ID Date & Time state High Cost High Cost Comment Community Network Community Network Comment Quality/ Efficiency Quality/Efficiency Comment End-of-life End-of-life Comment Public Policy Public Policy Comment Core Benefit Core Benefit Comment Financing Additional Comments 27251 07/18/06 OH Agree "Health care should not be a luxury. As the wealthiest nation in the world, it is disgraceful that some of our citizens do not receive the health care they need. We should all be ashamed of ourselves!" Agree Agree Agree Agree Agree 27253 07/18/06 IN Agree most of the insurance plans that are available are priced way to high for people to afford. No response No response No response No response No response 27254 07/18/06 FL Agree "One nation, indivisible..." Agree I agree only if we can cut the red tape and get patients in front of doctors. Agree Agree And also support Death with Dignity like they have in Oregon. Agree "I'll be voting Democratic up and down the ticket, because Democrats speak for my best interests and core values as a public citizen." Agree Abolish tax cuts for the highest incomes. These people don't need them. 27258 07/19/06 MO Agree Agree Agree Agree Agree Agree 27261 07/19/06 WA Agree Agree Agree Agree Agree Agree 27262 07/19/06 DC Agree Agree Agree Agree Agree Agree I agree with this goal. "It is critically important to the future success of our country that we all have meaningful access to quality healthcare. This is a economic and moral issue, and it has been unaddressed for too long." 27263 07/19/06 TX Disagree "* There must be incentive for a person to go through the hell they do in Medical school. When they get out they cant be made to compete with people trained overseas that will work for what a typical laborer makes. Many good Doctors are quiting their practices because of this insourcing from other countries and the fact that HMos and PPOs did notheing but make the insurance companys richer. I mean look at the facts. The patients are paying more for their care and the Doctors are receiving less so who is making all the money. Answer the politicians who greased the palms of the insurance lobbyist and the insurance ccmpanys. Get of thinking ""How can I the politicians make more money for myself and my friends. YOu are not taking care of your JOB. IN addition the health care provided should include so called alternative health care. You know the care that works better than allopathic medicine because it is not foreign to the body. Problen is that it cant make money for the politicians and their friends" Disagree You need to educate the people of low income to understand that they should not have children they cant take care of and if they have more than 1 child then their funding will be cut back to only include one. The people who cant afford insurance should be given acute care only. No response "* Heslth information should be for the patients and Doctors eyes only. Sharing information leads to abuses beyond imagination. Sharing informatoin should not be considered. Fraud should be stopped when illegals use the system and when generation people on welfare use the system. It is appauling that you who are in charge dont tell the peolple about the simple remedys they can use to take care of their health needs. ie. sugar for a topical antibiotic, the fact that flu will go away by itself and no medicine attacks a virus that causes flu. Flu shots are such a scam. Whether people take a shot or not their incidence to getting the flu will be the same.,and so on and so on. There are so many examples, and that is why europe and Mexico even in many ways has better ideas cause they are cheaper and in many hundreds of cases work as well as allopathic medicine. But it doesnt line the politicians, and the insurance, and the friends pockets. What about the people! THInk about it. When you meet your maker " Agree Disagree It should be provided if they are not dead beats that wont work or who are not contributing in some way. No response "The cost of health care could be brought down if 1. The government would stop lining the pockets of the insurance companys, theirs friends and their own. If people would be given incentive to take care of their own health. If preventive medicine would be practiced and encouraged. If the populations would learn about all the wonderful home remedies and were educated on how to maintain their health even at school age." The main thing I would like to emphasize has already been said. The people need to told it is not Ok to be fat and uninformed and not respondsible for their own health. They should be made to pay a price for this. 27265 07/19/06 MO Disagree "I agree with parts of this and disagree with parts. I agree that health care costs should not be very high. I think those that are Americans should have coverage but those that are here illegally, should not be given this same coverage. Low income individuals should be based on reasons for the low income. If they are lazy bums who just don't want to work, then I say NO to them. If they are trying to work and better themselves, then NO. If they use the system to get their ""fix"" then NO as well." Disagree Same as above Agree Agree Disagree Same as above Agree "Don't raise income taxes. Raise taxes on things that can damage the health of an individual such as cigarettes, alcohol, etc." 27266 07/19/06 OH Agree Agree Agree Agree Agree Agree 27268 07/19/06 NY Agree No response No response No response No response No response "Consider the following scenario.You are traveling on the New York City subweay or some other public transportation system and someone who has no coverage sneezes. You are now infected. THis should not occur, but does occur because we do not consider health care a ""right."" We need to ascend the ladder of civilisation and consider universal health care a birthright." 27270 07/19/06 MI Agree IF WE CAN PROVIDE HELP FOR ALL OTHERS NATIONS WHO NEED IT FOR NATURES CRUSH AND DISASTERS HOW CAN WE NOT HELP ARE SELF !!! Agree Agree Agree Agree Agree 27274 07/19/06 VA No response Disagree "At no point should you dismantle the currently successful Health Center model in your effort to ""expand"" access. Instead, you should seek to expand the availability of these patient-oriented providers to those in need. Eliminating, or modifying, the reason for their success is no an advancement." No response No response No response No response 27275 07/19/06 IA Agree If all the other advance nations in the world have coverage for all their citizens why not the United States of America. The only reason we don't right now is because everyone wants a piece of the money pie for medical cost. Government needs to step in to protect all it citizens and not private corporations which only look at the dollar cost to their share holders and to lining of their own pockets. Agree Yes this definetely needs to be done and quickly before the people that need the health care don't get it and cost all of us more. Agree "We should be doing this now already, instead of still discussing and writing about it. " Agree We should already being doing this Agree Agree 27278 07/19/06 CA Agree "I partially agree. As a health care provider, I think a single payer comprehensive universal health care system...such as the Veteran's system...would streamline administration, streamline paperwork (only one standardized form to fill out), provide opportunities for bulk purchasing of pharmaceuticals thus lowering prices for consumers, and many other benefits." Agree I partially agree. Public hospitals need to be protected as well. Agree Agree Agree No response "Single payer, comprehensive, not for profit, universal health care!" "Your survey would have been better if you had a partially agree, neutral and partially disagree option. " 27280 07/19/06 AZ Agree "I would worrry about a private company running it more than the government, as an ICU nurse who has worked in for-profit hospitals they only care about the bottom line, not quality care." Agree Agree Agree "We have major end of life issues in this country. I believe that advanced directives and power of healthcare should be discussed and intiated by primary care providers and that forcing the discussion should be tied into federal reimbursements. In other words, if your doctor doesn't discuss this with you then they don' get paid." Agree Agree 27281 07/19/06 IA Agree "What most don't take into account is that healthcare for all is a people benefit. If it were some kind of corporate welfare,Republican Congressmen would have helped enact it into law long ago. " Disagree Disagree Disagree Agree "If we could get a Democratic Congress, there would be a greater chance that this would happen." Disagree Sounds complicated enough to never work. I favor a single payer system. "Again, sounds complicated enough to never work. Germany has had national healthcare since 1883. If they could do it that long ago, why can't we do it now?" "If I were to name one thing that consistently seems to keep this country from working for the benefit of all, in this instance healthcare for all, it would be GREED." 27283 07/19/06 AR Agree "I would encourage a public program. Medicare is much more efficient than private health insurance. Medicare Part D, an example of a private system, is an administrative nightmare that will do nothing to control costs. " Agree Agree Agree Agree "This should be a collective solution (like Medicare), not an individual solution (like Health Savings Accounts)." Agree Expand Medicare to cover everyone. The increase in taxes would be offset by an elimination of private insurance premiums. 27285 07/19/06 NE Agree Including coverage for families who are caretakers for adults with developmental disabilities/intellectual disabilities from being de facto medical financial supplements for adult children with disabilities who live at home. Agree With national health care database to protect migrant workers or natural/aggression event refugees. Agree "The counselng profession provides quality, time limited and effective care on par with psychology and social work but with unique approaches that stress developement and wellness. TRICARE does not allow for counselors to practice independently like social workers, and Medicare does not directly reimburse counselors like they do for social workers despite being economical and demonstrating a significant need for more mental health workers. " Agree "The counselng profession provides quality, time limited and effective care on par with psychology and social work but with unique approaches that stress developement and wellness. Medicare does not directly reimburse counselors like they do for social workers despite being economical and demonstrating a significant need for more mental health workers. " Agree "With parity between physical and mental health coverage for deductables, copays, and lenght of coverage." Agree "Managed care does not appear to be reining in costs - they are spiriling out of control. The over reliance and promotion of medicine rather than therapy (both physial, and mental) must be addressed. Not all medicine is bad - most are good, but paying for therapy (physical and mental) can save money. " I particularly agree with the wellness focus and the parity for mental and physical health. I'd like to have results and updates from this project as well as suggested times to contact representatives and senators to promote this project. 27287 07/19/06 MI Agree "* I have friends and direct family members who have been hit heavy by medical bills or worse yet, no medical help at all - unable to even purchase much needed prescription medications that can keep them working and productive in our society. Please make health care and medications affordable and accessible for all of our United States sisters and brothers, mothers and fathers, grandparents, aunts and uncles, war heroes and courageous firefighters, police officers and other civil service workers! Do what is right. Provide affordable, accessible healthcare for each and every one. " Agree I refer to my comments above. Agree "Health educators are often the first to go when budget gets tight. This is a stupid move - it is only in PREVENTION and EDUCATION that we can slow and even turn around the rising health care issues that hurt our loved ones. Take action - spare words; just DO IT because it is the ""right thing to do."" " Agree See my comments above. Agree "Spare the words - take action! JUST DO IT because it is the ""right thing to do.""" Agree I agree on this one but would want to be very careful not to get dooped into some private-pay agency that can take advantage of the system and steal hard-earned money from the masses. 27288 07/19/06 CA Agree Especially for children. Working adults need protection to keep them working and providing for their children. Agree Agree "Lately, it seems that health care quality is going down for both insured and uninsured. " Agree Agree Absolutely - should be a right not a priviledge Agree "Should be some way for all to share the cost, employee benefits, government programs, personal cost - all have a stake in keeping folks healthy. Prevention should be funded and rewarded more." 27290 07/19/06 CA Disagree "* It should be public policy that all Americans have affordable health care… Financial assistance will be available to those who need it. I favor a national health program which: 1) is financed by tax payers, in which all Americans would get their health insurance (as supported by 72.2% of respondents to the CHCWG online poll) 2) has minimal premiums, co-pays, or deductibles, graduated according to income and therefore making financial assistance unnecessary 3) will take effect by 2012. " Agree Disagree The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to overhead and profit and replacing them with a single insurer like Medicare with only 2-3% overhead. Disagree "I believe that only public programs can and will give us what we need. As soon as the profit motive gets involved, the profit has to come from the existing monies and the public loses." Agree Disagree The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to overhead and profit and replacing them with a single insurer like Medicare with only 2-3% overhead. "The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to overhead and profit and replacing them with a single insurer like Medicare with only 2-3% overhead. A benefit package should cover all treatments deemed medically necessary by an individual’s health care providers to address physical, mental and dental health. " "I believe a sinjgle-payer healthplan, similar to the other industrialized countries, is the most efficient and cost-effective way to cover all the people in the country." 27291 07/19/06 MA Agree I do not agree that privatized health care accounts and high-deductible health plans will fix America’s health care crisis. I and my children are healthy. Paying $800 for a family plan is outrageous. I can not afford the price of health insurance. Affordable health insurance for all Americans should be a right not a high priced option. Agree Community health networks should be funded by the federal government. Prescription should be included in the funding. Drug costs in other countries are affordable. Why not here? Agree Community Health Centers are great but there is no affordable way to get the medication that has been prescribed. Agree End of life services should be avaiable or the cost will be transfered using nursing home facilities (at higher costs)instead of keeping our elderly at home where they belong. Agree No one should have to choose between health care or food and lodging. Agree "If other countries, that are less financially stable, can have health care for all then the USA should be able to get the job done." The core health services seem to be very accurate and fair. "I am hopefull that people will do the right thing. If everyone paid into the same fund then the well would finance the sick, the rich finance the poor and everyone will be in great shape. Sacrifice for the greater good of all mankind. I thought that is what America stood for (equallity for all)." 27292 07/19/06 MN Agree Agree Agree Agree Agree Agree 27293 07/19/06 NY Agree "however i have a problem with ""ALL"" Americans. Perhaps a more effective term would be all ""Working Americans and their familes."" I question the value of including every American in such a program. Have any parameters been established as to who will qualify and how it will be paid for? " Agree No response "does the term ""evidence-based best practices"" include alternattive and complementary practices?" Agree Disagree "it is difficult to agree with such a statement with out understanding how this type of system is going to work... don't get me wrong, i firmly believe that an affordable health care system is a must however terminology such as ""a health care system where everyone participates regardless of financial resources or health status"" doesn't add up." No response this section is rather convoluted... difficult to understand. i agree and disagree... see comments above. 27294 07/19/06 CA Agree Agree I also would like to see a waiver for faith-based community clinics to be able to qualify for FQHC status and still maintain their own governing boards without requiring the board be composed of 51% users. Agree Right now our health care delivery system is very fragmented and there are many gaps. We need to integration wherever possible. Agree Hospice care also needs to be emphasized and physicians encouraged to use the s ervice more readily. Too often hospice is not accessed on a timely basis. Agree It is a national disgrace that we don't have a system that affords all Americans access to affordable health care. Agree I agree with the above recommendations. We will need to make some tough decisions that will impact the insurance and pharaceutical industries who profit form our present system. I agree with the establishing core benefits; we must realize that we must establish limits since our resources are not unlimited. This is a very important issue that must be addressed. 27295 07/19/06 FL Agree Agree Agree Agree Agree Agree 27296 07/19/06 OR No response "* First, I'm writing this in the context of having seen the one minute video intro which I must say is ridiculously patronizing as if the readers are oblivious to how such projects as this channel and coopt grass roots energy for change by presuming the good faith of the ""president"" or congress. E.g., one sentence in other introductory material references the Secretary of HHS but without alluding to the historical fiduciary relationships between cabinet posts and industry. Give me a break!!! If the prelude to this survey presupposes respondents naivete I can only assume that when you make such a grand statement as ""No one in America should be impoverished..."", that your recommendations are going to be interpreted as substantive less by senators and congress people and the industries of the medical/industrial complex they represent...long ago. Up to 20 of the GNP goes through the healthcare sector. Without addressing the capital imperative of such investment upfront, I just don't believe you are seriou" No response No response "* Fantasy land! So called ""empirically supported"" treatments are severely compromised by big money. The NEJM, e.g., published an investigation into the fiduciary relationships of the authors of 70 different studies on calcium channel blockers. Researhers paid by the manufacturer of a particular drug rated that drug favorably at about a 3 to 1 ratio over the researchers not paid by the manufacturer. That's not an aberation but supported by many other studies. The influence of money is pervasive and merly waving the flag of science (like the caveat for ""evidence-based"") will sufficiently protect consumers. Just a few months ago a JAMA article reviewed 15 years of the most frequently cited ""orthodox"" treatments (only using major journals) and found that in just 15 years a significant % were overturned in subsequent research and only 24% remained unchallenged. Read e.g., the ""The Private Regulation Of American Health Care. M.E. Sharpe Inc. Armonk, NY 1994 by Betty Leyerle to be informed/reminded of the a" No response No response "* How about national healthcare? Can you say Nationalized medicine? Eliminate insurers. See how simple that was. The notion that government is less efficient just doesn't hold up to empirical inquiry. The University of Michigan's studies a few years back showed consumers rated corporations roughly equal with goervnement agencies, including the IRS. Further, some managed care companies were actually flying patients to England for heart by-pass operations because it was cheaper for the insurer. Further, recent studies showed how the Enlgish and Canadians were jsut as healthy or moreso on much less money. How about The Federal Government will pay all providers directly. Put insurers on notice--they failed!" No response 27299 07/19/06 NY Agree Agree Agree Agree Agree Agree 27301 07/19/06 TX Agree Agree Agree Agree Agree Agree 27302 07/19/06 WA Agree "Any health plan should include all citizens, including Senators and Representatives, if it is to be truly fair to all and to insure that Congress will work toward that fair and equitable plan." Agree Agree Agree Agree "I say again, ""everyone participates"", including Congress and other government employees, up to and including the President." Agree "If we are 'all' going to be paying, then all medical expenses should be grouped with all those other tax deductions, instead of holding it to above 7.5%. If 'all' will not be paying, then it should be those who can afford to pay that pay, and they should still be all deductible. That's basically the way it is now, except for the deductions part, and the fact that not all are taken care of." "We must make sure that all treatments are judged on their own merits by a diverse group, not all medical doctors, who tend to poo poo other types of treatment. Granted it doesn't happen as much these days as it did in the past." 27303 07/19/06 FL Agree "fixed low copays, no deductables, low cost medications,fixed health care cost locked in for a set number of years.go to any doctor, no referals needed.and most of all good quality low cost dental plans. " Agree Agree Agree Agree Agree see above comments. 27304 07/19/06 MI Agree And no age profiling other then by patient's physician Disagree Its just another expensive layer with less going to the caregivers and facilities that actualy provide the care Agree "This recommendation does not go far enough! We need to collapse all the Federally funded healthcae programs(including the wasteful verteran program that no one uses, as stated by most Vets) into one main program eliminating all the redundancies in administration and high cost facilities. With the savings in administrative cost alone you can fund coverage for all Americans without raising taxes!!!!Some times the best solutions are the most obvious!!!!" Agree This is already done to some extent. Agree This can be funded from the savings incurred from collasping all Federaly funded healthcare plans into one and eliminating the cost of redundant administration. Agree This can be funded from the savings incurred from collasping all Federaly funded healthcare plans into one and eliminating the cost of redundant administration. A wellnes plan will offer a return on investment of 3 dollars for every one dollar spent...its just good policy! As a 27 year healthcare executive and a recently elected county commissioner...I like bringing solutions to the table. Call me at 248 280 2020 27305 07/20/06 TX Agree Agree Agree No response Agree Agree 27306 07/20/06 TX Agree I strongly agree! Agree Agree Agree Agree "I wholeheartedly agree. I know too many people who have inadequate health care. Although most everyone can pay something, the high cost of care means that ""something"" is not enough. If you can't pay the whole cost, and don't have insurance, you can get emergency care, but not regular, health maintenance care. " Agree "Definition of ""Health"" should also include vision and hearing (it isn't clear from the text above). " "I would like to see a system that treats all citizens fairly and respects their dignity. Not a system that treats the poor like cattle (ie the old welfare system), with long waits and lack of respect for people who need the services. Think of how you want YOUR family to be treated, then apply that standard of care to everyone. " 27309 07/20/06 MO Agree No response No response No response Agree No response "I think when the last spouse expires, that some portion of the single or couple's last 5 years of medicare expenses should be paid depending upon the size of their estate, i.e. say they pay 50% of their bills up to 50% of their estate value so say a couple used 300,000 of medicare benefits and had an estate of 500,000 dollars, then they would pay back 250,000 to the government. " 27310 07/20/06 WV Agree Agree Agree Agree Agree Agree 27311 07/20/06 AR Agree No response Agree No response Agree No response 27312 07/20/06 NC No response Agree No response No response No response No response 27313 07/20/06 NJ Agree Agree Agree Agree Agree Agree "* While each recommendation is laudable by itself, one is left with the impression that implementing them all is likely just to add to the uncoordinated, unintegrated, unwieldy, expensive patchwork that is our current system. To make this work, we need an overarching recommendation for a FUNDAMENTALLY REORGANIZED system at the national level to administer a variety of programs in a transparent and efficient way. We need a vision for a UNIFIED SYSTEM, not just more and more programs and agencies that should be integrated but are not. Without such a unifying vision, I fear that these recommendations will go nowhere, or may get pulled apart into little pieces until they are unrecognizable and can make only incremental change--not the fundamental change we are looking for. " 27314 07/20/06 OH Agree "I pay high insurance premiums now, and have poor health care, because the out of pocket expenses are also too much. Basically I'm paying high premiums for catastrophic insurance. The government could not do worse than what the insurance companies are doing now. If we had Universal Health Care, I would feel our tax dollars were being spent wisely." Agree Agree Agree Agree Agree "I pay high insurance premiums now, and have poor health care, because the out of pocket expenses are also too much. Basically I'm paying high premiums for catastrophic insurance. The government could not do worse than what the insurance companies are doing now. If we had Universal Health Care, I would feel our tax dollars were being spent wisely." 