240 The making of American domestic policy
- it has been estimated that as many as 10 per cent of health care claims are
fraudulent.
The shortcomings of the private insurance system led the federal govern-
ment in 1965 to introduce Medicare, an insurance programme to cover the
elderly and some disabled persons. Medicaid was also introduced to cover the
very poor. The states, in combination with the federal government, finance
health care for low-income groups and those receiving public assistance, such
as the blind and the disabled. However, Medicaid is tied in with the state’s
welfare system, so that entitlement varies from state to state. The states
differ in the arrangements they make for their citizens. Hawaii created a
government-run scheme similar to the British National Health Service;
other states have attempted to go it alone, without becoming ensnared in the
complex federal regulations attached to Medicaid. Oregon adopted a policy
of rationing health care in order to provide a programme that covers a much
larger proportion of the needy population.
The richest country in the world, with magnificent health care facilities,
does not provide basic care for many of its citizens. In 1992 some 35 mil-
lion Americans were not covered by any of these plans, and millions more
were underinsured. Sixteen per cent of Americans under the age of sixty-five
were uninsured, with much higher percentages in minority groups such as
blacks (21 per cent) and Mexican-Americans (35 per cent). During the 1992
presidential election campaign Bill Clinton had repeatedly promised that he
would reform the nation’s health care system, and public opinion seemed to
be in favour of some initiative to overhaul it. Five days after his inauguration
in January 1993, Clinton appointed his wife Hillary to head a Task Force on
National Health Care Reform. This was an unprecedented move. The wives
of Presidents had in the past exercised considerable influence, particularly
in cases of presidential illness. Edith Wilson was apparently in charge of the
government of the United States after President Woodrow Wilson suffered a
stroke in 1919; Nancy Reagan played an important part in running the White
House when her husband was shot; but this was the first formal appointment
of a First Lady to a government post. It caused a good deal of controversy, al-
though Mrs Clinton soon impressed Congress and the public with her grasp
of the complexities of the health care problem.
The Task Force took four months to complete its work. It did not seek
simply to provide a solution which was politically acceptable to the interests
involved, but set out to devise a plan which would meet the basic objectives
that the president had espoused, in particular universal health care coverage
for all Americans. From the day, 22 September 1993, that Clinton unveiled
his plan before a joint session of Congress, critics said the proposal was too
complicated. In November the Bill was introduced into Congress. Clinton
planned to provide permanent health care coverage to all Americans by re-
quiring employers to pay 80 per cent of the cost of a basic package of benefits
for their employees. He proposed to control skyrocketing health care costs by
capping the amount that insurance premiums could increase annually. He