summarized very briefly in my talk, the sentiments of ronald reagan about the family, they were genuine. i don't think it was just political fluff. i think they were genuine beliefs. many of his advisers didn't hold those beliefs. or saw them just as instrumental things. but i think -- his beliefs were genuine. maybe even more so, because of some of the problems he might have had in his own family. brent? >> brian robertson, family research council. i was wondering if some of the social security reforms you referenced in your talk, even though they had the intent of strengthening the family, could be seen in retrospect as weakening sort of intergenerational dependence and ultimately weakening the notion that children are responsible for their parents in their old

age, and strengthening an individualism in our society to be their intent, from some of your comments and your talk. >> the book does talk about that to some considerable degree. assuming you're doing a summary, you have to kind of hit just a few things. on the one hand, i do think that the social security system, as it was finally put together in 1939, had a positive pro family effect for maybe 20 to 25 years. i think that period of american history between 1940 and 1965 when we saw marriages strengthening or a high marriage rate or declining divorce rate and a baby boom going on, part of what was helping that happen was a government that was, in fact, positively helping young families. not only helping them through the kinds of security provided by the social security system, to help them with subsidized

housing loans through the v.a. and fha mortgage programs. it helped them with a very family-friendly tax policy. very generous tax policy, which really did encourage more children, encouraged traditional marriage. it encouraged -- and it discouraged divorce. i think those public policies had an effect. things started going wrong in the '60s, though. although, actually even earlier. one flaw in the maternalist plan was what to do with mothers having children who didn't have husbands. they were never quite sure how to deal with that. some said we'll just treat them as any other motherhood. in fact, that sort of seemed to be the dominant view. some worried a great deal that giving help and aid and support to women bearing out of wedlock children would encourage the practice. and, in fact, there was a moral hazard there. well, in fact, that turned out

to be true. one other storyline in my book is about what was happening to african-american families. and starting in the '50s. there was a lot of good news in the white suburbs about families. but when we look at african-americans mostly -- even mostly in urban areas in the north, a growing problem was emerging. more and more children born out of wedlock. drawing benefits under afdc and other programs. there was -- i talked at some length about the -- the moynihan report of 1965 called the negro american family, a case for national action. which was horrified that the out of wedlock birth rate among african-americans had risen to 25%. among whites, it was still just a couple percent. and was trying -- what to do about it. well, its solution was a maternalist solution. its solution was to try to find

ways to create jobs where african-american men could be better bread winners, making them better husbands and better fathers. that was the e, one idea, to have plan. and they said it in so many words. for example, one idea was to have two mail deliveries a day rather than one, and hire inner city black men to be the mail carriers on the second delivery. so they were thinking. but you're right, there were some problems and flaws. also what happened, the 39 amendments created a social security system that was supplemental. and not designed to replace other forms of care. such as family-centered care. and it didn't, until the 1960s. it was only in the mid 1960s that congress just got -- went nuts in the mid '60s, just tried passing all kinds of legislation, one of which was a vast expansion in the value of social security benefits. as late as 1957, something like'

57, good year, the peak of the post family era. less than 50% of the elderly were drawing support from social security. it was still sort of a limited system, not all professions and jobs were covered. and the amounts given were supplemental, not -- you didn't live on it. you needed something else. while over 60% of social security -- of the elderly were drawing support from their grown children, which might be called the traditional way of solving the problem. by 1980, 13 years later, the proportion on social security was nearly 90%. the proportion drawing support from their own children was about 3%. the one form of support had completely driven out the other form of support. that was because benefits just increased so much. that was not the original intent of the creators of the system. nor was it to create a system that encouraged out of wedlock

berths. but once sort of discipline on the system broke down, as it did in the '60s, the moral hazards of the system broke free, and became -- i agree, became damaging to american families, rather than strengthening. another question? >> one or two more questions. >> quick question. sorry, steven baskerville, howard university. the reagan administration's executive order, the one for the family impact statement. i don't believe that's been reinstated by the bush administration. has it, or what has been going on with that? and i was also wondering, what would you recommend a federal government could do? what can the president do? what can be done on the federal level, if an executive order like that is not strong enough to deal with this kind of thing? what more could be -- >> to my knowledge, it's not been reinstated. does anyone know any different? i think we would have heard about it if it was.