27325 07/20/06 IN Agree Agree Agree Agree Agree Agree 27333 07/20/06 LA Agree There must be universal coverage not dependent on employer payments. Agree "I agree subject to the warning that the government must be held accountable for its work. At present federal government has been shown to be incompetent, inept and inefficient as well as corrupt." Agree These programs must be integrated! Agree THis should include stem cell research. It is wrong for one man to hold veto power over the wishes of the citizens. Agree Every civilized country has universal coverage. So should we. Agree Healthcare can not be distributed as a profit making venture. It is this that has made our system inefficient and not patient focused or service focused. Hospitals must be non-profit entities and doctors are way over paid and have a vested financial interest in the sytem that does not serve the publlic good. 27334 07/20/06 MI Agree "I don't understand why healthcare is so expensive. It seems like it goes up on a daily basis. We need to reign in the healthcare costs. In two years, My husband and I will not have any health insurance. I already told my husband that if I get really sick to just let me die. I've spent too much of my life worrying about money." No response No response No response No response No response "I had a good part time job working in a library, then my husband's employer, Steelcase decided if spouses worked that they had to get their own insurance. My employer did not provide insurance but I could buy into a group policy that was so expensive that it wasn't worth working. I really miss working and the income. I was able to help my children who are all struggling because of the high cost of living." 27336 07/20/06 TX Agree "* Everyone should have access to quality health care and not be forced to decide between food and health care regardless of race, creed, age, sex, etcetera. National Insurance is the one way to go, but how do you replace the current health insurance system that generates jobs, tax dollars and millions of hours of frustrating paper work for all health care providers? How do you provide coverage for all when we have people wandering the streets who are foraging from dumpsters and illegals hiding in the shadows? How do you convince me that increasing my tax dollars to initiate these recommendations will decrease my out of pocket costs? I am a retired military health care worker, currently employed in civilian health care. It is difficult for me to navigate the system to get the health care I need, much less recommend a pathway for others. We have to do something. Do we select/elect/call for volunteer communities to act as pilot projects? Where do we begin?" No response No response No response No response Agree "This will be a tough one. How will you introduce this process into the current health care system, if you do determine a core of health care services? " "A lot of people make a living because our current health care system is so unwieldy. Resistance is to be expected, but there are going to be saboteurs waiting in the wings to dismantle this project and schemers waiting to take advantage of any flaw for their own financial gain. What safeguards/penalties for gaming the system will you put in place? " 27340 07/20/06 NY Agree "need to streamline, non-profitize , and to work toward accesible care for all" Agree "with provision that this be the system used by all , no segregrated services" No response No response Agree yes Agree "remove excess middle moves and profit, no place for it in health care" yes "please make it happen, we've waited far too long, people are suffering, we're allowing our own tragedy" 27344 07/20/06 OR No response PLEASE SEE COMMENTS UNDER FINANCING. THANK YOU! No response No response No response No response No response "* Dear Citizens' Health Care Working Group, First, I want to thank you for working on this crucial subject. I do not totally disagree with your recommendations, but I believe an important issue has been left out, which is that of reducing health care costs (prices). Making health care affordable for all needs to involve not only new financing options, but also a reduction in the prices of services and medications. A surgery that takes a few hours should not equal what many people are paid in two years of full time employment; a doctor's appointment that takes a few minutes should not equal what many people are paid in a day of full time work; a single pill should not equal what many people are paid in half a day. The disconnect between health care costs and what the average citizen earns is probably (ironically) due to the existence of health insurance, which creates a sort of unreal economy. It leaves uninsured John Doe subjected to costs that no John Doe could ever pay, but which Blue Cross can." 27349 07/20/06 TX Agree "My 94 yer old mother is in a race between her money for healthcare and her health. The Enron debacle stripped her of much of the fund she had set aside to support her in her declining years. Her parallyzing stroke four years ago forced her to rely on paid help to allow her to live at home. A short stint in a nursing home almost killed her because of untrained, indifferent staff. She shouldn't have to sell her small home to pay for a nursing home just to live a terrible life at the hands of cruel people." Agree No response "* My mother suffers from well-meaning but innept in-home health care that is paid for by Medicare funds. The agency apparently is more interested in lining their own pockets than in providing actual services. For all I can tell, though, the system has played into their hands by mandating certain services whether the client needs them or not, and by refusing to offer other services unless the claim is vetted by each of a host of ""authorities"" who have no direct kinowledge of the situation. Each step of the process puts more money into the hands of the provider without giving any benefit to the client. In our case. A CNA ""caregiver"" comes into the home ""twice"" a week to bathe my mother. She takes P & Rs on each visit, but an LVN has to oversee her. An NR needs to oversee the CNA and the LVN. The result is a revolving door of people from the agency who wake my mother, or disturbe her meals, and distract me, the real caregiver, from being able to help my mother. You need an advisory pannel made up of real peopl" Agree "The two nursing homes in which my mother found herself are neither worse nor better than they were when she worked as an RN in one forty years ago when regulations were few. Just like public schools, nursing homes should answer to a review board comprised of a mixed bag of LOCAL people." Agree "After serving in the Army in England during the bombing, and after a career of working in the most dificult of VA hospitals, a TB ward, my mother should not be stripped of all her dignity and money by a system full of graft and apathy. " No response 27364 07/20/06 ME Agree The system is broken. We need a step-by-step plan that will provide us with the health coverage infastructure we've failed to build in this country. Agree Disagree "a focus on a consumer model that sees health care as a commodity is in conflict with a single-payer, universal system, which I support. this sounds like politics as usual with potentially negative consequences on vulnerable populations" Agree Agree Agree "univeral, single-payer. Medicare works and is efficient. Let the rest of us in on that kind of model" 27368 07/20/06 WA Agree "We need a single payer healthcare system. We should have had it 60 years ago! Consequently, we have the highest healthcare cost (15% of Gross Domestic Product)& the poorest coverage (40 million uninsured)of any industrialized nation! Enough already, let's join the other modern nations with a single payer system!" No response I'm dubious! No response WE can reduce administrative costs dramatically with a single payer system! No response Agree A health tax should be deducted from paychecks like the income & FICA taxes are. Agree "Check the European, Canadian & Japanese financing methods. We may not need to reinvent the wheel!" See what other industried nations have done! We're 60 years late! Let's get it done now! 27370 07/20/06 IL Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! Agree I agree there should be coverage for all legal American citizens... The key word here is legal!!! I agree there should be coverage for all legal American citizens... The key word here is legal!!! 27371 07/20/06 CA Disagree The only kind of program that will truly work is one that is completely public. I do not support any plan that involves private insurers. We need Universal Public Healthcare! Disagree "The recommendation keeps referring to public/private networks - the only kind of program that will eliminate price gouging insurance companies is one that is completely PUBLIC, not private!" Agree Disagree "Eliminate all private programs and create Universal Public Heathcare - like Medicare, which uses only 2% of its funds to cover the cost of bureaucracy. Private insurers use more than 30% of their funds for this - monies that could be better used to pay for actual healthcare" Agree Agree "The system should be financed via wealth and corporate taxes. If every American paid 3% of their incomes and every corporation double that, most Americans would be paying far less than they're paying now, and everyone would have excellent, comprehensive Healthcare! " 27372 07/20/06 AZ Agree "* The disconnect is that the $17,000 per capita for all americans spent into the system does not relate to the best estimates of $ 6000 per capita paid to all health care providers including Doctors, Hospitals, Dentists, Clinics, Chiropracters, Accupuncturists and all other providers. Its about time we forced the heavy handed, for profit, greedy healthcare insurers to come clean and take away their license to steal!!! From Tenet,Cigna, United Health Care, etc. Just a few non-profit (sic) blue Cross/ Blue Shields are being sued by New York, Pennsylvania, New Jesey for Billions of dollars in excess reserves because they do not want to reduce their rates because it will make them too competitive. This stink looks worse than Enron!!!!" Disagree The private are too rapacious and corrupt. They will screw up the works and so confuse the issue that nothing will be gained!!! Agree Sounds good! Now who is going to guard the hen-house? George Bush!!! Ken Lay is dead. How about Skilling or even the current head of Homeland Security or even that fathead from Pennsylvania. Agree Is this a problem? How about those 46% of our population who have no health care. Agree That sounds simple! How about a Single Payer National Health Insurance System????? That and a National Pension Plan!!!! Disagree "WE are already paying more than four times what it costs Canada, Britan, France, Germany, Japan and every other Industrial Country. They all have National Singe Payer Healthcare systems and non of them are paying $17,000 per capita. They are all around $ 4000-5000 per year per person, but they are inefficient beaurecratic government systems. They do however cover everyone, not just the eletes. " "What an oxymoron ""non-partisan private-public group""> Who are you kidding!!!!" "I cannot swear to it, but this sounds like one of those Pharmacutical/Health Insurance inductry scams! " 27373 07/20/06 MN Agree Agree Agree Agree Agree Agree 27375 07/20/06 TX Agree The government needs to mandate that employers provide health insurance to their employees as would have been the case with the Clinton Health Plan. The lack of health insurance of 46 million Americans is a testament to the corruption of Congress. Agree Government works best for Americans when the Private Sector is well regulated by the Public Sector. Agree Pharmacutical prices should be regulated based on the cost of manufacture with a reasonable profit discounting marketing expenses. Agree Agree To do otherwise is criminal. Agree An Income tax surcharge would be the fairest financing method. "A commission of members should be elected, one from each state." 27376 07/20/06 CA Agree "Yes, everyone should have access to quality, affordable healthcare - based on income. The wealthy must share with the low income individuals and families. No one should go bankrupt because they get sick - two problems at once! Oh, No! Sick and broke!" Disagree "Single payer -- everyone gets healthcare, equal quality and access and pays according to income. None of this piecemeal stuff -- for vulnerable populations." Disagree "The VA provides a good model for fair and equitable national healthcare, bulk buying of drugs etc. Medicare also shows the savings that can be made when all the billing is done through one office - rather than multiple HMO's submitting bills, reduction of cost can be from 4% by-not-for-profit like Kaiser, compared to 25% for billing and administrative costs for Blue Cross and other HMO's." Agree Of course people deserve to be taken care of compassionately through the entire span of their life from birth to death within a single payer system. Agree Right on! Agree American's healthcare should not be sold on the stock market. Eliminate the for-profit HMO's with their exorbitant CEO salaries and shareholder profits and wasteful administrative costs. Enough of them telling doctors who and how they can treat a patient. A person's healthcare must not be a HMO administrator's decision. yes. "We must institute a healthcare system that provides quality, affordable care for every American at a fairly shared cost per income, or lack there of, ensuring that people who change jobs do not lose their health insurance, leveling the playing field for business. This will stop the current hemmoraging of our economy because of exorbitant healthcare costs. " 27378 07/20/06 VT Agree "Health care should be affordable for everyone and without high deductibles. Deductibles should be applied on the basis of individuals ability to pay, not so high as to, effectively, make health care coverage excess insurance." Agree Sick people should not have to go to emergency rooms of hospitals to receive care. Agree Veterans health care through the Veterans Administration should be available to all veterans that apply without stalling tactics and long delays. Agree Agree "Health care is a right, not a privelege for those that can afford it." Disagree Presently there is a lot of wasted money in the administration of health care insurance coverage. Each insurer has their own staff to determine benefits and administer coverage. This represents a huge and costly duplication of efforts that is driving up helath care costs without proviing any care. Health care should be available to the level determined as needed by individuals' personal physicians. 27381 07/21/06 AK Agree Agree Agree Agree Agree Agree 27382 07/21/06 FL Agree Agree Agree Agree Agree Agree 27383 07/21/06 FL Agree Agree Agree Agree Agree Agree 27389 07/21/06 NY Agree "* I have personally experienced the shift of the financial burden to the employee. I am a Union member that works for Constellation Energy in Upstate New York and we just ratified a new contract that increases health care costs from about 12% to 30% in the next 5 years to the worker. There was no cap placed on these costs and I fear that with rising health care costs, this new ""shared"" responsibility will severely diminish my Cost of Living raises and will further erode monies that are available to spend that keeps the economy strong. Therefore, I am in favor of financial protection for everyone." Agree Agree Agree Agree Agree "Since employers like mine are following the path of shifting financial burden to employees to provide the all mighty dollar to the stock dividend and not taking care of the employees that work diligently to creat the corporate welath, we must ensure that large corporations like these are contributing their fair share to the new community health care system by using the existing Federal Medical Tax. Increase their share while not placing more burden on the employee." 27400 07/21/06 TX Agree "...life, liberty, and the pursuit of happiness If this applies to all Americans, then the health all Americans should be ensured and protected in order to have the opportunity to live, be free, and be happy." Agree Agree Special emphasis on bullets 4 & 5 Agree Agree See recommendation #1 above Agree 27403 07/21/06 NY Agree "* Regarding the “immediate protection for the most vulnerable” noted in the heading to this section. This point, although well intended, is contradictory. The “most vulnerable populations” are the working poor, women, disabled and racial and ethnic minorities whose incomes are not low enough to qualify for Medicaid. If we cover these people now, as the interim report recommends, we will all but correct the inadequacies in the health care access and delivery system. This means some form of universal health care will need to be in place, not by 2012, but right away. However, if 2012 must be the overall deadline with some portion of “the most vulnerable” aided immediately, then incremental actions to drastically improve preventive health care delivery to cover more at risk populations, through pharmaceutical bulk purchasing, employer mandates or expansion of Medicare, ought to be a priority now." Disagree I am concerned that too much emphasis on one size fits all “best practices” and tightly governmentally controlled public/private partnerships can unduly restrict consumer choice and adversely impact the flexibility needed to support the provider/patient relationship. Disagree Must allow consumer choice of providers in their community and allow these providers to have maximum latitude to help devise a quality of care regime best suited to patient comfort that does not hamper physician ability to render the best diagnostic and treatment plan. The spirit of Recommendation #6 needs to exist seamlessly throughout the continuum of health care access and delivery and not just at the end of life. Disagree Must allow consumer choice of providers in their community and allow these providers to have maximum latitude to help devise a quality of care regime best suited to patient comfort that does not hamper physician ability to render the best diagnostic and treatment plan. The spirit of Recommendation #6 needs to exist seamlessly throughout the continuum of health care access and delivery and not just at the end of life. Agree "* However, there is no practical reason the American public needs to wait until 2012 for affordable and accessible health care coverage for all. The United States has the resources (evidenced by the fact we can mobilize massive capital to wage global war in matter of months and sustain excessive follow up funding thereafter) and ideas (see Congressman Conyers’ bill HR676, for example) sufficient to make this happen by 2007. What we lack is the political will. The 2012 date reflects this obstacle. Frankly, whether it’s 2007 or 2012, as long as pharmaceuticals and big money corporate health care providers are able to buy off public policy with big campaign cash, politicians will not be persuaded to solve this problem in any way short of the failed incrementalism that has plagued this issue since President Nixon recommended similar changes in 1970. The substantial efforts of this working group can only be implemented with a commitment to Clean Money, Clean Elections campaign finance reform. " Agree "* There is no practical reason the American public needs to wait until 2012 for affordable and accessible health care coverage for all. The United States has the resources (evidenced by the fact we can mobilize massive capital to wage global war in matter of months and sustain excessive follow up funding thereafter) and ideas (see Congressman Conyers’ bill HR676, for example) sufficient to make this happen by 2007. What we lack is the political will. The 2012 date reflects this obstacle. Frankly, whether it’s 2007 or 2012, as long as pharmaceuticals and big money corporate health care providers are able to buy off public policy with big campaign cash, politicians will not be persuaded to solve this problem in any way short of the failed incrementalism that has plagued this issue since President Nixon recommended similar changes in 1970. The substantial efforts of this working group can only be implemented with a commitment to Clean Money, Clean Elections campaign finance reform. " "* Phrases like “dedicated revenue streams” in our fractious political climate are buzz words for more of the same regressive taxation used to avoid having to directly address the inequities in the current health care delivery system. Such “revenue streams” place an excessive burden on the populations reform is designed to assist, while ignoring the bloated and excessive private sector bureaucracies and the anti-democratic campaign financing feeding the current failed system. What we need from OUR legislative leaders is not another incremental approach, but the most beneficial method for equalizing the excesses of the current system and the overall costs to the consumer. Although the process of conversion from our current health care access and delivery system to “universal coverage” will take time, it will not take 6 years and it will not take “multiple financing resources.” See comments at Recommendation 1 above. NB: A far shorter and simpler time frame and more transparent funding " "* This electronic comment form does not correspond with the order and format of the interim report as it appears on the web site. In addition, certain recommendations are split on this electronic form while they are integrated as a whole on the interim report. Overall, the manner of presentation here causes many confusing and unnecesarily complicated issues should someone, like me, bother to read the interim report before taking the time to comment. The issue of affordable and accessible health care is a complicated one. To comment in a manner that will be of benefit takes time to think through before commenting. To have such poor coordination between the actual format of the interim rport and this form makes it even more complicated. " 27409 07/21/06 OH Agree "Universal health care is implied in the established rights to lie, liberty, and the pursuit of happiness." Agree "If there are safeguards to control bureaucracy and the resultant diversion of program money to unintended pockets, the FQHC idea may be a good way to ensure good quality medical care to all. " Agree "Excellent, essential recommendations." Agree "As a former caregiver (family), I know how important the second recommendation is." Agree Agree "A Frebch citizen told me that her country levies a uniform 25% income tax, with which the government provides universal health care, education, infrastructure maintenance and other services. Why not learn what we can from this model?" 