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S. PRt. 101-113

Printed for the use of the Pepper Commission

U.S. GOVERNMENT PRINTING OFFICE

28-859

WASHINGTON : 1990

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, DC 20402

THE PEPPER COMMISSION

U.S. Bipartisan Commission on Comprehensive Health Care

SENATOR JOHN D. ROCKEFELLER IV, West Virginia, Chairman

HOUSE OF REPRESENTATIVES

SENATE FORTNEY PETE STARK, California, Vice Chairman MAX BAUCUS, Montana, Vice Chairman BILL GRADISON, Ohio, Vice Chairman

DAVE DURENBERGER, Minnesota, Vice Chairman MARY ROSE OAKAR, Ohio

JOHN HEINZ, Pennsylvania LOUIS STOKES, Ohio

EDWARD M. KENNEDY, Massachusetts THOMAS TAUKE, Iowa

DAVID PRYOR, Arkansas HENRY WAXMAN, California

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Dear colleague,

In P.L. 100-360 the Congress called upon the Pepper Commission to recommend legislation that would ensure all Americans coverage for health care and long-term care. With this report, the Commission fulfills that charge and calls upon you - our colleagues in the Congress, the President, and the American people-to turn its recommendations into law.

The Commission's intensive efforts to develop recommendations have not been an academic exercise. This report presents a workable plan of action to address the rapidly growing crisis in health and long-term care. To agree on that plan, Commission members have had to make hard choices and compromise strongly held positions. Members who believed action was critical refused to allow their personal vision of the best to become the enemy of the good.

In health care, a workable plan means we have no choice but to build universal coverage by reforming and extending the job-based and public coverage we now have to make it work well for all Americans. In long-term care it means we must establish priorities to build the protection we now lack. And in both areas, we must build deliberately, a step at a time, to allow all parties to adjust and to ensure a sound and stable structure.

Some will say that it is naive to pursue even such worthwhile social investments in the current fiscal environment. But there will never be a day when the answers become easy or cheap. There will never be a day when all of us can have our first choice or ideal solution. There will never be a day when some of us will not have to make some sacrifices to achieve what is best for all of us.

As the nation's political leaders, we face a choice: we can continue to duck our heads and hope this issue will not bring the nation to its knees, or we can use the Commission recommendations as the rallying point for the political consensus that can make universal

coverage in an efficient system a reality.

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