so no, it has not been reinstated. certainly it could be, but i think if it was, it should be strengthened. in fact, in the book, i talk about some of its weaknesses. and what then has to happen after that? el with, heads have to roll if it's not done right. and if it's not done. and that never happened. under the reagan and the bush administration, certainly not under the clinton administration. the people just didn't do it. or if they did, it was a routine, quickly forgotten thing. and they -- they just -- the documents weren't paid attention to, or it just wasn't done. and nobody paid a price for not obeying the order. somebody would have to pay a price. and, again, i think some of the weaknesses of the order should be removed. it could have been much stronger than it was. for example, one weakness, a serious weakness, never defined what it was it was defending. it never defined, what is the

family we're measuring this against? what is the structure of the family? if you don't have that in place, i -- don't even bother. if you're not having an ideal against which you're measuring policy, or at least a structure which you say -- this is what we're interested in protecting, this structure, if you can't have that, there's no reason to even bother. so i think -- i hope they will reconsider doing it and make it much stronger. and enforce it. >> let's take one more. >> how would you suggest tackling the supreme courts, since they obviously are not going to be intellect enough to see some of these points? >> oh, boy. well, i think obviously the administration is trying to put in new justices and having a great deal of trouble getting them through. and i'm told that many of them probably would be be more

family-friendly than some of the -- maybe some have been in the past. i think you know the answer to your question is how do you break the logjam in the senate. and probably nothing is going to happen. it sounds like, too significant until the next election. which might make a difference. beyond that, judicial re-education i guess needs to take place. actually, i know some organizations which do a very good job of taking judges on summer retreats. they spend money, they bring 20 or 30 judges, state and federal judges, to a retreat center somewhere. treat them real nice. and try to help them think through these issues again. and that's a private -- something for the private sector to do. but i think in the long run it could have some real effect as well. one more. we're all done. >> yeah, i think we'll wrap it up there. but let's express our

appreciation to dr. carlson once again. next week on "history bookshelf," iris chang discusses her book "the chinese in america, a narrative history". the book con cells chinese-americans involvement from the building of the transcontinental railroad to modern day contributions. "history bookshelf" airs on american history tv every saturday at noon. starting monday, the supreme court is scheduled to hear oral argument on the current health care law. next on american history tv, an excerpt of first lady hillary rodham clinton's 1993 testimony before the house energy and commerce committee on president clinton's health care proposal. this is about 45 minutes. >> thank you very much, mr. chairman. i want to thank you and the members of this committee for giving me this opportunity, but

more than that, i want to thank you for the time that you have spent with me over the last months, as we have worked through a lot of the issues that will effect the future health care well-being of our country. i would also particularly like to thank the chairman for the good counsel that he has given to me, as i have pursued the issues related to health care reform. i think that is very appropriate for the chairman to have done, because as we all know, 50 years ago, the chairman's father introduced the dingell/murray/wagner bill, the first national health insurance legislation ever put before congress. the chairman's father understood the importance of providing health security for all americans. he fought vigorously to keep the idea alive in congress for 15 years, and you, mr. chairman, have continued that fight by

introducing similar legislation in every session since you succeeded your father in the house of representatives. you both proved to be men ahead of your time. although parts of your father's bill have been incorporated into subsequent reform efforts, such as medicare and medicaid, we have yet to fulfill your father's dream, and the dreams of many other americans of providing comprehensive health care for all of our citizens. health care reform is not a new idea, nor a revolutionary concept. but while most americans favor reform, we have failed as a nation to make much progress when it comes to providing health security for every citizen. sadly, health reform in this country is less a story of the typical american can-do attitude than a story of procrastination

and parochialism and all too often, greed, fraud, waste and abuse. thomas jefferson was the first president to talk about the importance of individual health. franklin roosevelt hoped that health security would be the other half of the social security system. but political realities forced president roosevelt to discard that dream, and the result, as we know, has been ongoing insecurity for millions of hard-working americans. when harry truman campaigned for a comprehensive health program in 1945, he told congress, and i quote, millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. millions do not now have protection or security against the economic effects of sickness. but president truman's pleas for health security fell victim to the politics of the day, and

scares about socialized medicine. dwight eisenhower came before the congress in 1955 and said that health insurance could be improved by expanding the scope of the benefits provided. john f. kennedy proposed expanding coverage to the elderly and the mentally ill. by the early 1960s, both presidents eisenhower and kennedy could not say that their hopes of health security had gone forward. but instead they saw, once again, the familiar sight of a dream of health security being stalled by outside interest groups and partisan bickering in the congress. then came presidents lyndon johns johnson, richard nixon and jimmy carter. there was progress made on medicare and medicaid. president nixon came forward with a comprehensive health care reform proposal that built on the employer/employee system.