27413 07/21/06 FL Agree "* This coverage should be independent of employment so that the American working class no longer feel imprisoned to an employer they can't stand. Instead, every American should have equal coverage, but every employer should be made to participate in reimbursing the national government for part of the cost of national healthcare, especially if the nature of the employment raises the risk of exposure to health related problems (such as mining, chemical industries, nursing, firefighting, etc). I feel it is also justified to tax Americans for healthcare coverage based on their income. I don't believe that illegal immigrants should be entitled to the same benefits as tax-paying Americans." Agree "The government must get a grasp around the illegal immigrant population, this country cannot afford to fund the healthcare of our own poor and that of half the population of nearby 3rd world countries." Agree "* Please, please bear in mind that controlling costs and patient safety do not always go hand in hand. While the government today strives to cut reimbursement to hospitals even more, hospitals must cut corners to break even. This often means fewer care providers in relation to census. Meanwhile, agencies such as JCAHO and ACHA keep adding initiatives and standards and core measures to improve patient care and safety. These are lofty goals but how do they expect the hospitals to accomplish this while getting so few dollars in reimbursement? It's a wonder there are any nurses left at the bedside today, and no wonder why so many are leaving the profession. It takes money to run a good hospital. And forcing smaller hospitals to join a conglomerate in order to survive is not always good for the community they serve." Agree "Recently having had exposure to Hospice Care I feel that they are probably receiving sufficient funding to provide the needed care, and they do it with all the kindness of God Himself. What is lacking however, is the community awareness of this invaluable service and the physician reluctance to approach families regarding Hospice care or even to discuss with the family that the patient is terminal." Agree "Yes, yes, yes, this is it! Especially for America's working class, both employed and self employed." Agree "* 1. Establish a Health Hazard Tax for manufacturers of products that potentially harm the health of Americans, such as Cigarette manufacturers, junk food companies, mining companies, polluting industries, etc. 2. Every taxpayer should be a paticipant contributor in some fashion. 3. Every employer (with > 25 employees) or corporation should participate in contributions. 4. Maybe there should be some type of penalty tax for non compliant individuals...such as those who smoke or are morbidly obese and are offered a cost-free plan to help them quit/reduce but refuse to participate thereby potentially increasing the cost of the healthcare burden for all Americans. (I am not being cinical, as I am morbidly obese)" "Too little is done today in the area of ""prevention"" except for certain disorders. For example, insurers will not pay for baseline routine colonoscopy. There must be a reason such as rectal bleeding,for many it's too late by then. Insurers won't pay a gym membership for the obese to reduce, but then will pay for cardiac rehab AFTER a heart attack. We talk preventative services in this country but do not exercise it!" Haven't I said enough already! FYI; I am a 54 year old RN. 27422 07/21/06 FL Agree Set insurance policies coverage based on the accepted standards of care and update these standards anually. Restrict or regulate high tech high cost proceedures. Agree Maintaining an openness and flexablitiy in the federal and state run plans that insure patient and provider common sence practices. Return access to care as a primnary way to restore the system. End managed care and its bloated buerocratic nonsence. Deny acess to managed care. Agree Evidence based practices may leave some people out of the treatment they need to fullly benefit from care. They are to limited and must have built in exception to the rule coverage to work effectively. Agree Yes end of life care should definatly be funded by government. After all we pay alot of taxes our whole lifes. Give us dignity at our death. Agree True. There is no reason the cost of haelth care should be so high. who can pay there life savings for 2 weeks in the hopital? That is out of control. Regulator cost controls for hosital services are needed. Agree You may find that regulation of high end health care costs is the best place to reduce cost. Many high tech high cost proceedures need to be highly regulated as well. Many of todays health issues are related to dietary and lifestyle choices people make for themselves. Health conditions that are related to these issues should be in a share the cost catagory. If they dont help themselves they should not be rewarded by the system either. Make excersice and nutrition National icons. Make a healthy lifestyle the norm not the health nut. That is what will make the biggest impact. Correct the cause. Common sence. "yes, Reward low cost effective treatment choices and make high cost health services harder to fund. Low tech low cost services like chiropractic are addressing acute and chronic musculoskeltal and arthric conditions related to aging managable at a low cost. This is the direction we need to go for the aging population because these services will be a big plus to the system." 27425 07/21/06 CT Agree "THIS IS NOT STRONG ENOUGH. THERE SHOULD BE A SINGLE PAYOR SYSTEM THAT COVERS EVERYONE EQUALLY, COVERED BY FEDERAL INCOME TAXES AND ADMINISTERED THROUGH REGIONAL AGENCIES. " Disagree THIS IS TEMPORIZING AT THE EXPENSE OF RISING COSTS AND PIECEMEAL SOLUTIONS. A SINGLE PAYOR SYSTEM WILL MORE RAPIDLY DECREASE COSTS NATIONALLY WHILE PROVDING CARE FOR EVERYONE WITH QUALITY OF CARE SET AT A UNIFORM STANDARD FOR EVERYONE. Agree Disagree A SINGLE PAYOR SYSTEM WOULD INCLUDE THESE WITHOUT THE REDUNDANCY OF PUBLIC PLUS PRIVATE AGENCY OVERHEAD. Disagree NOT JUST A CORE SET OF HEALTHCARE SERVICES - THE IDENTICAL SET OF SERVICES FOR ALL. Disagree FINANCIAL SHOULD COME FROM INCREASED (GRADUATED) INCOME TAX PLUS EMPLOYERS' TAXES IN LIEU OF EMPLOYERS' PAYMENTS TO INSURERS. SEE PREVIOUS COMMENTS Postponing the transition to a single payor system that provides standard universal coverage loses funds that could be saved by eliminating the redendancy of the mixed private/public system. It delays access to full services to those who now have poor or no care. 27426 07/21/06 VA Agree Agree Agree Agree Agree Agree 27427 07/21/06 MN Agree Agree Agree Agree Agree Agree 27434 07/22/06 IL Agree Agree Agree Agree Agree "This is critical, and I believe that affordable core health care should be based on citizenship, not on employment." Agree I believe that core health care services should be paid for by the federal government through taxes on all American's. "This is clearly critical given the need for an affordable, yet comprehensive system. Such a system, and its financing, should be structured in such a way that it promotes personal responsibility in wellness, but still provides health care for all and allows individual choices in providers." 27439 07/22/06 NY Agree Agree Agree Agree Agree Agree 27440 07/22/06 NY Agree Agree Agree Agree Agree Agree 27441 07/22/06 CA Agree "Since we already have a single-payer system set up for those 65 and over which functions very effeciently with minimal administrative costs, we should just extend this program downward to cover everybody! I cannot understand why our business/industry sector is not the loudest voice for such a change when they say that rising health care costs are causing outsoucing, offshoring, downsizing. etc." No response No response No response No response No response 27443 07/22/06 NJ Agree Agree Agree Agree Agree Agree "Set up a single NON-PROFIT organization to handle health care. Yes, I SUPPORT NATIONAL HEALTH INSURANCE. Eliminate for-profit corporations from the system, thereby cutting the costs tremendously!" 27446 07/23/06 WA Agree Every American deserves a complete health care package. If the Senate and House of Representatives can have coverage so can all Americans regardless of their income. Health care is an issue that can not be ignored. Agree Agree Agree Agree Agree I think that all revenue streams should be used to some degree to finance the health care for all Americans 27447 07/23/06 WA Agree I have recently been laid off & the cobra cost for just myself is $324.61.If I had dependents it would be $730.90 a month.This is ridiculous then there is the deductible & 20% copayment. Agree Agree Agree Agree Agree 27448 07/23/06 MI No response No response No response No response No response Agree "* I work closely with someone who has says she has mcs. Investigating this, i found no scientific consensus on whether it even exists, much less how it is best treated. This person is relatively low income, though above poverty level, and cannot afford much of the treatment she would like. However, in reviewing literature i have found many of those ""treatments"" to be questionable. I have to wonder how realistic it is to determine, given significant polarization here, on whether this would be included in the ""core health services"". Yet your recommendation, in general at least, seems the best way to go about making this and similar determinations." "A lot of health issues integrate with larger issues - social cohesion and interaction, economic inequality, and environmental pollutants are three of those that are particularly important. The recommendations do not address how these issues interface with health care. This, to me, is their most serious shortcoming, though i support all the recommendations in general as far as they go." 27449 07/23/06 FL Agree Disagree It seems that you are still talking about at least two systems. We only need one system for everyone. No response Agree Agree Disagree "* We don't need to wait until 2012 or 2014 to begin a national health care program. Core services and the taxes to fund them can be added in gradually. We already have a system, Medicare, in place, that can be expanded. We already have a bill in congress, HR676. The house and senate could come together beginning a national system now. People are sick and they are dying because they can't access healthcare. These are people with and without ""Insurance"". I find it disgraceful that this working group would even consider debilitating on this until 2012 or 2014." "I think it would be easier to decide on what is not covered. Why not consult with other countries? A core benefit is a service that any person is willing to undergo for the purpose of their health. People don't just go out on a lark and seek irrelevent procedures and put themselves in vulnerable conditions. Get the facts from other countries, not from the guttered minds of the insurance company underwriters." "* My husband died this year at the age of 52 because of an incompetent and inaccessable health care system. I recently testified at a Citizen's Congressional hearing along with many others. These hearings are going on all over the country. I hope you are able to listen to some of these people's stories. I now pay $895 per month insurance premium for family coverage. Additionally I have deductibles and copays. I make about $600.00 per month at my job. My 16 year old son receives about $1,000 monthly as a survivor. He has Juvenile diabetes. I figure I have about 1 year until by life insurance money runs out mostly going to health insurance. During this time I must get myself marketable for a higher paying job with benefits. If I am unsuccessful my family will be out of luck. My son's life will be noticeably shortened without good healthcare. That is the healthcare that is rationed to the poor. Our nation needs to have one system in order for all citizen's to have excellent healthcare. Other countr" 27452 07/23/06 WA Agree Human rights! Agree Agree Agree Agree Agree 27454 07/23/06 CA Agree Agree Agree Agree Agree Agree 27458 07/23/06 CA Agree No-one should ever be bankrupted or have their financial situation threatened by a health care crisis! Agree Integrated heatlh care systems are the way to provide reliable and high quality care for all Americans. Agree (See above). Agree "An unsupportably huge percentage of our health care dollars are spent on fruitless, painful, and often inhumane life-extending care for our elderly. We must re-structure our care to emphasize dignity and observe the wishes of our elderly and their families." Agree "How is that every other developed country in the free world sees health care as social responsibility. How is that we sell it as a commodity, like cars?" Agree "Extend Medi-Care like benefits to all phases of the life cycle--pregnancy through end of life. The scope of care should be regulated and prioritized, with input from stakeholders from consumer groups. economic experts and health professionals." (See my comments above). 27461 07/23/06 PA Agree National health care should be instituted after a careful study of European and Canadian plans and problems and faults ferred out and assets and plus points included to insure the best plan. No response No response No response No response No response 27462 07/23/06 FL Agree "* This would, of necessity, have to be innovative. Practically all of the socialized medical endeavors, spanning more than a century past, have either failed outright, (UK comes to mind) or are now bordering on failure due to the non-consideration of four major factors. 1. The population of any industrialized nation outstrips the money offered to run such a program, because the program failed to consider illegal non-citizens, prison population growth, graft, corruption, fraud, and waste. 2. changes in governmental attitude towards the population it controls, in which a subtle conversion from something near democracy changes to an oligarch, or through outright dictatorship takeover. 3. Quite simply that technology advances bring with them new injuries and diseases, both mental and physical, coupled with heretofore unexpected high cost of treatment due to research of new technologies' effects on health. 4. Bureaucratic reversal of the concepts of public servant diligence." Agree "Just fine if you can remove all of the negative factors i postuilated in my answer above. For further comments on the subject, hum ""To dream the impossible dream"" to yourself while looking into the sky for flying pie." Disagree "* Looks good on paper, BUT, past history of such reorganization shows that the intent eventually revereses to penalize the individuals least aboe to withstand the effect. Before the above can even pretned to have a workable concept, some sort of ""no loop-holes"", with stiff penalties for inept controllers must be brought onto the law books, and left there untampered with. The possible outcome of combining all of the above, even in the innocent manner described above would result in great cuts in fundidng for each category, and greater deprivation of individual care than we have today. Such plans fail to take into account the RATE of inflation." Agree Looks great! Long overdue! Where's the money going to come from? Agree "I absolutel;y agree, however, I notice that our congress has been over-generous with our dwindling funds at presnet, by allowing benefits for illegal aliens and various forms of fraud involving non-existant beneficiaries. Before you fix the problems you have brought forth here, you must fix the government, and it will not be fixed. It lacks the corp[orate will to be honest." Disagree "here we go! More money. the money is already ther in abundance,l all a government has to do is to stop fraud, waste and abuse. About half of any goven agencie;'s budget is wasted. civil servants routinely use government funds to augment theinr pay in various weays. Until we find a way to replace theincome tax with something workable, we will also cxontineue t l;ose on that ""front,"" and coroporate law is just a huge giveaway. Why tax us more to gloss over the huge leaks in our revenue picture?" "You will never get a non partisan base for this. we already have such a representation going on in government, it is call ""Congress."" Old ideas won't make any chages. What I se above reminds me of the preamble to a ""Ponzi scheme"" much like social security turned into." "Not really, I think that this may be yet another government spawned racket in the making. Keep me informed of your progress, and tell me how I cna check on that progress from outside of your influence base." 27463 07/23/06 TX Agree "* Currently our two children are enrolled under a children's program, Community Health Insurance Plan (CHIP), because our income meets the current requirements for us to qualify, but this is just a children's program. Insurance for us is a total separate story, we don't make enough to cover a monthly insurance plan for myself or my husband, and we make too much to qualify for medicaid (or medicare - I get them confused), so we fall somewhere inbetween. If a major illness were to befall one of us, our financial security and our family would suffer tremendously. " Agree "It is important to have quality care, especially for families that are a productive part of society. Just because we can't afford a private plan, should not subject us to second rate care, where medicines or proceedure recommendations are not suggested ""because our plan doesn't cover it"". Health should be a priority regardless of income. " Agree Agree Agree Agree 27464 07/24/06 OR Agree "With the degradation of job opportunities, and the loss of protections from environmental hazards it is imperative that health care become a priority for all Americans. Taking care of this problem will boost our economy, and preserve our future work force--today's children." Agree "Providing access to preventive health care as well as the capability of acquiring health care for smaller injuries and illnesses will lower the costs for the American public for health care in general. When people wait until their health concerns are more serious, it costs the public more. All Americans deserve health care. It is part of the Life, Liberty and the Pursuit of Happiness that our forefathers defined in our sacred documents that established our government." Agree All it would take is for our lawmakers to make changes to this program that is already in place to make it apply to the general public--all ages and all the time. No response No response No response "Health care is important to every person in this country. It should not be extended only to those with resources, but be available to every person regardless of race, color, creed, gender or religion." 27467 07/24/06 WI Agree "Health care coverage should be considered a right and not a privilege. We are the wealthiest nation in the world, and we should be able to care for all of our people." No response No response No response No response No response 27469 07/24/06 TX Agree "Ther should also be a protection for families that may not be low income but are facing catstrophic health acre issues, such as cancer treatment, and mental health diagnoses such as Bipolar Disorder, Asperger's Syndrome and Depression" Agree there should be a regional authority to oversee the ability of the health collaboratives to mee the cultural and medical needs of the participants. Every region of the country has specific needs that only that region can fully understand. Agree "This must include mental health issues as well. Parenst who are raising kids with mental health diagnoses and mentaly il parents are at greater rsik for not seeking appropriate care at the earliest possible time, which only increases the costs of treating the disease and decreases the ability to the person to effectively manage their lives. " Agree "tHIS SHOULD INCLUDE GRIEF AND LOSS COUNSELING FOR THE PATIENT AS WELL AS THE FAMILY MEMBERS WHO ARE EFFECTED BY THE DEATH OF THE CLIENT. THE LONGER THE DYING THE PROCESS, THE MORE IMPERTIVE IT BECOMES TO HAVE APPROPRAITE COUNSELING" Agree "Core heath care service should include mental health care in tyhe form of psychiatric visit and therapy visits. To be effective the MD visits should be at least monthly and therapy at least twice a month with family therapy monthly. Substance abuse treatment should also be included with outnpatinet being the prferedd mode, with one 30 day inpatient treatment epidose per year, if client follows up appropriately afterwards." Agree "* the funding should include every demongraphic; even drug dealres buy things! There could be a box on Income Tax Returen like there is for the preseidntial elecetion thing for national health care funds. Each state has some sort of lottery or other ganbling thing that even the porest people participate in. Add a percentage of the take from lottery to the national healthcare fund. Additionally sin taxes are a good way to encourage more healthy lifestyles, but if they have their desired effec, there will be less and less revenue generated from these items. There has to be a back up to that. Those states that have income taxes can designate a percentage for health care funds. " "I support the abose recommendations, howevere, I would caution agaist coverage for such things as VIAGRA, etc. These are extremely expensive drugs with severe side effects and provide no health benefit. " I am an advocate for the poor in the city of San Antonio with particular focus on children's mental health needs. I would be very intersted in being a part of any committees in this area. 27473 07/24/06 TX Agree "In general I agree, but I worry that this type of plan would create an even bigger mess since prices would still not be held in check by the consumer. Health care is one of the only areas in which the consumer generally doesn't have any idea what the actual cost of a service is. Because of this, it makes it SOOOO easy for health care providers to inflate prices and 'run up the tab'. " Agree Sounds good in theory- I wonder how quickly the system will be overly bureaucratic. Agree "Again, I must express my skeptism about the recommendation. Sounds good, but I am interested in the process of implementation." Agree Agree "Yes, but you will never be able to have a completely level playing field; the rich will always have access to better, more convienent health care." Agree "Very complex issue, I understand, but at some point politicians are going to have to stop worrying so much about doing what looks good around elections. Continued cuts to social services paired with tax cuts to the wealthy is just bad for everyone." "As a family therapist, I would hope that mental health benefits would include relational mental health issues as well. Decades of research has continually found that a dysfunctional family environment is a significant risk factor for substance abuse, violence, crime, decreased work productivity, etc. I am continually frustrated by a health care system that only defines the patient as an individual and often refuses to pay for services that are aimed at benefiting the larger family system." 