing doctor, "After all your adventures, don't you think private practice will seem-well, sort of dull...
...The end of the document reads: States represented: 23 Gender: Female 23 Male 23 Race: White 30 Non-white 16 African American 9 Hispanic 4 Asian American 2 NA I Where's Hillary...
...There were some communications to her [in the papers] but none from her...
...Then there are the notes an unidentified task force member scribbled as he or she slogged through March 9, 1993: Began 7:30 Indian Treaty Room-this til 10:00 AM...
...some key figures sent almost no papers, while others sent quite a bit...
...And they reveal much about the struggle within the executive branch as the White House, the Treasury Department, the Department of Health and Human Services, and others maneuvered to influence the final product-and in some cases, distance themselves from it...
...There is top official Walter Zelman's note to the press office entitled "The Marketing of Managed Competition...
...Magaziner brought in Towers Perrin, the firm that had bought his own company, Telesis, for a reported $6 million back in 1986...
...The answer...
...a third is "Female/Black/Child Mental Health/Mass/Gore...
...Most people on floor or in window areas...
...But they were issued strict rules about what to say...
...For example, they shed new light on the extensive role played by the justice Department as the task force struggled to determine whether its "global budgets" and federal mandates would violate the Constitution...
...Indeed, Starr could not have known about the commodities deal...
...Yet that was the prevailing faith, and critics could just get used to it...
...She was allegedly the chairman of this whole thing," says Dr...
...Under our plan, even if they enter the alliances, they cannot get any [cost] cap for at least four years," Starr continued...
...1 The Health-Care Paper Trail As the Hillary crowd prepares to make another run at health-care reform, a newly released cache of confidential memos reveals what the first plan really involved...
...O At a dinner in March 1993, deputy White House legal counsel Walter Dellinger suggested a plan to pre-write federal regulations enforcing the Health Security Act, so that it would be instantly enforceable upon passage by Congress...
...Yet, because this adversarial process has been missing one adversary-the con side-there is substantial risk at least one of [them] may become part of the reform package by default...
...The working groups included dozens of staffers from outside interest groups, and it was the groups' papers that the judge ordered the White House to release...
...I had no idea whatsoever, I thought it was an example of a low wage firm that would be affected...
...He signed the letter "DN...
...Ira Knows Best The clearest picture is of Magaziner...
...When then-White House counsel Bernard Nussbaum refused a Freedom of Information Act request, the group filed Association of American Physicians and Surgeons v. Hillary Rodham Clinton et al...
...It is not...
...The material in this article comes...
...Shortly after they were released, the New York Times published a brief set of excerpts with a headline that suggested they were no big deal: "Now It Can Be Told: The Task Force Was Bold and Naive and Collegial...
...Still, through all the chaos, a few pictures emerge, glimpses of what went on as the Clinton White House planned what was triumph...
...He again became impatient during my presentation on price controls...
...The reason is one of the main issues of the lawsuit...
...But the Clinton Plan is not as dead as it seems...
...22 The American Spectator March 1995 Members were given strict instructions on what to do if asked about who was...
...and you couldn't herd people into health-insurance cooperatives without reducing doctor choice...
...For all its importance, racial and ethnic diversity sometimes took a back seat to political diversity, especially when it came to including people from states with large numbers of electoral votes, or those represented by powerful Democrats...
...Clinton's role...
...Other publications did even less...
...24 The American Spectator March 1995...
...Magaziner was so obsessed with keeping details of the plan secret that he didn't even make much use of the White House's extensive polling machinery...
...sympathetic...
...In February 1993, the Association of American Physicians and Surgeons challenged the administration's decision to hold closed task force meetings, and to withhold the names of hundreds of participants Byron York is a writer and television producer in Washington...
...by Byron York Remember "managed competition...
...you couldn't cut medical spending by massive amounts without cutting care...
...One is listed "Male/Whitellnternist/Mass/Kennedy-Dukakis...
...But an anonymous working group member's handwritten notes of Magaziner's talk to an "all hands" meeting on April 8, 1993, suggest what he had in mind: "Auditors...
...A partner in the Rose Law Firm writes to recommend someone...
...Employer mandates...
...10-1 PM Kicked out by Pres...
...cultural skills" in each new class of doctors...
...She was on the task force, and it was not considered subject to the Federal Advisory Commissions Act...
...And there are the repeat ed admonitions to hurry the new system into placebefore people got a chance to know what was in it...
...They believed they could redesign one-seventh of the American economy, sitting in these little rooms at midnight and talking only to other like-minded people...
...And before I could finish my sentence, she said, `But we need cost containment.' And then she ran off...
...This fact doesn't get me free coffee, but I voted correctly (thank goodness) like a bunch of other Republicans (did we have a choice...
...In a January 1993 memo on potential task force staffers, Magaziner wrote, "I sold my company to Towers "The President's concern about chicken and furniture factories that pay between $7 and $8 an hour has set me thinking about potential opposition that he seems very concerned to avoid," Starr wrote...
...He was not interested in a balanced evaluation of the option...
...Virtually every memo in the health-care papers offers some small insight into the mindset of Clinton-Magaziner health reform...
...Politics as Usual There is a curious memo in the papers of Paul Starr, a respected Princeton University professor and a key figure in the health-care reform effort...
...I regret very much that the efforts on health care were badly misunderstood, taken out of context and used politically against the administration," Hillary Clinton told the New York Times recently, lamenting the "misunderstanding" but not the reform plan itself...
...He replies, "On the contrary...
...Another is Male/White/Urologist/California Campaign...
Vol. 28 • March 1995 • No. 3