president carter proposed a number of advances and particularly mrs. carter championed the cause of mental health benefits. they too envisioned reforms that would give americans more health security and our nation more economic security. but, like their predecessors, their efforts and their hopes were not realized. so here we are in 1993. 50 years after the chairman introduced -- the chairman's father introduced the first legislation. we are still wrestling with many of the same issues and the same problems that previous generations have worked on. the difference is that today, our system has many problems that have gotten increasingly expensive, and the difficulties of delivering health care in a cost effective way is making a challenge to the fiscal integrity of the federal and state governments to businesses,

to individuals across the country. now is our chance to beat the historical odds and give the american people the health security they need and deserve. for the past 12 years, this committees has fought to extend health care benefits to every american. for years, this committee has tried to root out fraud and abuse in the health care system. for years, this committee has been ahead of its time. now i hope that all of our time has come. i hope that this committee, building on its rich tradition and many contributions, will help this president and this congress and this country pass health reform legislation so that we can control health care costs and provide every american with affordable, high-quality medical care. i hope that during this session

of congress we will finally give chairman dingell's father the tribute he deserves. this committee will see the realization of the work it has done. but most importantly, as public sue wards, the people you represent will know that their government has listened and heard and acted on their behalf. thank you very much, mr. chairman. >> the committee thanks you for a very fine statement. one which i take great pride and pleasure in. your mention of my old dad, who would have certainly been proud to have heard you say these things today. it was his hope and his dream and his prayer that we would one day provide a decent measure of health security in this country for all of our people. and i'm sure that he would have been very proud that you were taking the leadership on it, and he would be very pleased that you had mentioned him today, as indeed am i. i'm only going to say that i intend to do my best to help you push through the best possible

form of health security legislation for all of the people at the earliest time. and you have my pledge to that. and having said that, the chair is going to recognize my colleagues for questions in the order in which the rules prescribe. the chair will recognize then for five minutes exactly first the gentleman from california, mr. waxman, chairman of the subcommittee. >> thank you very much, mr. chairman. mrs. clinton, i'm really delighted to see you here. my father just passed away, as did yours. and we started going through his papers, we found a letter he wrote around 50 years ago. complaining about the fact that a doctor wouldn't come to my mother, because they couldn't afford to pay the bill. she suffered for the rest of her life, because of an illness that might have been controlled. so i know it was my father's dream, as well. and is others around this country that we finally have guaranteed access to care for all in americans.

that's really what the core of the president's proposal is all about. and some of us who have worked in this area for a long time have felt that we needed a president who was willing to take the bold leadership to deal with this difficult issue. i used to think that would be enough. now i know that what we needed more was also a first lady like yourself to give us the expertise and guidance you've had and given us in preparing this plan before us. the crux of the whole issue is that we have everybody get comprehensive set of benefits. your proposal would have us do that through the jobs site, through employer/employee contribution. everybody is giving lip service to universal coverage. but some people are just simply saying employers ought to just offer it, without making a contribution. some others are saying that what we ought to do is require each individual to go out and buy insurance and, again, no

requirement that employers play any role. how is it that you came to this conclusion that we needed to require employers, large and small, and all employees, to participate in paying for health insurance? >> well, mr. waxman, i think that you've pointed out what is one of the critical features of the president's plan. and for all of the members of this committee who have struggled with the costs of health care and how we would achieve universal coverage, you know that there are really only three general ways to approach this. and we have looked at all three. the first would be a large, broad-based tax that would replace the existing private sector contributions. that would mean it would replace the existing employer/employee system and any individual contributions. for a number of reasons, the president rejected any kind of

broad-based tax that would substitute for the system that we currently have. a second possibility that you alluded to is to put the burden on individuals. as some states currently do with respect to auto insurance, to essentially mandate that individuals would be responsible for their own health care insurance and that in order to make that affordable, there would be some insurance market reforms and some kind of support through financial payments of some fashion to low-wage individuals who otherwise could not afford it. we looked very closely at that, and we are continuing to work with those who advocate that position, particularly the senate republicans who have advocated an individual mandate. but we have a number of questions about it. one is that we worry that it would undermine the existing employer/employee system in which on a voluntary basis, as a matter of either collective bargaining or employer choice

for competitive purposes, employees have responded over the last decades in increasing numbers to provide health insurance. and that employer/employee system has served as the basis for insuring more than 90% of the people in this country who have private insurance. and we would worry that shifting the burden wholly over to the individual would result in many employers who currently insure ceasing to do so. or maybe only insuring their high-wage workers and not their low-wage workers. and we would worry that if we subsidized individuals below a certain income level that there would be pressure on employers to keep wages below the subsidy level so they would continue to be paid for by the government. so we have a number of problems with the individual approach. what we concluded is that -- what we want to do is preserve what's right about our system and fix what's wrong. we think one of the things which