27483 07/24/06 NC Agree Agree Agree Agree Agree Agree 27484 07/24/06 VT No response No response No response No response No response No response "* ***General Comment on the American health care conundrum*** As a specialist M.D. (anesthesiologist)I deal with serious health problems every day, and I perhaps have a different view of what is important or attainable within our system. I hope I am not alone as a citizen, but reading through all these comments is a bit mind-numbing. The breadth of wants, wishes, demands, and pleadings only reinforces to me the feeling that individuals' views of how our health services should be structured and financed are so diverse as to be virtually impossible to reconcile within one centrally organized ""system"". The central problem for our population is not so much the ""care"" delivered but the ""cost"". Yes, I am simplifying these concepts for the moment. Remember that all physician care amounts to less than 20% of the 1.6 trillion dollars spent annually. So if as often said, physicians should just be paid less; well, go and halve our income and make the pundits happy to put us in our place. But you have the unpleas" 27485 07/24/06 CA Agree "Despite the challenge of such a statement planning, improving our healthcare delivery model, and focused attention on this issue will accomplish the goal." Agree Critical to this issue will be to use public/private/nonprofit systems of care already in existence as the models. Agree This is a critical area of need. Using the dynamic processes of lean transformation practiced in the manafacturing world must be implemented in our healthcare industry. Nothing we do as it relates to EHR etc will be valuable without reducing the waste in our systems. This does not need to be done at the expense of comprising quality care but rather will allow for the expansion of to valuable services to those most in need. Agree Agree Amen. Agree "This is the cart before the horse. We need to transform our healthcare system for efficiency in all areas of care allowing for reduced costs which allows for better use of funding opportunities. We need to ""find the money"" but have a plan for best practice use of funds." In general I agree but we should be specific about mental health care. Thanks for beginning this process 27488 07/24/06 MT Agree Agree Agree Agree Agree Agree 27492 07/24/06 HI Agree "However, I do not want government to run it! " Agree "One size will not fit all. It will take considerable work within individual states and communities to coordinate and not duplicate existing services. Turf wars are likely to erupt between community health centers, FQHC's, even CAH's - incentives will have to be developed that move communities that have overlapping services to consolidate." Agree "But, please can it be a public/private effort? ""Government"" doesn't have the bottom line concerns a private business does - my considerable work experience in both sectors have shown me that private business does it better (more efficiently & more creatively with more motivated staff (ones that can be fired for not performing unlike unionized gov't workers)" Agree "Absoutley agree. Our culture must change to one of embracing and accepting death ,alleviating pain when possible. More at home burials and death should be encouraged. I have heard shows on National Public Radio about people who assist with at home deaths & burials; this type of work should be encouraged and supported. " Agree "I absoutely agree. How do you accomplish this in a world economy, however, where labor is cheaper elsewhere due to poor working conditions/standards? Amerians want everything, but how will we ever be able to afford it all?" Agree "As usual, I believe, the middle class will end up carrying the ball. The current administration and others in the ""upper class"" do not have to part with their money or contribute the way the middle class does. They have accountants that work to decrease the amount in taxes they will ever pay, living or dead...The rest of us use H&R Block. How about the upper class REALLY paying their fair share?" Core services are beneficial; however some sort of 'cafeteria' mixing should also be possible. Perhaps allow X benefits up to X dollars? Individuals vary in their health needs; they should not be denied what they need and what they are contributing to just because it does not fit in a predefined package. "Hawaii continues to have the oldest private health care insurance system covering over 90% of its residents. This has happened with an employer mandate as the base, with somewhat of a defined benefit package, emphasis of insurers on preventive care and individual contributions. " 27493 07/24/06 WA Agree Agree "While the Federal government might lead the initiative, I believe as much local control as possible is best so the service can reflect the commuinity's values." Agree Patients should continue to be allowed to choose their own doctors under this system. Agree Excellent! Agree Agree Strongly agree! Hopefully we can learn from other countries who have universal health care in order to allow individual choice of doctors and to avoid long waits for service. 27494 07/24/06 AR Agree Basic coverage with an emphasis on prevention and early treatment for all should be the goal. Catastrophic coverage should be next. Not becoming impoverished by basic health care cost would follow closely. But in all cases we are talking about basic coverage--not elective services or world-class treatment for everyone. No response Agree Agree Agree Agree "The government is going to need help to make these recommendations a reality. We can only do so much of pushing and monitoring healthy life styles, but we could require anyone who receives benefits to sign up to be an organ donor or state their religious objection to being an organ donor (cosigned by clergy) or they would not be allowed to participate. " 27497 07/24/06 CA Agree "Please ensure that ""means testing"" is not used to establish who qualifies for health care and/or financial protection. Means testing is regressive and historically used to crate barriers for the most needy and vulnerable. We need to establish that health care is a ""right"" not a privelege. " Agree Agree "This should include a mandatory ""Health of the Nation"" yearly report card " Agree Agree Strongly agree. Health care should be our right not a privelege Agree 27498 07/24/06 MO Agree "For this country to have approximately 43-46 million Americans WITHOUT healthcare, nearly 10 million of whom are children, is an American Tragedy!!!! Something needs to change!!! " Agree Agree "Revisit the devastation of Medicare Part D with the passage of the Medicare Modernization Act 12/2003. Allow Prescription Drug plans to contract with Medicare and use the collective purchasing power of Seniors to acheive the best price for prescription drugs. At the very minimum, eliminate the penalty for late enrollment and fix the coverage gap (donut hole)." Agree Excellent recommendations!! Agree Agree 27499 07/24/06 CO Agree "I agree that no one should be without healthcare coverage, however, I'm not sure that a private or national program could guarantee coverage. There's too much room for greed. What would be the guarantee that a person would even be able to see a physician. And what about a national WELLNESS program. " Disagree "Federal government has too much control as it is. Allowing the Federal Government would mean people would probably die before they could get through the ""red tape""!!!" Disagree "Sounds good in theory. But again, were would the wellness fit in? At the bottom? " Agree Agree "I could agree with this if you also provided alternative care. (acupuncuture, chiropractic, etc. ) People deserve choices. Western Medicine is not always the answer!" Disagree Sounds alot like Socilized medicine. How does it differ? "Allow alternative professionals as well, and perhaps this would be viable. " People are dying from tradional medicine the way it is set up. Too much attention is being paid to the bottom line and not to the patients needs. We should be required to take wellness programs to learn how to prevent disease. We also should have the right to choose whether or not we use tradional western medicine or opt for eastern medicine or a combination of both would be ideal! 27500 07/24/06 NC Agree Agree Agree Agree Agree Agree Get everybody into Medicare and use the savings in administrative costs to finance health care for all the currently uninsured citizens. 27501 07/24/06 IA Agree All people should have a right to health care. Agree Agree Agree Agree "yes, Yes, YES!!!" Agree Make our tax system more equitable and raise taxes of the wealthy. Cut back in our involvement in Iraq. "Make SURE members of this non-partisan public-private group are not trumped by partisan, public-private people who stand to gain personal wealth from the healthcare system." 27503 07/24/06 WI Agree Agree Ensuring access to preventive care for everyone is key to keeping health care costs low. This must be done in combination with education about prevention. Agree "Payers, like the federal government, and providers should thoroughly examine and study the effectiveness, safety, and the vaule all technology in healthcare brings to the system before it is used or paid for. " Agree Agree "* I agree to this with great hesitation because I am concerned about how ""need"" and ""sufficiently comprehensive"" will be defined. We as a society have not decided what is ""affordable"" or how much we're willing to contribute to have this access. Making constituational amendments or creating a new ""right"" in a system that has been created around markets/capitalism, not rights, will have severe challenges and may endanger some along the way if not properly and adequately implemented. I think anyone close to the current system would have these concerns. Society has not decided as a whole what is affordable or what they are willing to contribute. Proceed with caution..." Agree "* This is where the ""rubber meets the road"" on the universal coverage issue. Many want and appreciate the need for universal coverage but how to pay for it is the problem. I am a firm believer that there is plenty of money in the system to bring universal coverage to all. Certain areas of the current system are harboring much more money than other very important areas. For instance, chronic and end-of-life care are highly incentivized while prevention remains less ""sexy"" and less valued while it's probably the most key area to save costs. With proper reforms and proper incentives, the costs can be evenly distributed and quality can be preserved. " This group should be kept out of political circles and should not be allowed to influenced by outside parties. "I appreciate the attention the recommendations gave to including a public/private partnership. The current system is definitely in need of reform but let's not through out the baby with the bath water. It will be important to study what is and what is not currently working, and build the good aspects into the reformed system. " 27504 07/24/06 CT Agree The time has come to do something Agree "A new program needs to be available to everyone, especially those of us who ""fall through te cracks""" Agree Preventive care for all is of utmost importance Agree Agree As one who has been driven to edge by health care costs I feel very strongly that treatment of high quality must be available Agree This is a topic I don't have enough knowledge to really make any suggestions. I do know that there are highly educated people who are more than capable of designing a program 27505 07/24/06 OK Disagree The coverage issue will not help and we can't afford it until we attack high health care costs. Other nations have universal coverage and still struggle with rising costs. Agree "Since a medical education is so heavily subsidized by government (research funding, teaching hospitals, stipends for residents etc.) perhaps we could ask graduates to give a year or two of community service. We require graduates of the service academies to spend time in the military so why not?" Disagree The federal government is not the entity best equipped to carry out these strategies. Disagree "We can't afford additional spending on these programs. As important as it might be, we just can't have everything we want." Disagree Most Americans do not want to be asked to give up what they have now in order to participate in a program like this. Disagree "The problem of financing in this country is that nobody wants to pay for their own health care. They want someone else to pay for it. Even if we were able to reduce the actual cost of getting care to something ""affordable"" there are those who don't want to contribute to the cost. They also don't want to be responsible for their unhealthy lifestyles. Of course, there are those who truly can't afford to pay for care. They still should be accountable for living healthier." There is no need for this unless we are trying to implement a true single payer system. 27506 07/24/06 OK Agree I think it is a travesty that parents have to file bankruptcy because of high medical costs. I think there needs to be a representative panel of the U.S. constituents - as a single mother of two children one who is MR/PDD and ED - there is enough pressure on taking care of two kids without help let alone nont- qualifying for programs because of the being over the income limit by $5.00 Agree I think that the new recovery support specialists could offer and extend to abilitities of service provider in rural areas. Agree Agree Agree Agree 27508 07/24/06 NY Agree Agree Disagree Agree Agree Agree "The medicaid system that presently serves the underpriveleged is an unfair practice. It has led to fraud and unethical practices. We all shouldm have thje same health care coverage that is comprehensive, regardless of our financial status. A good exaple is the health care system of Canada." 27509 07/24/06 OR Agree Agree Agree Agree Agree Agree 27510 07/24/06 SC Agree Agree Agree Utilization of the existing community health care center (FQHC's)network is a step in the right direction. Agree "Many families would prefer having family members spend their last days ""at home"", as opposed to nursing homes." Agree Agree "This makes sense, but probably won't be funded." 27511 07/24/06 NH Agree I agree with bullet 1 but we will never solve our basic health care sytem problems until we have a universal system along the lines of soical security or medicare. Everything else is simply a shell game of transferring costs to someone else. Agree "All these fforts in and of themselves are good - but do nothing to get at the core problems. Lack of access; unequal accesss; shifting financial risk to patients, etc." Agree "Isn't it ironic that even within the federal government health care is not ""integrated"". Each of the above listed programs is separate, with its own rules and regulations, funding, and objectives. Why not establish a ""federal"" health care program to encompass all of these???" Agree ok...start convincing the healthcare providers to support such programs. you can read in the newsmedia every day of situations where individual's wishes have been ignored or disregarded. Agree I strongly agree. Nothing will change until we have a universal system - and take the health care system out of the hands of the wall street stockbrokers and bankers !!! Agree "If one believes that health care is a societal benefit then it becomes obvious that society should pay the costs. And if one believes that protecting oneself is a form of insurance, then it becomes obvious that it should be a national insurance tax - period" In theory it sounds good. As soon as the administration hires all the pharmaceutical and medical insurance companies lobbyists et al to draw up the details we'll be in business......... Let's look around the world - and stop kidding ourselves that we have the best healthcare system in the world.. 27512 07/24/06 FL Agree "This is, to me, the most personally relevant clause. As someone with a chronic illness, I live in fear that I might go bankrupt from medical expenses. In fact, this would have already happened several times if I could not rely on my parents to provide me with money to help me afford insurance premiums when I could not." Agree Agree "This is perhaps a more subtle point than the others, but equally important. The current system for maintaining medical records makes it difficult for patients to know what's going on and to seek second opinions or care elsewhere. Sloppy record keeping also engenders dangerous errors. It is simply absurd that the system is as antiquated as it is. " Agree Agree "I cannot express how much I agree with this point and how enthused I am to see it included in the recommendations. It should be a societal and civic value, as well as simply policy. It is simply ridiculous that a nation as strong and prosperous does not ensure that all of its citizens have access to health care. " Agree I am willing to pay more than my share for a transition to universal coverage. "This will require some tough decisions, but I think it is a far fairer, more human, and more rational approach than our current system of deciding based on who can pay the most for what services. " 27513 07/24/06 FL Agree I agree we should establish a national public -- not private -- program. Only a single payer program will work because it will contain costs. Agree Agree Agree Agree "Yes, yes, yes, in a single payer system." Agree "A single payer system, by eliminating waste and duplication in our current wasteful non-system, will make up most of the costs. Further saving will come from negotiating with the drug companies to lower drug prices." Look to Medicare (not part D); look to the VA hospital system. Those are the models. 27514 07/24/06 OR Agree Universal coverage should be a cornerstone of a national health program. Primary care coverage and wellness should be emphasized. Agree "Health Care Coverage needs to be expanded into underserved geographical areas where socioeconomic circumstances now preclude adequate services for the poor. However, I would like to see a unified system of health clinics in all neighborhoods/communities. I would not like to see a two tiered system developed in this country." Disagree "Having experience with Data and Health Care reporting systems for third party payers, I am skeptical about the ability of health care information systems to deliver on the promise of controlling costs and the quality of service (i.e. efficiency and effectiveness of care)" Agree "Yes, quality of life considerations should be paramount in how end of life care is delivered." Agree Universal coverage should be a cornerstone of a national health plan. Agree I favor a single payer with rapid evolution to universal coverage. "Yet care must be budgeted. I prefer an expert panel of providers making policy and decisions regarding the appropriateness of care and/or interventions, functioning within a capitated or budgeted health payment system." No. 27516 07/24/06 NM Agree Disagree Agree Agree Agree Agree 27517 07/24/06 FL Agree I work in healthcare in a not for profit organization. Whether a patient has money or not does not stop the patient from being treated. But we all know the balance is not always for the poor and uninsured. Agree The uninsured are overcrowding emergency rooms now. Quality Care and ongoing medical treatment should be provided to these people in the most cost effective manner. Community care centers will help these people obtain the right level of resources and help contain costs. Agree "The Medicare program as a federally run program is able to provide care cheaper than private for profit insurance companies. America is a consumer driven economy, so much of our GNP is funneled into healthcare profits. We should follow other government examples with healthcare in industrialized nations, i.e. U.K. Australia, New Zealand. " Agree "My husband died using Hospice resources at home. The care they provided was basic, leaving most of the caregiving and medicating to myself and family. The terminal illness and torture of dealing with limited resources is hard. Most people have a hard time finding help." Agree I work in healthcare finanical management and have for over thirty years. Esculating costs and limited resources are forcing many healthcare professionals to seek other professions. I just attended a bachelor degree program where I personally met six Registered nurses pursuing other degrees outside of the nursing profession. My graudating class was about 225 people. Agree Those of us who are employed have health insurance that costs us and our employers a great deal. Nothing worth having is free in America. I would be willing to assist. 27518 07/24/06 MT Agree Agree Agree Agree Agree Agree A percentage of income for all individuals would insure that most Americans would participate in the financing to the extent possible. 27519 07/24/06 NM Agree "* We have to get private, profit-making insurers out of the system and streamline the number of payors. It's a crime that insurers continue to make money (even some diguised as nonprofits) and the number of payors is causing a severe administrative burden. If you don't achieve this - and it does not have to be single payor, but at least limited payor - costs will never be lowered and someone will continue to profit. Also, it appears you are limiting coverage. There should be some equalization and no pre-exisitng condition loopholes." Agree "This contradicts recommendation one, unless it is interim until there is coverage for all Americans. " Agree The problem is that disease managment has been left to managed care. Agree An excellent recommendation. Hospice care is underutilized and the elderly in particular do not receive enough services to assist in their daily care or quality of life. Nobody is coordinating care for cancer survivors. Agree Wonderful! Better wait to pass it until a change in administration if you want to see it happen :-) Agree "Premium costs will go down if payors are eliminated, as will providers' administrative costs, cash discounts and allowances, uncollectibles, etc. So providers may be open to reimbursement effects if costs are lower and payment is guaranteed. Just one possibility." "I hope you really include citizens, not just policymakers and particularly not lawmakers influenced by pharmaceutical companies, payors and even providers." "It's great to see the dialogue begin (again?) but as I said, good luck getting anything to change with current leadership. The general public is probably not your roadblock, at least not with good education. The roadblocks are the same as always - those who have to gain from the status quo. " 27520 07/24/06 MD Agree Agree "* Community health centers have been proposed in the past and have failed due not to the concept but to inadequate funding. In addition, community health centers must be planned to make transportation as easy as possible. Medicare and Medicaid were designed to form a safety net for poor people, the elderly and the disabled, but both programs are seriously flawed because of administrative and procedural problems. Opportunities for outright fraud and for inappropriate medical care with the goal of increasing payments to providers must be prevented. This likely cannot happen with health care in the hands of the private sector." Agree This is an excellent recommendation that has been around for years. Barriers to implementation must be eliminated. The public programs named above are NOT good models for improving quality and efficiency. Agree "More emphasis should be placed on living wills and health care directives. If a patient doesn't have a living will, hospital staff should help to draw one up in consultation with the family." Agree This should be the cornerstone of health care policy. It seems redundant with the first recommendation. Agree "* VERY, VERY FEW ADVANCES IN TECHNOLOGY HAVE LED TO LOWER HEALTH CARE COSTS. TYPICALLY THEY INCREASE COSTS (E.G., CAT AND PET SCANS, NEW DRUGS HEAVILY MARKETED DIRECTLY TO THE PUBLIC, BONE MARROW TREATEMENTS). THERE ARE A FEW EXCEPTIONS, E.G., LAPAROSCOPIC SURGERY, CATARACT SURGERY. THE SICKNESS IN THE SYSTEM IS EVIDENCED BY THE DIFFICULTY IN GETTING DRUG MANUFACTURERS TO PRODUCE ANTIBIOTICS. THERE IS MORE PROFIT IN THE NEW HEAVILY MARKETED DRUGS (WHICH SELDOM ARE BETTER THAN THE OLD TREATMENTS) THAN IN ANTIBIOTICS. NEW ANTIBIOTICS ARE NEEDED TO FIGHT DRUG-RESISTANT BACTERIA, TO PROVIDE TREATMENT IN PANDEMICS OF UNKNOWN ORIGIN, AND (I THINK)OVERCOMING PROBLEMS WITH ALLERGIES TO ANTIBIOTICS. BUT WE HAVE TO RELY ON OVERSEAS DRUG MANUFACTURERS WHERE MONITORING QUALITY IS MORE DIFFICULT. RIGHT NOW, THE INSURANCE COMPANIES PROVIDE THE NECESSARY FUNCTION OF DECIDING WHETHER A TREATMENT IS APPROPRIATE. DOCTORS COMPLAIN ABOUT BEING CHALLENGED BY NONPROFESSIONALS, BUT THEN THEY DON'T LIKE BEING CHALLANGED BY ANY" The US Preventive Services Task Force does much of this already with respect to identifying medical tests that actually do some good. The Task Force seems to have a good process and does its work relatively quickly. This system could be built upon. "* The current health care system is a little like a city that has contracted for its police services with two private sector companies, and citizens are asked to choose which police force they would like to call in an emergency. The economic and scientific research needed to create a system that provides appropriate, cost effective and humane health care is vast, although some of this research has already been done and is now gathering dust on the shelves. A better health care system than the one we have now could be cobbled out of existing practices, but it likely would be inadequate." 27522 07/24/06 ND Agree Agree Agree Agree Agree Agree 27524 07/24/06 OH No response "Force health care costs down. It is unchristian to deny health coverage to so many Americans , while senators and representatives enjoy the best that money can buy. Why should so many have to choose between buying hospitalization and medications or buying food. Businesses should not be permitted to dump health care costs on employees, active or retired. There wouldn't be so many uninsured people if costs were not so outrageous. " No response Agree Agree Agree "High quality health care should be for everyone, not just the rich, or legislators. High quality health care should not need additional revenue. Health care providers should not be making exhorbitant profits at the expense of the people they serve. Why are medications, sold world wide at reasonable prices, so costly here?" Agree see above 27525 07/24/06 FL Agree Agree Agree Disagree Agree Agree 27526 07/24/06 CA Agree Agree Agree I have been involved in healthcare administration for 20 years and am constantly amazed at the administrative duplication and waste that can easily be removed and will go a long way to reducing overall costs. This is mostly a process issue and has nothing to do with care. Agree Agree Agree "I would think that the money now being spent on ""health insurance"" by employers and employees, as well as profits by health insurance companies, reduction of waste and fraud, etc. would cover any necessary financing." 