To the trained ears of Southern California's health care professionals, President Clinton's call for national health care reform Wednesday night hit very few false notes.
The need to provide health care coverage to the uninsured, the emphasis on preventive and primary medical care, the problem of skyrocketing premiums that are pricing many out of the health care system, excessive paperwork--all are problems they have been forced to live with on a daily basis.
Reaction was strong in Orange County, where health care and labor officials were generally impressed by the President's speech, although they're waiting for details to make a final evaluation.
"I would say hospitals strongly support the President, especially the plan to provide universal health care access to everyone in America," said Ed Foley, Orange County regional vice president for the Hospital Council of Southern California.
Dr. Peter Anderson, director of the emergency department at Fountain Valley Regional Hospital and Medical Center and president-elect of the Orange County Medical Assn., said Clinton was "right on" by emphasizing reduced paperwork and less consultation with insurance companies in the practice of medicine.
"I think it sounds like more of our time will be spent with patients and less talking with the bureaucrats or the insurance companies that are constantly looking at the bottom line," he said.
And Dr. Walter Henry, dean of the UC Irvine College of Medicine, said Clinton did "a very effective job of presenting the rationale behind health care reform. I was impressed by the strength of his convictions and the examples he used to point out problems with the existing health system."
However, Dr. Howard Waitzkin, chairman of the Orange County Task Force on Indigent Care, opposes Clinton's plan, saying it will only increase the power of the largest insurance companies over the delivery of health care.
Under Clinton's plan, he said, insurance coverage for the majority of Americans "will undoubtedly get worse because their payroll contributions will go up and their co-payments and deductibles will go up and they will be herded into a very small number of huge managed-care programs that will be run by very large insurance companies with a terrible record for service."
Yet labor was pleased by the president's message, and Mike Potts, area representative for the Los Angeles/Orange Counties AFL-CIO Building Trades Council, said universal health insurance coverage would help union contractors--who already provide health insurance to their workers--compete for business with non-union contractors.
"Cost shifting is wiping us out," he said. "When our contractors go to bid on work, the non-union competition has the ability to bid without the cost of health care included and their work force is free to get their health care at the cost of the public and of the insured worker."
On a more partisan theme, Orange County's Republican congressional delegation took Clinton to task for promising much without detailing how the program will be paid for.
Rep. Dana Rohrabacher (R-Huntington Beach) said, "Anybody who can get up in front of Congress with a straight face and say they are going to give everybody more for less and we are going to solve it with a little plastic card, has got some credibility problems right off the bat."
Elsewhere in Southern California, the long-awaited presidential address was heartily welcomed.
Wendy Lazarus of Children Now, an advocacy group for children's health care, said the President's speech "hit all the critical marks for children: the need to provide health care for every American child, uninterrupted care, preventive and primary services and affordability for services."
Like others, Lazarus, who watched the President's speech on television in her Santa Monica office, said that the true test of the health plan will be in "the details" of how it will work. But, for now, she said there was very little to complain about.
Los Angeles County Health Director Robert C. Gates listened to the speech during rush hour traffic on his way home. "There is very little in the speech that I would disagree with," he said later.
One disappointment for Gates was that Clinton didn't address the problem of what to do with illegal immigrants in the health care system--a dilemma of particular interest in California. The President's plan, as it stands, would provide emergency-room reimbursements for hospitals that provide the care, but at the same time the federal government would end hundreds of millions in payments to urban hospitals heavily impacted by illegal immigrants.
"He didn't get into it, and I can see why," Gates said. "It's a politically touchy area. But he did make a point that if some people don't pay, it drags down the whole system. I think undocumented aliens fit into that category. Someone has got to pay for their care."