is right is the employer/employee system, which does work well for most americans. it's biggest problems have been that the cost of insurance has made it more and more difficult for many businesses to be able to participate. if you build on the employer/employee system, you are already building on what is available and familiar to most americans. and if you do as we propose to do, to provide discounts for small businesses and to subsidize low-wage workers, we think that is the fairest and most responsible way to get everybody into the system and it's a system that is already working for most americans. and that's among the reasons why we concluded it would be the best approach for us to take at this time. >> thank you very much. >> the gentlemen's time has expired. the chair recognizes now the gentleman from virginia, mr. bliley, the ranking minority

member of the subcommittee, for purposes of questions. >> thank you, mr. chairman. mr. chairman, under the rules of the committee, i ask unanimous consent to be able to distribute to the members two copies of -- or copies of two graphs that i intend to use during my questions. >> without objection, so ordered. mps mrs. clinton, first let me add my personal thanks for the job that you, the president and the task force have done in preparing your health care plan and beginning the national debate on the issue. i also want to thank you for the time that you and our magaziner -- though i wish wouldn't meet at 7:00 in the morning, have spent with the task force over the past several months. mrs. clinton, like many others, we are currently working with a draft of the president's reform proposal to enable members to more fully understand this very complicated plan, i would ask that you make available to the committee the task force

quantitative working papers concerning financing, premium caps, actuarial analysis of benefits, job impact and the national health expenditure data. mrs. clinton, the early evaluation of the president's plan, by a wide range of experts, including economists and members of congress, is that the plan will not cut costs nearly as much as forecast, and that the federal budget deficit will dramatically increase as a result. that is because the success of the president's plan depends upon unprecedented cuts in the medicare and medicaid programs. the cuts generate $285 billion in savings, which represent almost two-thirds of the plan's financing. a cap is also placed on both private health insurance premiums and the federal entitlements. when fully phased in, the cap is equal to cpi plus the annual percentage growth in population. and your own data projects the annual growth in population at less than 1% or .8 of 1% to be

precise. mrs. clinton, this chart, to your left, shows an international comparison of the average annual growth rate of health expenditures adjusted for inflation for the years 1985, 1991. for example, in this period, german health expenditures actually grew by 2.87% above the inflation rate. the canadian system grew at 4.8% inflation rate annually. and the british nationalized system grew at 4.07% above inflation. all of these countries are showing significant real annual increases above inflation. in contrast to the experience of these nationalized systems, your cap on health expenditures allows real growth above inflation of less than 1%. mrs. clinton, this data shows that nationalized, single-payer systems, such as britain and canada, have not come even remotely close in limiting health expenditures to less than 1% above inflation. in fact, except for germany,

they have been growing at least at 4% per year above inflation, and even germany has been growing at close to 3% annually. in the case of britain and canada, we are talking about systems that explicitly ration care. my question is, how is the president's plan going to accomplish these extraordinary reductions in health care expenditures when even systems thatration care have not remotely approached these growth limits. >> mr. bliley, that's an excellent question. i really appreciate your asking that. because this is one of the crucial issues that we have confronted. and let me start -- and i hope the chairman may give us just a little bit oflyway on time, because it's such a critical inquiry. let me start by saying that we anticipate realizing some substantial, one-time-only savings over the next several years. for example, we believe that insurance market reform, particularly in the nongroup and

small group market, will result in substantial savings. we believe that moving toward a single-form system will result in substantial savings. we can outline in more detail and will gladly do so the kinds of changes that we anticipate beginning to bring down our base level of expenditures. secondly, we think that the crux of achieving the kinds of savings and then stabilizing those savings over time into the outyears will result from changes in the way we organize and deliver health care. and there are many examples of that around the country that we can point to. and let me just quickly mention a few. in the medicare system, we know that medicare expenditures vary greatly between different localities in our country. without any difference in quality outcomes for the patients. largely because of differenceses in the way health care is organized in a particular area,

and because of differences in practice styles and decisions of doctors. currently, there are no incentives in our fee-for-service reimbursement system that will move those decisions from being high-cost, inefficient ones toward being lower-cost efficient ones. but we have substantial data to prove that if we change the way we provide incentives and reimbursement to providers, we will begin to reduce the costs that are currently continuing to escalate within our system. in fact, the public/private model that we propose is, if anything, closer to germany than closer to any of the single-payer national systems. because it's a joint system of employer and government payments joined by individual contributions. so to try to -- with the red light flashing at me, congressman, to say that we will give you