27527 07/24/06 MD Agree "I believe we should have universal high quality health care for everyone in America. One good way would be to expand Medicare to include everyone - babes, infants, youth, adults and elderly. I believe health care should be funded as Social Security is, namely, by a deduction from pay to be put into a Health Care Trust Fund (HCTF). Additional funds from general taxes should be added to the HCTF to cover health care costs for the under-employed, the unemployed, disabled. and children." No response "I beleive that America's health care system should not include insurance companies,HMOs or or other for profit agencies. They are expensive, bureaucratic entities which consume funds that should properly be utilized for health education, health maintenance, and medical care of individuals. " No response "While electronic record keeping has many valuable benefits, the need for some paper record is imperative for unexpected emergencies or for a routine need for information, as electronic systems are sometimes ""down"" and electronics are vulnerable to mishap." No response "Since I envisage a system where everyone pays for and receives their health care from the universal health care system, there would be no need to integrate public and private payers or programs as they would be a natural result of a universal system." Agree The first prinicpal to guide an American universal health care system is that everyone should have high quality and affordable health care. Everyone regardless of financial resources should receive such high quality health care so that neither their health nor their financial security will be jeopardized. Agree "As I wrote above, I think America's universal health care system should be funded as Social Security is funded, with a payroll tax, plus general revenue funds to cover health care for those who do not pay into Social Security and for those who are not paid for their work (stay at home parents, care of elderly relatives, etc). A Health CAre Trust Fund should be established to receive funds from payroll taxes and from general revenues to pay for health care costs." "Members of the independent non-partisan group should included doctors, nurses, university and medical researchers at not for profit institutions, representatives of NGOs: e.g., American Heart Association; MedicaidMatters!Maryland; Maryland Citizens'Health Initiative. It should not include representatives of for profit groups such as pharmaceutical companies and insurance companies. " Thank you for asking for comments from Mary Q. Public. 27529 07/24/06 CO Agree Agree " WIll the politicians reading this have some explanation as to what an ""integrated community health network"" would look like (last bullet)? Who will participate as the ""public-private group"" and how will these people be chosen?" Agree WIll this include prescription drugs? For example using the VA model of negotiating prescription drugs? Agree Agree Agree This will definitely be the most difficult piece of providing health care access to all Americans. One of the keys may be providing hard data as to how our society is already paying for the health care of the uninsured/underinsured population. You hear this but I rarely see data to back it up. Many of these recommendations are a bit vague - is this how they are meant to be? Since I have not been involved with this type of proposal I am unclear as to when specific goals would be identified. Thanks for your work on this. This is a great start. 27530 07/24/06 NJ Agree Agree Agree Agree Agree Agree One of the first areas you should look at to save money is the big increase of workers needed to process claims. This is in the private sector as well as the public. Each company has its own procedures and a doctors office needs to hire additional staff to process claims. This cost of these employees is raising the cost of health care. As you simplify the process cost can come down. When you see an efficient procedure you do not mind paying extra. 27531 07/24/06 MN Agree "We need a single payer (nationally, by state or by region) to save money over the 260 plus payers we and the vendors now must deal with." Agree I think I agree but not sure this is all needed is we gaurantee universal health care for all citizens. Disagree Most of this is small and has little impact on quality or cost. Agree Agree "Change it so the individual or the employer isn't set to make a payment but fund it all based on a fair tax structure. It can cost less than we have now, thus enabling covering all and covering all needed services, if we get the middle man out of it and save the 30% going to Manged Care admin. costs." Disagree "* Medicare for All. Look at the Canadian system but at our funding level. Look at the public utilities commission idea for setting hospital budgets and services. Have a single payer for all bills and have rates set like pure old fashioned Medicare has done it. If government paying the bills is aomehow a bad idea, force all private managed care companies to become one great big entity that creates a single payer -- nationally, state by state or regionally. The provate manged care companies and their high salaries, etc. are sucking us dry and doing the same thing as the war profitering companies like Haliburton. We must stop this. Medical care should be a right in this country and not a privelege. " "Creates unecessary administrative cost. Let the care needed be decided between the doctor and the patient. Oversight or second guessing what care is needed or some base benifit set will not work to create quality, fair access or save money." Universal access to medical care via a single payer system is necessary. Stope allowing drug companies to advertise perscription drugs. Stop allowing drug companies and managed care /insurance companies to make political contributions. 27532 07/24/06 VA Agree Agree I believe state and local government should also be involved and held responsible for insuring access for their citizens. Agree "As a director of two FQHC's, it is imperative that we have continued finacial support to not only maintain services, but expand those services. We are currently seeing 61% uninsured and can not continue to be fiscally sound without help." Agree Agree "I absolutely agree with this recommendation. My younger sister died at 46 of breast cancer. She was a single mother, working two jobs, neither afforded health insurance and she put off going to the doctor, even thought she knew she had a lump in her breast. When she finally got there she had stage 4 breast cancer. Breast cancer was the diagnosis but she died because she did not have health insurance. This should not happen in our country, but it does every day." Agree "I think it is very sad that the uninsured, because they have no one to advocate for them, are charged more for health care when they have to go to the hospital than the insured." We see this every day. Health care is so much more than just about primary care. The cost will only go down when we take care of the whole person. 27535 07/24/06 IN Agree Agree Agree Agree Agree Agree Single payor Simplify filing 27536 07/24/06 CA Agree "* Who can be against these principles? Nobody. However, we already have such national programs. They are called Medicare, Medicaid and Veterans Health, in addition to other smaller ones. Don't re-invent the wheel. All we have to do is set it up so that no one has to prove they are old, poor, veterans, native american, employed by so-and-so, etc., in order to receive care. All health issues are public health issues; a sick populace is unproductive, sometimes communicable, a stain on our public integrity. The Public (as represented by the government) must address public health issues." Disagree This sounds like so much corp-speak. What you really mean is everyone needs to do their jobs and do them well. Disagree "* The government will promote reduction of fraud and waste? Isn't it their job to stop fraud and waste? The government will promote disease prevention? health promotion? consumer information? What's new about that? IT'S THEIR JOB! And don't fall into the trap of expecting IT and electronics to enhance efficiency. Computers were supposed to lead to paperless offices, remember? We generate more paper now than ever before. The greatest efficiency you can achieve is a single payer system - not necessarily a single funder system, but a single payer: one claim form sent to one address." Agree End of life care should be part of health care? Of course! Agree "Yes! However, policy does not mean action. You need to make this a practical plan, not just advice. People should not have to prove they belong to some particular class to participate in health care delivery." Agree "Yes, and these are all advantages of the single payer system (note: not necessarily single funder system). I'm sure employers would be happy to help fund the system in return for not being continually kicked around by the system. Health care should be treated like a public utility: profits should be limited by some reasonable formula so that investors get a decent return, but obscene profits like those now enjoyed by big Pharma would become a thing of the past." Give the panel teeth. Such a group will be effective only if it is overseen and if it has real authority. "* Medicare is the most efficient health care intermediary in the country. We should gradually move everyone into that system. Begin with the poor: scrap Medicaid and funnel that money into Medicare. Next enroll infants and children 0-6: family enrollment will fund it (poor kids are already enrolled). Next, people 60-64: let them and their employers contribute to the fund. And so on. AND INCLUDE PHARMACEUTICALS IN MEDICARE WITH NO DONUT HOLE GAMES, INSTRUCTING THE GOVERNMENT TO NEGOTIATE DEALS WITH THE DRUG COMPANIES." 27537 07/24/06 OK Agree "Benefits should only be for US Citizens, not illegals. " Agree Agree "We MUST improve in all of the areas above, but we have to stop allowing insurers to dictate what's best for a patient's care. Too many carriers get away with denying claims that should be paid with no recourse for patients or their providers." Agree Agree Agree "I could live without dental care, but physical and mental care are necessary." "* I have payed up to $2800 a month for health insurance. One of my prescriptions costs more than $300 a month. I cannot aford to drop my insurance, and I cannot change insurers because no one will take me. I work for myself so it is individual coverage instead of group coverage. I can't go on Oklahoma's High Risk Pool because they won't cover my illness for 12 months and I would have to pay over $800 a month for 12 months until my illness is covered, plus pay for my current insurance so I cannot afford to do that either. We have to be smarter about how carriers operate - they are the ones making all the money and it seems they make the rules, too. We have to be smarter about using our benefits wisely and staying healthy, too. But we MUST all have access to healthcare. We need to focus more on US Citizens instead of illegals. As a US taxpayer, I resent paying for coverage for people that are here illegally and who use Medicaid benefits. I also resent people that abuse the system when they could ge" 27538 07/24/06 TN Agree "There needs to be ""Universal Health Care Sufferage"" We all nned to contribute in a national plan. Employers should no longer have to be part of the matrix and have to fund this. If all are covered the risk is spread" Agree "Affordable fees from health care providers. Stop the ""hollywood"" bookkeeping where a provider has a ""rack"" rate for a service but is reimbursed far less by insurance companies/medicare." Agree Basic health care knowledge would encourage the use of doctors & allow early intervention in possibly expensive health costs later on. Agree Too much money is spent on heroic medical intervention in the final days of patient's lives diverting valuable public health resources. Agree See my reply to the first question. We should all have coverage. Eliminate the medicare tax ceiling so more wealthy tax payers help put funds in the system. Increase minimum wages so poor people have a living wage & can afford premiums. Agree See previous answer. It is amatter of personal responsibility to make sure we are covered. We need to put aside money to pay for health care. It comes before the trip to the mall or the movies! Eliminate advertising on Prescription Drugs - Any drug that requires a prescription cannot be advertised to the public. Streamline medical data processing & the bureaucracy surrounding medical insurance. Train & hire more doctors. The AMA is a closed shop & regulates the number of doctors. 27540 07/24/06 NV Agree Agree Agree Agree Agree Agree 27544 07/24/06 PA Agree Agree Agree Agree Agree Agree 27546 07/24/06 KS Agree Agree Includes expanding use of nurse practitioners and their ability to prescribe across all states. Agree Agree Reimbursement for health care providers in this area needs to be examined and probably increased in order to attract individuals into this area of continually growing need. Agree "With a common core and some institution of managed care principles, we can begin to get a handle on what is needed. We can also reduce costs through appropriate use of services." Agree Preventive care must be expanded to prevent the expensive chronic diseases that are now eating us alive financially. 27547 07/24/06 KS Agree "I only agree if this is a PUBLIC approach, not a private one that wastes money on excessive profits for private entities already receiving a disproportionate share." Agree "I only agree if this is NOT a replacement for public insurance such as Medicare, Medicaid or SCHIP." Agree What is new here? Agree Long overdue. Need to break LTC out of Medicaid also. Agree Let's start with this premise and move on - quickly. It's been on the table since 1916. Agree Let's build upon what Massachusetts is doing at the federal level. Private or public - just get it done. Time to catch up with the rest of the world. I hope this isn't more BS from DC. Our healthcare system is falling apart. I find it very hard to take any efforts coming from Washington seriously anymore. 27548 07/24/06 IA Agree "All American's should have health coverage - if we can send millions of $$'s overseas to help others, we should be helping USA citizens first" Agree Agree Agree Agree We need coverage for everyone! Agree 27549 07/24/06 OH Agree "The Federal Government must create a ""catchy campaign"" relating to prevention. I feel that our people must know the truth about prevention and the real condition of the nation's health status." Agree The Federally Qualified Health Center concept is wonderful the way it is crafted in legislation. The concept needs to be expanded and not modified. Agree Paitent centered care and patient self-management are very important. Agree Populations that do not have funds to aide familiy members with palliative care must be given opportunities to identify resources. Agree "The Federally Qualified Health Center movement must grow and be adapted in moer places throughout America, even for those who have health insurance." Agree "This is good;however,individuals and health care organizations (direct care givers, insurers and the Federal government) must now be identified to bring the disparate parts together. Implementation must be completed within ten years." Emphasis must be place on patient self-management. The process to obtain the aforementioned information across the nation was very good. 27550 07/24/06 CT Disagree "Private will not work; it needs to be public. No insurance! Healthcare should be a right guaranteed to all Americans, like Medicare or Social Security." Agree "However, if there is a national health plan, Medicare for all, there will be no need for a ""safety net!"" Everybody will be in, nobody will be out." Agree Agree Disagree "Not merely ""affordable."" All Americans should have healthcare, complete coverage, paid for out of general tax revenues. Insurance companies should be out of the game. You deal with the administrative inefficiency, waste, and justice issues all at the same time." Agree "I disagree strongly. A single-payer, ""Medicare-for-all"" plan is optimal. All you have to do is expand traditional Medicare to cover all Americans. No need for a transition." These recommendations do not seem to reflect what I heard from the majority of people in attendance at my meeting in Hartford. There was a near-universal and very strong preference for single-payer healthcare with the insurance companies being out of the game. This seems very much watered down to protect special interests. 27551 07/24/06 UT Agree Agree Agree Agree Agree Agree 27552 07/24/06 CO Agree I think ther should be a National Insurance that would be paid for by a special tax that every american could afford ( ie Hilary Clinton's ideas] Agree Sounds good Disagree Tooo much government Agree Many past friends used and were treated well at the end by hospice care. Agree "People who can afford premiums because they have alot of money should not be included,because they can afford Health care." Disagree "Make sure the wealthy either pay their greatwer share, or don't include them in this health care." Who would deside this? Ther should be health care and recognition of gay and lesbian unions. 27553 07/24/06 NC Agree The national program should be a private/public partnership somewhat like is being done in the state of Massachusetts. Disagree "There is too much federal-this and federal-that in the above recommendations. We need as little bureaucratic meddling as possible. Every tax-paying citizen should be required to have health insurance, with EVERYONE IN THE US in the actuarial pool and with some type of sliding scale for the lowest-income people. Having health insurance should in no way be tied to employment status." Disagree "* You have grouped WAY too many different concepts and proposals under one recommendation!! The government has historically and repeatedly shown itself to be unable to put institute ""best practices,"" and/or ""reduction of fraud and waste"" into an area of its administration. What in the world would make you think that is going to change in the future just because someone writes that into a white paper if recommendations! The 2nd, 3rd and 5th bullet points are no-brainers but you don't say how government involvement is going to improve what we already have in this area." Agree Agree Agree Financing should come primarily from health insurance premiums with supplementation (for the lowest income recipients) by government funding through whatever taxation method is deemed appropriate. 27554 07/24/06 KS Agree Agree Increase the incentives for collaboration between hospitals and FQHC's to provide primary and specialty care to vulnerable uninsured persons. Agree Agree Agree Agree 27555 07/24/06 CO Agree Agree Agree Agree Agree Agree 27556 07/24/06 AZ Disagree "The system should cover everyone regardless of income. A two or three-tiered system such as proposed above would be unworkable, open to gaming, and would tend toward providing second class care for ther poor among us." Disagree "The system should be public to ensure that the needs of all communities. The public private model guarantees the continuation of our current fragmented non-system. We don't need a safety net, we need a health care system that provides high quality care, the same high quality care, for everyone." Agree "It would be good if we could move in this direction. I do take issue with the 4th bullet point in that we have already seen what happened to elderly and sick people when they were forced into the Medicare D program. Average folks are never going to have the knowledge necessary to pick a surgeon or other provider, treatment based on what it is. The only quantifiable category above is price, and that quite honestly is nonsense." Agree "The program such not , however, have a private component. Otherwise we are still including profit motive in the delivery of health care. W" Agree Agree * These are the same recommendations that we were faced with initially. There apparently was no room for alteration in the plan. This process asked a lot of the public and thousands delivered. Too bad their views are not genually reflected. The folks at the sessions I attended were much more radical in their thinking and were looking for solutions that matched their creativity and understanding of the needs of all people in this country. These recommendations maintain the private profit motive with a little tweaking. This is not a program for the people. 27557 07/24/06 KS Agree Disagree The safety net system is a piecemeal approach to health care. We need universal access--nothing less. Agree "Again, this is good as far as it goes. The feds should absolutely use their bargaining power to negotiate the lowest possible prices for prescription drugs(see: Medicare debacle). Once again, universal access is the goal that must be attained." Agree "Yes, palliative care, etc., should be an integral part of a health care system providing universal access." Agree "If this means universal access, I agree with it. Otherwise, how will you define ""affordable""? " Agree "The fairest way to pay for universal access is through a progressive income tax--the one tax truly based on ability to pay. I would have no objection to various ""sin"" taxes, either--especially given the fact that they might help promote healthier lifestyles by making alcohol, tobacco, etc. more expensive." "I guess I agree, as long as this means universal access." "Why can't the politicians get out of the way, and let us have what our neighbors in Canada have? Canadians may have to wait for elective procedures, but not urgent health care services. That's fine by me." 27558 07/24/06 FL Agree "I agree in part, but the ""protection"" should be insurance-based, not a government program like social security." Agree Agree Agree "This should be a public/private partnership, using resources such as Hospice for their expertise and knowledge." Agree "There needs to be access for more than just core services. And certainly some can be covered by insurance, for those that have coverage." Agree "I don't support the idea of taxes (of any kind) to support this effort. In that model, those who have more end up paying for those who do no. And businesses should not be taxed, especially if they are providing health coverage for their employees. Let's look at how other countries do this." 27559 07/24/06 AL Agree Agree I support community care that offers a wide range of health care options in one location Agree Gov't control of tobacco industry and promotion of breastfeeding are two places where evidence based practice and policy can work together to improve health Agree Agree Agree 27560 07/24/06 IN Agree Get rid of the overpaid insurance CEO's Need to get everyone covered so that some with coverage aren't paying for those who don't. Better coverage for everyone will reduce unnecessary costly Emergency Room visits. Agree Local health care systems need to stop building and stop competing with one another. Health care systems need to be supported (financially and administratively) and encouraged to provide outreach secondary and tertiary care in local rural/remote areas. Agree Agree Agree Agree Insurance through employers will likely need to stop. Better for everyone to pay their premiums on a sliding scale - and keep the premiums down by adequately covering preventative care and making sure that all have access to cost-effective care. "Please don't forget the disabled. Too often services that are important are being cut from coverage- like denying adults with new onset disability like stroke the ability to receive therapy or a wheelchair. And current policies that deny children with chronic disability the therapy, the bracing, the equipment they need is absurd and apt to cause bigger long term problems. Core benefits must provide for the habilitation and rehabilitation of individuals of all age groups." 