Bill Clinton (AP photo/Danny Johnston)

Efforts to keep private long-term care insurance (LTCI) around complicated efforts to write health system change laws and regulations in 1993.

Ira Magaziner, a health policymaker in the Clinton White House, talked about private LTCI concerns in an interview done at the White House in April 1994.

The Clinton Library included a transcript of the interview, and many other internal Clinton White House documents, in a batch of health policy documents it posted on the Web last week.

An interviewer asked Magaziner why Bill Clinton’s White House had tried to introduce such a long, complicated health reform bill in 1993.

Magaziner recalled that the drafters based one 150-page section of the bill on a private LTCI market regulation bill previously introduced by former Sen. Lloyd Bentsen, D-Texas, Magaziner said.

“It is the least intrusive, least governmental part of the bill, yet it’s the longest section in the bill,” Magaziner said. “And I remember having discussions about that with somebody, saying, well, in a sense, when you try to leave something private as opposed to having the government take it over, you then have to put some regulatory framework around it. If you spell that out, it sounds regulatory. And it’s either going to be in the bill, or it’s going to be done afterwards.”

Magaziner said considering the private LTCI section and similar sections convinced him that introducing a detailed bill was the right thing to do.

The biggest danger of this reform effort is not that you don’t pass the bill, but it’s that you pass the bill and it doesn’t work,” Magaziner said. “It runs haywire. And you really mess up things.”

By introducing a complicated bill, the Clinton White House gave Congress a chance to create a better bill, Magaziner said.

“I’d be scared to death to just pass that skeleton bill, have some things be fundamentally wrong with it, have a bunch of bureaucrats that run the departments sit down and actually write out how it’s going to work a year or two from now, and have the president blamed if it doesn’t work,” Magaziner said.

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