27561 07/24/06 AZ Agree this is fundamental...helath care should be an entitlement program for all americans... Agree Agree Agree "this statement seems to indicate that there will be a public and private healthcare system...unless it means publicly operated and privately operated, (but publicly funded) providers of care...we need a seamless publically funded health system..." Agree "The question of financial assistance for services is problematic...if you have a seamless, publically funded system with an agreed upon benefit program - then there isn't a need for public assistance...the whole system is publically funded...access is assured to everyone..." Agree there is evidence that a single system will save enough administrative money that it will pay for the current uninsured population...either way...there a shifts in funding to pay for this system ...it should be close to budget neutral... 27562 07/24/06 PA Agree Agree Agree Agree Agree Agree 27563 07/24/06 CO Disagree The health care crisis is not about insurance coverage-its about access to health care. Supporting an insurance industry is not going to guarantee individuals against very high health costs-its going to make health insurance industries rich and the average American poor. Agree Agree Agree Agree Agree 1) reduce/eliminate fraud and waste 2) not every community or hospital system needs all of the latest technologies-collaboration would save alot of money 3) standard reasonable profits and executive packages is reasonable-billion dollar packages to the CEO of Healthone or Kaiser or other health organizations is a sign that all is not as it is meant to be 27564 07/24/06 LA Agree Agree Agree "* Health care systems must have consumer driven decision making, i.e., consumers 'must have drive the bus', so to speak. Patient advocates, who are patients themselves, should be part of the decision making process because consumers/patients are the recipients of these services and are the 'experts' on these matters. Evidence based practices are needed as well to ensure receipt of services are accurate and correct. Consumers/ patients should be informed and in a consumer friendly mammer regarding health care and health promotion." Agree "To ensure cultural sensitivity and integration of end of life support for indivduals and their families, hospice care should be restructured to have a health care system with fundamental choices. " Agree "All citizens of the USA, Americans, should have access to affordable health care. " Agree Transition into financing health care should be smooth and seamless. "Important to note that health care include mental, physical, and dental. This type of holistic health care is imperative to the well being of all Americans." "* I am an elderly person, sixty two years of age, a mental health advocate for the past twenty years on the state and national level. It is essential that all aspects of health care be included. For too long mental health care has taken a back seat to physical health care. A person must be treated in all aspects of his or her life. Whether it be mental health including addictive disorders or medical or dental or physical, treat each person as a whole. One part of treatment of an individual without treating and taking into account all parts of that person is not effective." 27565 07/24/06 NM Agree "I agree, as long as we can do this in a way that does not cause tax rates to soar out of control, further stressing working-class Americans." Agree "My fear is that thsi will lead to more beaurocracy, taking health care decisions out of the hands of the local health care provider and not providing quality, cost-effective care to patients." Agree "It sounds great, but can it be done?" Agree Family leave time for family members providing care for loved ones at the end of life would be helpful as well. Agree I lost my healthcare coverage as the result of a divorce. COBRA was unaffordable to me. We need a better way of covering people who lose coverage through no fault of their own. Agree "There needs to be access to alternative medicine, which is often less invasive and has fewer side effects than traditional western medicine. Prescription drugs are causing too many deaths, are too expensive and are too widely prescribed. We are creating drug addicts with expensive, destructive habits encouraged by their own physicians!" "I will not support a system that in any way devalues life, whether it be the unborn, those with disabilities or the terminally ill. Please respect the fact that many of us feel this way, and don't ask us to provide ""services"" that devalue life in any way." 27568 07/24/06 TN Agree Health care is vital to the wellbeing of all people. Every person should have access to the best health care available no matter what the cost. Agree Agree Agree Agree "Cost should not be the issue concerning a person's health. A person should not have to decide between putting food on the table and paying for their health care costs, including medication. Every person should have access to the best health care available." Agree "I think working persons, businesses and the government should financially support the ""reformed"" health care system. They should also financially support the health care of those who are unable to work. Financially supporting the ""reformed"" health care system should be done using a variety of funding tools." 27569 07/24/06 CO Disagree "This is a tax burden we cannot bear. We already have many ""safety net"" programs providing coverage. We need a full tax deduction for individual coverage to help in the individual market. I am not supportive of any further ""governmental programs."" These programs are more expensive than private plans because of the bureaucracy. Let the Free-Market System work!" Agree Agree "I would support any form of an IT system that integrates all the different healthcare systems. It would be even better of all medical history of patients could be entered into one health history system, accessible to medical providers only. This would eliminate prescription drug reactions and would help keep continuity in the treatment plans. " Agree Disagree "As mentioned before, this is a tax burden that will be out of control very quickly. Look at the drug benefits in Medicare. Already out of control and barely implemented. " Disagree I currently pay for my own insurance costs. I get to choose the level of coverage and the company I want. I do not think any additional taxes are they way to pay for health care. The final costs of this program will increase more than what the private sector currently charges for insurance. Give individuals full tax deduction for the own individual health insurance. Let me make my own decision of health care! 27571 07/24/06 CO Agree "Define ' very high out-of-pocket costs ' by income brackets. Those who have the means to handle more should accept a higher threshold of out of pockets v. those who are uninsured, umderserved or underinsured. Define ' all Americans"" , is that those who are citizens, here on a visa, here on a work visa, student visa, undocumented workers ? Who is an American for this purpose ?" Agree "Very lofty goals, I fear that this si os very far reaching and braod that it may fail due to trying to do too much at one time. Work with the IOM, Leapfrog Group, and AHRQ who have mines of information already." Agree "Again, great appropriate goals but rather lofty. Let's try not to over reach and plan so broadly that this program becomes cumbersome nurdensome and therefore impossible to implement." Agree "* Everyone can not receive EOL care in the 'environment they choose'. We must be realistic. The cost of mainataining the EOL pt in their home w/ 24 hour round the clock care is unrealistic, prohibtive and not at all feasible. We should supplemt that choice and support it but NOT totally fund it. There must be compromise from all for this plan to succeeed. It is essential to set up the groundwork for this compromise at this point and stage, not later. This plan can not be everthing to everyone and provide all they want. This must be need based and realistic and doable." Agree A threshold out of pocket must be established based on documented income levels. Those who have more should pay more to meet a higher threshold that is income adjusted. Agree Sin taxes are a most for those who smoke and use substances. "Dental must be limited tomainatinence but not expensive dentures, implants or orthodontia." "The govenment MUST support the education of Drs, NP's, PA's who will work in rural or underserved areas and with underserved impoverished or remote poulations by paying for their school and forgiving all loans with a work-off-the-money programs." 27572 07/24/06 NY Agree Agree Agree Agree Agree Agree 27573 07/24/06 ND Agree "Learn from the mistakes of the bankruptcy laws that were already supposed to help this situation, although in a slightly different way. Be sure lessons from Katrina relief are considered, so that those that don't really need help with coverage are not receiving the coverage." No response Agree "Be careful that this information isn't given to insurance companies to use as a basis for denial of health insurance to certain individuals. I think efficiency has improved throughout the health care system, but we still need a lot of focus on quality of care." Disagree "Let's make a change here. Let's celebrate life and the end of life. Let's help people be put to rest in the most comfortable way possible, but let's not continue to spend the amount of money we are currently spending in this area. Instead, let's redirect these funds to prevention and lifelong healthy habits." Agree Agree YEAH! I think I have made comments to this effect above. I would like to be more involved in efforts like this. Please let me know of any avenues of volunteerism/service that are available. 27574 07/24/06 TX Agree Disagree Federal government should stay out of this. This is a local community project. This sounds very similar to Govt. Single Payer Health Care. We don't need new Federal bureaucracy. Agree Agree Agree Agree "* Individual community financing through co-operatives is the most efficient method of financing. For rural areas, several towns would be in one co-operative. A minimum co-opertive size of say 100,000 members would be necessary. All co-ops should be reinsured by present insurers after a calims level of $5000. From $5000- 250,000 insurers should compete for the co-ops. Above $250,000 the Federal Gov't should reinsure all co-ops. An HSA should be used for the first $5000 of individual expense. For the poor, a cash voucher should be used for health care. " "Predictive modeling strategies should be used for Risk Mgmt. Every citizen should have an annual series of blood tests to catch early disease after age 40. Before age 40, it would be optional and shared cost." "Yes. It is obvious this group is interested in Single Payer Federal Gov't run health care. I am opposed to this. Health care is always LOCAL, and problems should be solved LOCALLY. We need the Federal Gov't only for compliance issues, and possibly reinsurance payments of excessive claims. We should not lose the efficiencies of private enterprise in claims paying and service." 27575 07/24/06 IA Agree Agree This is also huge. We have all these stand alone systems that don't talk with each other.....It always about money. Agree Reduce Fraud and Waste ? Good luck. The entire system is corrupted. Billable events and billable procedures. Agree This is huge. We spend 90% of our resources on the last 6 months of life and without much effect. Agree See my comments below regarding two tiers. Agree "Once the special interests get done slicing and dicing it, the above won't happen." This could be dicey.What is covered and what is not covered....creates an automatic 2 tiered system. The bottom tier will not be covered as well as the top. This creates disparities - even greater than the ones we have. "* Until we take some responsiblity in preventing problems, there will continue to be a high cost health care system. I have taught at 5 different Universities, teaching nurses to be Nurse Practitioners as well as in the US ARMY. The emphasis remains on pathology and treatment rather than prevention and health. After 6 years of tertiary care, I got out of acute care to become an NP in 1981 and for 20 years tried to do health promotion and prevention. 5 years ago I left that to try and make a difference by Directing a Public Health Department. Health Promotion and Prevention and even Public Health are so grossly underfunded that we will never have a chance to turn this around. The key is to educate people at a young age to avoid tobacco, drink in moderation and eat right and exercise etc etc. We still subsidize tobacco in this country. The answer to the problems we face as a Health Care System isn't rocket science. We need to turn our Illness Care Arrangement INTO a HEALTH CARE SYSTEM. Instead of pumping billi" 27576 07/24/06 AZ Disagree I disagree with the way it is stated. I believe the recommendation in Phoenix was some combination of public/private/employer. Agree Agree Agree Agree "* I heartily agree. The problem is NOT with lack of resources in this country. The problem is that the resources are maldistributed. There are plenty of resources in this country to give EVERY person a decent place to live, enough food to eat, work if he or she wants to work, and health care for everyone. For some reason, we think the rich have the right to any and everything they want and as much of it as they like. If we are, as George Bush (by far NOT my favorite president, just for the record) says, a nation built on religious principles (an arguable point, I guess), the poor should not be suffering here as they do. I don't know of any major religion that teaches that the rich have the right to everything they can get their hands on and the poor have the right to nothing except despair and hopelessness. We need to ACT on those religious principles, not just talk about them in carefully-worded speeches! " Agree "This is a statement that causes me concern: ....will take time.... I can't endorse this recommendation without further definition. How fast was Medicare Part D up and running. I think it takes something much more powerful than time: Political will! Why take the time to study the country's attitudes, beliefs and desires about health care if you will be slow to implement them?" "I certainly agree with 1 caveat: that health be defined in broad terms. If a patient has physician, mental, dental, prescription and ancillary services coverage but now way (no car, no money for gas,a job that won't allow them to leave work to access those services, etc.) to get to the services, what good will it do them? These are the realities of the poor. " "* I think it would be a money-saving investment to train people how to use the system, too. Money could be included for outreach. MANY people(Medicaid- and Medicare-qualified ,privately insured, etc.)have NO idea how to use the coverage they have. They either overuse (example continuous Urgent Care or ER visits for chronic health conditions or problems that need physical therapy or other services not accessible through these services) or underuse (feel powerless to break through the system so they don't go until they are at the point of needind hospitalization), as a result. Insurance coverage by each entity is different that the next. Differences also exist between different types of private and employer-sponsored policies. It's CRAZY!!!! Also, living in a culture of poverty the poor learn alternate coping skills, ways to get by each day. Usually, these methods are not well-planned, scheduled measures but desperate attempts every day at survival. It takes a LOT of education and consistency and rea" 27578 07/24/06 CT Agree "This does not go far enough. all Americans deserve basic, adequate healthcare coverage - I strongly support a single payer universal healthcare system and am willing to pay a proportion more in my taxes to see that this happens. " Agree Agree Agree Agree Agree 27579 07/24/06 TX Disagree "No one in America should be impoverished by health care cost or loss of a job, or death, or unhappiness, or anything else that make one uncomfortable in life. Every one should be able to drive a nice shinny new car every year, and afford a new spacious house but not at my expense. Nothing rewarding is free including healthcare. I don’t want to spend my money on some one else sedentary life style." Disagree "Bull shit! I would be willing to bet no one can tell me what this actually means. I defy you to define ""quality"" health care." Disagree These are all fine well run efficient programs - ritht? Any one of these organizations would be out of business in the private for for profit sector within 12 months. Disagree This is so self serving it defies coment!!! Disagree Health care without personal responsibility and accountability is totally unworkable!!! Disagree Another unique financing idea – just what we need. Maybe they will be as successful as the ones in the past like HMO’s. One better decide what the cost is and control that before you create a new financing mechanisms. If you don’t know what I am talking about then you don’t belong in the business of “managing” health care. "These are the most ridiculous ""recommendations"" I have seen come down from any group in a long time. Staffed in experts in what? ""Identification of high cost and core benefits"".... Who thinks up this stuff? You have made assumptions that the hypothesis is correct to begin with. " * This is the only industry that tries to control and manage itself without any idea as to what its cost is. Just plain stupid. Can you imagine an auto manufacture even turning on the assembly line without knowing what the finished product will cost? The health care industry does that all the time and will always be asking for more money because they cant make ends meet. Read the definition of stupid!!! Publish if you dare but i doubt this will see the light of day. You can start the process by requiring all Americans to participate in the national health and retirement benefit system including and especially the beloved senators and congress people. If that happens then I will take this exercise serious. FAT CHANCE 27580 07/24/06 OR Agree "I would suggest a sliding scale approach, so that perhaps the very rich would NOT be protected against high out of pocket costs, if they can afford it." Agree Disagree "I would like to see these programs scrapped and one inclusive one implemented. I think that the questions we were asked did not give us an opportunity to ""think outside the box."" One way to reduce waste in clinical practice is to use other health care professionals than MDs, particularly in such areas as childbirth. More bells, whistles, drugs, ultrasounds and surgery do not necessarily make better medicine. I DO agree with promoting all of the issues above." Agree "I would extend this thinking to beginning of life care, as well. Midwives can be used for normal births; but not every baby has to live, particularly when the cost to society is extremely high. Beginning of life care also should be provided in the environment that the parents choose." Agree "I could not agree more. Health care should be a right, with individuals also taking responsibility for their health status." Agree "Take some of the money we are spending on war, leave Iraq, and shift some of that money to health care expenditures. I also believe that everyone should have a co-pay for office visits, even if only $1, to give some ownership and responsibility. I also believe that employers should provide some of the money. Remove the middle man of insurance companies." "Please include a representative from the midwifery community in the ""experts"". Keep the drug companies out of the mix." "I am happy to see the US attempting to move in a positive direction on this issue, which is currently a growing problem. Without this change, we will have many impoverished elderly within the next decade. I would be willing to serve on the committee as well, with a background in Health Information Management and Law." 27581 07/24/06 KS Agree "As long as the medical costs are associated with medically necessary care, there should be financial protection against very high out-of-pocket medical costs. Elective care should not be shielded with this protection." Agree Agree Agree Agree Agree 27582 07/24/06 MO Agree Agree FQHCs are a powerful underutilized force in meeting health care needs in this country. Agree "I can support most of this statement, but the most important part is the primary prevention piece. We spend way too much money on end of life disease issues and only a pittance on prevention of disease-specifically chronic disease." Agree I agree only if a serious look at the use of extraordinary measures at the end of life is considered. Personal experience tells me that using such means at any cost when there is little likelihood of success is a financial drain on our economy and an emotional drain on the lives of the patient an d the patient's family. Agree Disagree We have a terrible record regarding infant mortality and any other number of diseases compared to developed countries in the world. Yet our health care costs are extraordinarily high compared to the same countries. We are not doing something right and financing strategies are only one piece of this complex puzzle. 27583 07/24/06 NV Agree we must provide coverage for all citizens Agree coordination is essential and must be led by the federal government; suggest this recommendation be dovetailed with #3 below to gain efficiencies and cost savings Agree i agree but believe this recommendation can be folded together with #2 above Disagree "if money were no object, i would agree; but this recommendation is worded in ways that do not allow quantification of costs, and also get into difficult ethical areas where different population sectors have very different beliefs.. this recommendation is potentially unfair" Agree strongly agree Agree "we increasingly are a nation of ""haves"" and ""have nots"" .. it is imperative that we find ways to provide care for all citizens and it is obvious that the ""haves"" (corporations and individuals) must assume a burden commensurate with their resources/earnings" this is a well thought-out approach to defining a baseline.. much needed ! thanks to all who have contributed their time and energy to this cause 27584 07/24/06 WA Agree "* I am concerned that the health care crisis always seems to center on insurance coverage. Insurance coverage does not equal health care. We need to forget about insurance plans and premiums, we need a single payor system of health care. Also, we need to ration health care. Organ transplants shouldn't be provided to people who are at the end of their life. Similarly, children who haven't yet begun to live shouldn't get organ transplants. These should continue to be extremely rare. The costs are just too high and take away from preventive services to safeguard the public health. We also need to eliminate consumer advertising of pharmaceuticals. " Disagree "I disagree because again, the private partnership always seems to mean insurance. We do not need insurance. We need to get rid of insurance. Overall, I mostly agree with this lesser of two evils plan." Agree I hope the government refuses to respond to the irresponsible criminals who cry about medical liability lawsuits. Health care should not be about who has the better lawyer. Agree "We need to have courts stay out of the end of life processes. Even when families can't agree, spouses have precedence over parents, parents have precedence over siblings... the courts have no business getting involved. " Agree I agree as long as the 'equal participation' from all Americans has nothing to do with insurance premiums. We should all pay taxes that fund health care services. Agree "I disagree with sin taxes. Unless the sins will include owning an SUV, working with and operating petroleum based fuels - the list of sins needs to be comprehensive." "Again, we need to ration health care. I know its a highly charged subject but we need to make tough decisions in order to get ourselves out of the hole that we've allowed big business to excavate. " 27586 07/24/06 WA Agree Agree Agree Agree In accessing the of care they want for their last days within the context of providing care that focuses on quality of life and does not support continued futile medical treatment. Agree Agree 27588 07/24/06 MS Agree We need to ensure that every individual that does have access to healthcare plans but chooses not to enroll is mandated to enroll (similar to auto ins). Agree I disagree with bullet point 3 regarding FQHCs. These entities do not always network in communities and are often disruptive to the healthcare system. Disagree I don't believe the public programs are good models to implement across the healthcare system Agree Agree Agree We need to combine public health with private health for one healthcare system. This will maximize resources and increase utilization. 27589 07/24/06 AZ Agree Agree Agree Agree Agree Strongly agree Agree 27591 07/24/06 MO Disagree "You confuse access to healthcare with ""insurance"". Your wording seems to imply the ""insurance companies full employment act"". I believe that all Americans should have access to necessary healthcare. I don't necessairly believe that means means via ""insurance"". Insurance is ONE WAY that healthcare gets paid for. There are many other ways." Disagree "Sounds like just another expanded government bureacuracy that costs more money and adds one more usless function. Rather than add more federal ""units"" find a way to better use the ones we have. The populations you identify absolutely need more access to healthcare. You don't propose here to get them better access but to add more government to an already disfunctional system overwhelmed with government intrusion. Find another way to get healthcare without expanding government." Agree Wonderful! Make the existing system accountable and more efficient. Empower citizens/patients to make informed decisions. Thanks Agree "One of the most recent estimates is that as much as 40% of healthcare costs are incurred in the last few weeks of life to support unnecessary ""heroic"" efforts. Known to healthcare providers as: ""The Million Dollar Sendoff"". Excellent suggestion. Improve pallative and hospice care. Pay for it." Agree "This is much better than your first suggestion to increase the size of insurance companies. Access to healthcare is the issue, NOT insurance. Insurance is only one way to ""finance"" healthcare." Agree "Very complicated.Much more complex than ""give everybody insurance"". I agree with your statement in principle. I want to see more detail." "Core ""benefits"" are different than insurance. But it still sounds like you are working on the behalf of insurance companies, not getting access to healthcare. If you can separate the two, which you haven't here, I would agree with your position." "I'm concerned that you don't understand the issues. This looks like an insurance company in drag. Access to core healthcare services is essential and I'd be willing to help pay for it with tax money. I don't understand your focus on ""insurance"" Show me how your recommendations result in better access and I'll support it. Start more government funded insurance companies and you lose me." 27592 07/24/06 CA Agree A national program should be implemented that provides a variety of plans for the total population. Health care provided by employers should be eliminated. Agree "The second bullet confuses me. It refers to an advisory group for ""health care safety net performance..."" Why not an advisory group for the entire health care program?" Agree The second bullet should be expanded to include portability of medical records. Agree Agree Agree 27594 07/24/06 WA Agree No response Agree Agree Agree Agree 27596 07/24/06 KS Agree Agree Agree Agree Americans need to continue to provide dignity to their loved ones throughout end of life care. Enabling this to happen is valuable. Agree Agree 27597 07/24/06 AZ Agree perfectly written. Now let's hope it can be implemented. Agree Agree These are insured products not offered through employers. Where do businesses fit under these models. Would they fall under Tricare types of products? Would this program eliminate healthcare through employers? Agree Agree Agree "I know that all this takes time, but many who lack health insurance and can not get it don't have much time. We need to fund this now." I didn't see maternity or family planning. Those are important too. Thank you for conducting these surveys. I hope our government listens. 27598 07/24/06 UT Agree "* These are enobling goals that I as a physician fully support. However, I doubt there currently exists any such program anywhere in the world that we canb copy, modify or adopt with adaptations to our unique American culture and expectations. My sister,her husband anf thier four children live in Montreal, Canada. Whereas the Candaian system had similar noble goals in mind when it was established, Canada now, unofficially, has a 2-tier system. MY brother-in-law can wait 3+ months within the ""public"" system for a liver unltrasound that is imperative to have as part of decision-making regarding his ongoing very expensive therapy for hepatitis or he can go ""privtae"" , pay out of pocket, and get the US within a day. I believe, it is absolutely imperative that as we set recommendations that we creat the model of health care delivery in mind. My question: we have the recommendations but where is the model of success !!!!!!" Agree Agree Agree Agree but please keep some personal responsibility and accountability within such a system. Also where is the prevention in the recommendations !!!! Agree "Again, do we have such a ""success"" model system anywhere in the world where we can copy, modify, adapt and adopt !!!!" already stated above. Thank you for your efforts. 27599 07/24/06 OR Agree How can anyone of conscience not agree? Agree "Every citizen should have access to high quality health care regardless of income, preexisting conditions, place of residence, etc. This can only be achieved at the national level. " Agree Agree Agree amen! Agree * For God's sake we need to stop talkking and start ACTING on the disgraceful system we have now. Where is the political leadership on this? The Bush hsa program is a total joke. When are our elected leader going to stop the games they are playing and start taking action on national health care? Get the drug companies and insurance companies out of the room in the beginning until the program is established. That means lookiing at sources of political money and not letting ther lap dogs in Congress lead the discussions. "Based on my skepticism that neither party will step forward to commit in making national health care a priiority, I am not holding my breath on reform. I hope I am proved wrong." 27600 07/24/06 IN Agree No response Agree "* However, I do have a great deal of concern over the electronic medical record system in terms of privacy, accuracy and completeness of information. I have myself experienced several instances where my physician was more concerned with input into the EMR than to listening to what I was telling him (this has, by the way, been more than one of my doctors and I have heard the same concern from others individuals) and also to errors in writing prescriptions that did not happen prior to the ""improved"" health care record. I think a very careful look needs to be taken at the accuracy of health care records, etc., before we go gung-ho towards EMR. Perhaps a mixture of EMR and old-fashioned transcription or charting needs to be implemented to gain a more complete picture of the patient. Certainly, the accuracy of prescribing, etc., when the prescriptions are spit out of a printer is an issue of major importance. In the cases I am aware of the patient was able to tell the doctor that multiple errors had been mad" Agree Agree "Access to health care should NOT be a function of one's employment. This discourages (or prohibits) individuals from changing jobs or starting their own businesses. I have my own business, but lack of access to health care benefits for my family dictates that I keep another job that is much less satisfactory, but through which I can purchase benefits. Thus, I am chained to a job I dislike and am limited in ability to expand the business I have created in order to provide insurance benefits for my family. " Agree 27601 07/24/06 CO No response Disagree "I am more concerned about the ""middle income"" individuals. Working hard to make ends meet, but supposedly making too much money to qualify for anything. It appears you have to be absolutely desolate or very well off to be included or exempt. We feel like the boat keeps filling up with water. Focus needs to be on the ENTIRE population with options in the event a catastrophic medical event occurs without sending you to the poor house." Agree This is a great option providing the improvements are passed on to the patient. Agree Agree See comments above. Agree All people benefiting from the healthcare treatment received need to be contributing...more give and take instead of always giving and supporting the same individuals. 27602 07/24/06 FL Agree "The very ""threat"" of financial ruin is enough to make us all sick. This protection is definitely needed in healthcare. " Agree "Reminds me of ""States Rights"" issues. We know what's best for our particular area of the country or community. Any change should be a cooperative effort with those agencies that are already in place." Agree "This is a ""given"". Anyone working in healthcare should always strive to provide better and more efficient care." Agree "ABSOLUTELY! Making these services readily available is a very important step forward. This provides peace of mind and a sense of freedom. Not being able to make these choices is almost as big a ""Threat"" to our seniors as the financial burden issue. " Agree Simplifying and standardizing the benefits and the way insurance policies explain those benefits would be a great place to start. There's no justifiable reason for insurance companies to make things so complicated and confusing (other than greed). Agree "The graduated subsidies concept seems to be an intelligent approach to begin with. I'm no financial genius, but I do know that any change MUST be fair. It's very unfair to allow persons of meand to continue taking advantage of Medicare." "I will leave the specifics up to those who know more about what can and cannot be done - financially. Again, it should be fair, but it should not be something that will ""break the bank"" before we start." "Thanks for the opportunity to comment. I hope this has not been an exercise in futility, but a real step toward healthcare reform." 27604 07/24/06 CO Disagree "* I believe the only way to insure all Americans, not just those low income individuals and families, is through a publically funded health care program. That's the job of government to look out for all . . . ie, defense, schools, etc. Americans can learn to take the best from health care systems around the world, minimize their minuses, and adapt them to America. No system will ever be perfect, but the priority has to be caring for us all. We have the ability to do it. We need the political will. Medicare has it's problems that require helpful solutions ( not those meant to undermine the system ), but it works at low overhead and for all those for whom it was intended. Medicare is not socialized medicine. It is socialized insurance." Disagree "I support Community Health Centers. They do an amazing job. But, it doesn't have to be as convoluted as the above structure sets out to do." Disagree "I generally agree with this statement, but I believe some of the text are code words for individuals bearing the burden of health care costs rather than spreading the risks out over all of us in order to keep costs in line. I hate the term 'provider,' a term coined by the insurance industry. I find it degrading. Physicians, nurses and other allied health professionals are just that, professionals, not providers." Agree Agree Agree "* I believe no system will be perfect. A system that puts the health needs of people first is the priority. I believe a public system, using as a model the best ideas from those systems that have been in place around the world and minimizing their minuses, is the only equitable and just approach. I do not want socialize medicine. I do want true freedom of choice of doctors, hospitals and other health care services - not from a list. We do not have that now. I do not want the government interfering with health care. I do not believe that will happen if the government is merely the conduit for payment of services, the insurer. A private supplement can surely be designed for those who wish to pay for more elaborate services. Those with more financial blessings will always want more. I believe a graduated income tax, in lieu of premiums, is the only fair way in our society to share the responsibility for caring for us all. If that means taking the insurance industry out of providing for the majority of health c" Please include in your list of experts physicians from Physicians for a National Health Program. These physicians are leaders in their fields as well as doctors who wish to see all of us cared for in a manner that is equitable and just. 27605 07/24/06 CO Disagree "* I believe the only way to insure all Americans, not just those low income individuals and families, is through a publically funded health care program. That's the job of government to look out for all . . . ie, defense, schools, etc. Americans can learn to take the best from health care systems around the world, minimize their minuses, and adapt them to America. No system will ever be perfect, but the priority has to be caring for us all. We have the ability to do it. We need the political will. Medicare has it's problems that require helpful solutions ( not those meant to undermine the system ), but it works at low overhead and for all those for whom it was intended. Medicare is not socialized medicine. It is socialized insurance." Disagree "I support Community Health Centers. They do an amazing job. But, it doesn't have to be as convoluted as the above structure sets out to do." Disagree "I generally agree with this statement, but I believe some of the text are code words for individuals bearing the burden of health care costs rather than spreading the risks out over all of us in order to keep costs in line. I hate the term 'provider,' a term coined by the insurance industry. I find it degrading. Physicians, nurses and other allied health professionals are just that, professionals, not providers." Agree Agree Agree "* I believe no system will be perfect. A system that puts the health needs of people first is the priority. I believe a public system, using as a model the best ideas from those systems that have been in place around the world and minimizing their minuses, is the only equitable and just approach. I do not want socialize medicine. I do want true freedom of choice of doctors, hospitals and other health care services - not from a list. We do not have that now. I do not want the government interfering with health care. I do not believe that will happen if the government is merely the conduit for payment of services, the insurer. A private supplement can surely be designed for those who wish to pay for more elaborate services. Those with more financial blessings will always want more. I believe a graduated income tax, in lieu of premiums, is the only fair way in our society to share the responsibility for caring for us all. If that means taking the insurance industry out of providing for the majority of health c" Please include in your list of experts physicians from Physicians for a National Health Program. These physicians are leaders in their fields as well as doctors who wish to see all of us cared for in a manner that is equitable and just. 27606 07/24/06 OR Agree Agree I'd like to see some figures on how much of the military budget would have to be cut to cover some basic health care for all Americans. Agree Agree "I do not agree, however, with heroic measures that add only a few months of life. Elder care should be evidenced-based, yet compassionate. Compassion oftens costs very little." Agree Agree Military budget. Limit care for the mentally ill to evidence-based programs. "There is increasing evidence that poor oral health contributes to systemic disease. I would, however, focus on preventive dental measures during the prenatal time period through the age of 2." "Since about 50% of Americans are without health insurance and I pay $300/month for myself, I figure that I will have to come up with another $300/month for a fellow human being. If the plan calls for more than that, I'll ask why. And thank you so much for proposing legislation to deal with this issue." 27608 07/24/06 CO Agree "The word ""coverage"" sounds like health insurance. Our group was very clear that health insurance is not the issue; it is access to health care. I agree with protection against very high out of pocket costs and financial protection for low-income families." Agree "* I agree with this as long as decisions don't get tied up in the federal government for many years. The federal government has had many opportunities in the last 10 years to come up with solutions, but has been unsuccesful. Community Health Centers cannot pick up the responsibility for all low-income or uninsured individuals so getting private providers to commit to the provision of some amount of care is essential. Private providers tell me that the #1 reason they don't accept Medicaid, Medicare or Tricare patients is because of the low-reimbursement rates. " Agree "To reiterate my comments above, the number one reason physicians don 't accept public programs is due to the low reimbursement rates. The government will need at a minimum to assure that the costs of providing care are covered. Perhaps an incentive program based on the % of care provided to low-income/uninsured patients could be looked at. " Agree Agree "I am pleased to see that the focus in this recommendation is on health care, not on health insurance. " Agree "If I could, I would like to allocate my tax dollars in the way I see fit, just as you do when you make a contribution to a non-profit organization. That way politicians would really see directly American's priorities and lobbyists would be left out of the picture." It is important to ask the people without healthcare what they want not always those of us who have it. We may not understand their priorities as well as we think. "Yes, please please do something so this is not just another wasted effort. As a public health nurse, it breaks my heart to see people who have to go without care or who have to wait months to see a specialist. We need a system that encourages or provides incentives to private providers to accept Medicaid, Medicare and uninsured patients." 27609 07/24/06 NM Agree Single payer or Universal Health Care should be put back on the table. Agree Agree Agree Agree Disagree Single Payer is the best option 27610 07/24/06 OR Agree Absolutely imperative! Agree Agree Agree Agree Agree Very important to include mental and dental care. 27611 07/24/06 MO Agree "Health care should be a basic human right, not a choice..." Agree Agree Agree Agree Agree "* While I recognize that a movement towards universal health coverage towards all will be costly, I don't necessarily think that the brunt of the expenses should be borne by your average citizens. If the US would focus more of its financial resources on care for its citizens, especially the most vulnerable ones, then there is more than enough money now to cover the expenses of providing health care. It would mean reallocating funds that are currently being used towards ""corporate welfare"" and financing the military. If we change our mindset there is already enough. For example, one of the first things G. W. Bush did when he became President was increase the salary of the President--why? He was already wealthy and any person running for the office of the President aren't necessarily doing it for the wealth associated with the position. If we took that $150,000 pay raise and other similar hikes, then we could more than afford to finance health care. Other countries do it and if we are supposed to be one" 27612 07/24/06 OH Agree Agree Agree Agree Agree Agree this has to be done. 27613 07/24/06 CO Agree I strongly believe that the poorest deserve the greatest protections. Agree I believe that the government should be the primary coordinator/sponsor of healthcare. I believe that it in IMMORAL for private entities to profit from providing healthcare to those in need! Agree I believe that prevention through education and training should be paramount. Agree I heartily agree! I also believe that physicial assisted euthanasia should be available according to the Oregon Model. Agree I strongly agree with Universal Healthcare. I believe that efficiency of the system needs to be improved through universal administrative procedures. The patchwork system needs to be abolished. Use the Canada Model and perhaps look at the healthcare system in France. Agree "* 1. Reduce administrative cocts (currently about 30% of total healthcare costs, Canada is about 1%) through standardizing administration of healthcare. 2. Lower the emphasis on expensive high tech and exotic treatments. 3. Allow Medicare to negotiate lower drug prices. 4. Allow importation of drugs from Canada and other safe sources. 5. Promote healthy lifestyles (exercise, diet, etc.) through education and training as well as media campaigns. 6. Use ""sin"" taxes on harmful products and practices. 7. Utilize a progressive taxation so that the poorest pay the least for quality care." Utilize a priority type system (such as is used in Oregon) to determine which treatments/procedures to list and the priority of those treatments/procedures. Everyone deserves to have healthcare. Healthcare should not be an object of politics nor the basis for profiting on someone else's misfortune. 27614 07/24/06 WA Agree Absolutely. No response "* This is not clear to me. Is this creating another layer? Are you just talking about expanding services to vulnerable populations? What is a ""national initiative""? If we had a set of core services available to everyone, then it seems, simply, that we need places all over the country where those services can be accessed. So, we need funding. Do we really want to recommend more ""research"" on whose falling through the safety net when now what we want is action in getting care to everyone. While statistics and other information would have to be the basis for creating care centers, I'm worried this project will not result in any specific changes while people say ""we need to do more research on who the vulnerable populations are...""" Agree "* I agree with the thoughts but is there any reason to think there would be political or fiscal will to increase funding to those programs which are already targeted by the Republicans for reductions or elimination? I especially agree that some kind of information technology that would enable patients to carry around their ""health history smart card"" would go a long way toward simplification of the gathering of health histories by medical personnel and also help guard against medical and pharmaceutical mistakes." Agree "We should have laws allowing death with dignity in every state and palliative care should be, if not already, a part of medical training for all medical professionals. I think the recommendation that payers should ""integrate ... so health services and community based care can better deal with..."" is too general to be of any value as a recommendation for changing our health care system. " Agree Amen. Agree "* I think a very basic, taxpayer financed program should be the starting place. Everyone should have a basic set of services available to him/her so that we can begin to use preventive care to lower overall costs. Once that basic set of services is in place for a while, perhaps people will be more amenable to increasing the level of services provided when they see the overall benefit to our society. I have no objection to the idea of a ""user fee"" or specific health care tax that is progressive rather than paying for a national benefit out of general tax revenues. It might be more acceptable to people if they see that they are getting a tangible benefit every year." "I agree generally except I don't understand the first sentence of the second paragraph. What is ""go across the continuum of care...""? And if you have a panel decided what the core benefits are, why do you define health care in this section in a manner implying that core benefits must cover all those things? I'd like this better if the second section were deleted or if parts of it (eg re evidence based medicine) were incorporated into the first section." "Though these comments obviously reflect feedback from the public meetings, I wonder if they should be structured so that there is a general statement of the policy or health care goals favored by the public and then a more specific recommendation of what should be done to further those policy type goals. As it is, there seems to be a mishmash of the two so that the recommendation is missed-i.e., you can't see the forest for the trees..." 27616 07/24/06 NV Agree "The Secretary of Health and Human Services, Michael Leavitt, needs to commit to endorsing this recommendation and advocating for it publicly and with private health companies of all stripes." Agree "The Secretary of Health and Human Services, Michael Leavitt, needs to commit to endorsing and advocating for this recommendation both within government and publicly." Agree "The Secretary of Health and Human Services, Michael Leavitt, needs to commit to endorsing and advocating for this recommendation within government and publicly." Agree "The Secretary of Health and Human Resources, Michael Leavitte, needs to commit to endorsing and advocating for this recommendation both within government and publicly." Agree "The Secretary of Health and Human Services, Michael Leavitt, needs to commit to endorsing and advocating for this recommendation both within government and publicly." Disagree "The Secretary of Health and Human Services, Michael Leavitt, needs to commit to peace, lower our imperial military spending and use those funds to provide universal health care for all Americans." Non-profit groups need to be given the lead to determine the core package for universal health care for all Americans. "The U.S. has the most profitable health care system in the world for private companies; we spend more per person for health care but receive smaller benefit. The Secretary for Health and Human Services, Michael Leavitt, needs to commit to endorsing and advocating for universal health care for all Americans. This needs to be a public commitment in order that its direction can be monitored by all Americans." 27618 07/24/06 WA Agree Agree Agree Agree Agree Agree "Payroll tax that pays for everyone, even those who are unemployed." "The ""core"" package should be what members of congress get. This should be available to all Americans. If we cut the insurance companies out of the loop, we shouldn't have any trouble paying for it. We can probably pay for it out of what the government already pays for health care. If you don't believe me look to Canada, Europe, or Japan. If you don't think it's important, as GM." 27620 07/24/06 MI Agree Agree Agree Agree Agree Agree 27621 07/24/06 MO Disagree "The recommendation is written in such a way that it would perpetuate private and government payor systems that don't work. It also leaves undefined ""very high...costs.""" Disagree "With the current White House Administration, I would be wary of any federal government intervention on this scale in health care. They have politicized private matters and would likely not cover critical aspects of care. " Disagree "I don't believe the federal government is capable of accomplishing this objective. This appears to me to be a way to cut coverage, not costs. As long as business runs health care delivery, they will always make a profit." Disagree "Here again, I do not want the federal government involved in end of life issues because it is another politicized topic." Disagree "As long as health care is provided by private companies, it must not be mandatory that people pay into that system. " Agree "In the past, I would not have objected to a publically, tax-supported system under normal circumstances. However, this Administration has shown how even private health care matters can become political issues." "I have been a proponent of publically-funded, universal health care that would increase access to care for persons with low incomes and everyone else. However, I felt that even the questions asked at the public meeting I attended served to perpetuate the broken, profit-driven private insurance system. The survey questions were biased in favor of the insurance system." 27622 07/24/06 AL Agree "I hope it would cover access to the basics, including evidence-based (midwifery) maternity care and nurse practitioners. I think it would be a good thing if nurse-practitioners provided a lot of care and like the British system, physicians were specialists called in only when needed. PS I am only a consumer, not a nurse or other health provider. " Agree "I'm not sure I like the idea of the government having access to my private health information, but believe many people are overlooked in the current system. " Agree "Physicans and evidence-based practices are like oil and water. Too often they do what they were trained to do; what is habit and NOT what is evidence based. Give us equal access to providers like chiropractors, physical therapists, and midwives!!" Disagree "I'm not sure, I can see this leading into euthanasia for the ill and elderly if they become too expensive or burdensome. " Agree "It would be nice but there isn't any such thing as something for nothing. How about more information and societal support for wellness, like exercise, healthy foods, vitamins and wellness providers like midwives/" Disagree "* We pay out the nose for insurance, and pay out the nose each year for deductibles and co-pays. And we have ""good"" insurance. We work hard to provide this for our family. If it is a tax on percentage of income, all should be subject to the same fair percentage. I wish it were less profitable for physicians' and drug companies. Some profit is good, these outrageous profits are insane. Keep our right to sue in a court of law, especially if we are limited by insurance constraints what kind of health care we must use. If I'm paying the ridiculous kind of money I'm paying for this care I don't expect mistakes, errors or a hurried care provider. " "Expert consensus does not constitute evidence based medicine! For example, what the WHO recommends as evidence-based is surprisingly different from the American College of Obstetricians & Gynecologists. Core benefits should be determined by looking at what the WHO, Cochrane Collaboration and others with out the profit motive have determined are good studies to base care decisions on, not the money and power grab inherent in protecting American physicians' interests. " These are radical changes. I think the American public needs a good lesson or two on how they are overpaying for scientifically useless medical care much of the time. Let me know if you need documentation for any of this. 27623 07/24/06 FL Disagree all americans need financial protection from high costs of healthcare Disagree we have plenty of programs for the poor. we need coverage for the rest of the population. most all of us are underinsured. Disagree "* federal programs are inefficient. we need new models of health delivery capable of serving people across the economic spectrum. we need to stop separating people economically and decide that a person in need, is a person in need. what bureaucrat wrote these recommendations. If providers have received monetary assistance to attend medical school, nursing school, dental school, they should be required to participate in programs to give back what they would have otherwise been unable to afford. In Florida you can't hardly find a doctor or dentist willing to take medicaid. Thats why our emergencies rooms are packed." Disagree our hospice programs are not broken. they work pretty well. leave it alone. hospice is a difficult concept for the providers and the families trying to cope with death in a country that can't even talk a death. Agree basic healthcare should be available to all regardless of economic status. Agree "everyone need to pay for this expense. the taxation venues above place to much burden on a small percentage of americans. maybe a flat tax needs to be looked at. we need not to provide healthcare to people who are not legal citizens of our country. if they want or need healthcare, they need to pay for it. most all other countries function under this rule." i agree but know that we do not have enough healthcare providers to accomplish this task. we have to many people in our country to make this work. "healthcare is probably the most important issue for the american people to look at. however, it always seems to be important during elections but forgotten about after elections. all americans from all ecomonic catagories should be able to access a basic list of health services." 27624 07/24/06 FL Agree Agree "However, I prefer a public-only plan." Agree "By utilizing more Nurse Practioners and Registered Nurses, the federal government could cut costs and improve quality of care." Agree Agree Agree 27625 07/24/06 MO Agree Disagree "* FQHCs have become a ""subsidized competitor"" in the free marketplace--and as such are a threat to the private practitioners. Their initial creation was targeted at vulnerable populations who could not afford necessary care. Since that time, their reach has extended into funding advertising for fee-for-service clients--a practice that unfairly competes (with Federal subsidy monies) with private enterprise clinics. Require FQHCs to stick to their target population and not compete for patients with private practitioners." Agree Disagree Informed decisions to end life should be respected--and the system should include professionals experienced in counseling and delivering (making available) techniques for ending life. Agree Disagree "The beginnings of life--in utero--are of key importance in producing well babies and hearty adults. Emphasis in good prenatal practices is a BIG MISSING in healthcare today. This one arena would go far toward a ""wellness model"" of health delivery." 27626 07/24/06 NV Agree "* Please make sure that people with decent incomes are also included. My husband had kidney failure and we nearly lost our home because our combined income was just under $50,000. No one ever bothered to subtract his medical costs out of our total salaries and even though we looked solvent on paper, there were many times while he was alive that I did not get enough to eat. In addition, our power, water and gas were shut off on a regular basis and we were told repeatedly to get divorced so that he could get help based solely on his Social Security. After 33 years of marriage, we just couldn't do it, and it would have been fraud anyway." Agree Steps must be taken from the outset to insure that this does not become another unmanageable program such as Welfare. Agree "* What is TRICARE? Also, please make sure that whatever test or medicine the doctor orders is avaliable to the patient. I fought with insurance companies for years to get what the doctor ordered for my chronically ill husband rather than settle for lesser cost alternatives promoted by the insurance companies. Nearly every time we settled for these lower cost options, we ended up having to go with the doctors' recommendations anyway because the alternative did not work for him. This had to have increased the cost of his care. Doctors know their patients and the insurance companies should not have the power to modify their instructions." Agree "Amen, amen amen!!!!!" Agree "I repeat, make sure that when the financial guidelines are set, they encompass working families who are trying to maintain jobs. A chronically ill person requires at least a $100,000 a year income or more and medical costs must be subtracted from the family's take home pay to get a true picture of the financial condition in the home. People who have worked hard all their lives should not lose their homes or not be able to eat because of chronic illness." Agree "* Both medical insurance companies and pharmaceutical companies are way too powerful in this country. There should be new laws regarding the lobbyists for these companies. Part of the money they use for research should be spent to insure coverage for all. Congress and the President needs to hear testimony from families like mine to understand how they have to live under the present system in order to keep someone they love alive. In addition, I am sick to death of hearing people say there is a finite amount of money for healthcare as there does not seem to be a finite amount of money to finance the war in Iraq. In addition, the US needs to cut back sharply on its foreign aid. People who have worked hard and paid taxes faithfully all their lives can't get what they need. Charity begins at home and most of the countries we provide financial aid for don't respect us anyway. American lawmakers need to take care of Americans first, and if there is money left over, then give to other countries in much the same way" "Please, please, please make sure that people who have lived this ugly mess that is American healthcare in order to keep someone they love alive are part of this group. No one who has not been through the process is qualified to make any decision regarding what constitutes core benefits. Please do not allow this group to become a voice for what the medical insurance and pharmaceutical companies want." Hundreds of thousands of Americans suffer every day because of skyrocketing health care costs and our government has not taken steps to help them. The only way you can hope to survive is to defraud by divorcing or quitting your job. This is not the value system that our country was founded on. We need to get back to basics. 27628 07/24/06 NV Agree I am saddened when I hear the particularly the elderly sometimes have to choose between medicine and food... and the president's plan to alleviate this burden sounds totally unwieldly Agree agree with all above Agree mainly interested in the aspect of cutting out waste and streamlining what we have... Agree "yes, these measures will allow people to die with dignity" Agree some measure that addresses the drain by non citizens or eligible residents needs to be looked to stem the use of these resources and have them run out for those who are eligible... Immigration issues need real work Agree "a system that encourages preventative care, and rewards efforts that promote health should be emphasized" "very glad that dental and mental health are included, these should never be optional or stigmatized...." "thanks for doing this valuable work, hope our President is listening and will help with this... as well as the congress..." 27629 07/24/06 CA Agree none Disagree Rather than this public-private bureaucracy we should have a single payor system. There should be transition benefits (eg retraining or priority for employment in the single payor sytem) for those in the private med insurance industry that will be displaced. Agree none Agree There still should be a single payor system. Private sector organization that are interested in this services can collaborate. Agree Disagree Should be single payor. The private medical insurance industry and pharmaceutical industry are too powerful and there would be a risk of them dominating this process if they participate. Support a single payor system. Provide trsansitional benefits for those to be displaced by the phasing out of the private medical insurance business. 27630 07/24/06 CA Agree Agree Agree Agree Agree Agree 27631 07/24/06 IL Agree My greatest fear since I lost my job last year is that with a major health issue I would lose my home if I couldn't pay the hospital. I'm told there are now almost 50 million American citizens without health care coverage and over 1 million work for WalMart and other Big Box Stores. Agree Rural residents have even a smaller chance of getting healthcare treatment and are forced to relie on folk remedies. Agree It's important to prevent health problems before they occur or get worse. Rx costs are too high to the Drug Companies I stopped taking my Lipitor because it was a choice between paying my food costs and other bills and this drug. I'm told that in Canada and Europe the drugs are 50% or less because their governments don't allow the drug companies to rip off individuals or Government programs. Agree When my mother was at the end of her life from cancer I had to have a lawyer speak to her Doctor in order to increase the level of the morphine pain killer so that she wasn't crying out in agony all of the time. Agree We spend the most and have the worst system! I'm not asking for the level that Congress has but can't we at least have one equal to Europe or Canada! Agree "Just remember, if your out of work it's diificult to pay for anything. The rich can always afford it and should pay more into the system with no fixed cut off point for health taxes. Walt" Excellent summary. Walt I hope to live to see this enacted. God bless you for taking the time to listen to people. 27632 07/24/06 AZ Agree "This sounds nice, but each word needs defining so that ambiguity, misuse, or misinterpretation do not occur, by either the government or the people." Agree "Additionally, establishing community-based health care centers in inner cities where there isn't an adequate center at the present time. Again, define words used." Agree Prevention of pharmaceutical or research involvement/influence/lobbying that would provide an ethical conflict with decisions made. Disagree "* This doesn't address the needs of those who are uninsured because of their pay levels; are disabled, can't get work with sufficient pay, & have no insurance; or individuals in this country for school or a short work visa and have no health care access and no money. Additionally, if those with chronic illnesses have better access to care and treatment early in life, they would be able to work and contribute financially to the health care and tax system that looks after them. Providing treatment and therapy early in life makes good fiscal sense." Agree Agree "Additionally, if those with chronic illnesses have better access to care and treatment early in life, they would be able to work and contribute financially to the health care and tax system that looks after them. Providing treatment and therapy early in life makes good fiscal sense." 27633 07/24/06 ND Agree * The key isue is access to necessary services including primary care. Americans face the most resource rich and inefficient delivery system in the industrialized world. Upper-middle class families with far better than average insurance coverage can be bankrupted by a single encounter with the U. S. healthcare system. Emphasis must be shifted to access to services and away from insurance coverage. No system that allows stratified or unequal delivery of services based on wealth of the consumer is defensible in a country that the most resource rich in the world! Agree "Initiatives should be established to eliminate wasteful competition within communities and to encourage networking that facilitates shared and efficient use of resources. Regardless of the funding mechanism used, the model of consumer governed and directed delivery of culturally competent primary health services should be replicated throughout the country (not limited to HPSA's and impovrished areas)." Agree Agree Agree These objectives are absolutely fundamental to repairing the very broken U. S. health care system. Disagree Access to needed services is a far more pressing issue than insurance coverage. The American preoccupation with insurance coverage is the single largest contributer to waste and inefficiency in our service delivery system. This approach will lead to a stratified access to services which cannot be tolerated in the most resource rich healthcare system in the world! All Americans should be entitled to whatever health services are needed to maintain a state of optimum health. "I hold out little hope for constructive reform in the current political climate, but voicing the issues here presented is a very positive first step. Constructive reform will take place when the public will no longer tolerate the status quo." 27634 07/24/06 CA Agree Agree Agree Agree Agree Agree 27635 07/24/06 CA Agree In my opinion it will be very difficult to have private organizations work together to provide a seamless system. The Medicare Part D Program is an example of what not to do. A National Program of this size and complexity must be managed by a government agency in order to assure quality and cost-effectiveness. Agree "* It is imperative that the Federal Government expand and update the existing FQHC concept. Many of the criteria that are used to grant FQHC status to clinics are outdated and not well suited to today's healthcare environment. It will be very difficult to get Public-Private cooperation in healthcare because the cost of providing care to poor and indigent people is very expensive. Unless the cooperation is between a non-profit hospital and a community based clinic, I do not see this concept working. In order for this to work well however, the Federal Government needs to develop national rules and regulations that mandate clearly how community benefit programs should work. In this era of technology the government will need to provide assistance both financial and technical to help move these local partnerships forward in developing better systems for sharing patient information. This will also be critical to the success of these partnerships at the local level." Agree The government also needs to target county health systems and community clinic coalitions not just academic centers. Disagree "As an internist I frequently see patients with terminal illnesses and understand the emotional and financial stress that ensues. However, from a public health perspective, I do not feel that this is where our national agenda should be focused. We should be focusing on ensuring less individuals develop chronic illnesses and in treating those who already have a chronic illness." Agree "This will fundamentally change our society for the better. It will be critical to engage all interested parties including the private sector, academia, medical societies, consumer groups, etc..." Agree We need to make sure that the transition period is very well thought out. I would be honored to be part of this group! I am very glad to see that my government is moving forward with this. 27636 07/24/06 TX Agree develop a universal coverage program for all americasns Agree It is urgent to begn as soon as possible! Agree Integration strategies are needed; much work already done. Agree this is an important and less emphasized area of care that needs expansion. Agree Emphasize all Americans. Agree The time is NOW! the needs are multiple. comprehensive services are needed. 27637 07/24/06 MO Agree Cost for procedures need to be regulated. I also feel patients should know a probable cost for procedures. Perhaps a minimum to maximum range could be established and presented before procedures take place. When feasible patients could even start to make incremental payments before procedures. Disagree I think the population needs to be dispersed throughout healthcare. Clustering vulnerable populations increases the likelihood of quality care Agree Agree Agree Agree Income-based? 27640 07/24/06 CA Disagree * I almost agree but would prefer to make health coverage a requirment of all residents and make it the responisiblity of each family to get their own health coverage. I would also like a federal program to help families with chronic illness or illnesses that could be fatal and for which health care would burden and inflate the cost of providing health insurance to the general population. I would also like a federal program to fund the cost of people who are not empoyed/employable. I would urge that we not provide medical coverage for people who are employed. I would also urge that legislation be introduced that an employer may not hire a person without health insurance. Agree I woud like to see funding for non-profit groups to provide prevantative health and minor medical attention. Along with that I would also like to see citizen groups deliberating on potential medical law suits prior to a formal legal hearing. Agree I would encourage that oversight resposiblity be given to local groups/non-profit groups/faith based organizations Agree I would encourage the federal government seek partnerships with local non-profits and faithbased organizations. Disagree I agree with the first statement but have trouble with providing financial assistance to those who need it. I would like to tighten the definition to provide assistance to those that are not employed/employable or those with chronic illness or life threatining illnesses that create a financial hardship for the family. I would not favaor helping people who are employed. I would also like to inlcude legislation that would make it mandatory for employers to hire only people with health coverage. Disagree I would like to move toward individuals financing their own health care unless they are not employed/employable/have a chronic illness or life threatning illness condition. I would also like to relieve the businesses community of this financial burden but would like to make mandatory that all workers have health insurance and would like to put that responisblity on the employers. "I think specialist from the health industry should speak before congress and that congress can and should make decisions that would proivde healthcare that includes physical, mental and dental to all Amreicans while providing an environemnt that increases the quality and reduces the cost of health care." 27641 07/24/06 ND Agree "Rationing health care by ability to pay is inhumane. The effect is to punish those who have the misfortune of illness. Further, it actually costs us all extra because people spend their money on catastrophic care meaning they don't have money for healthy diets or other activities that could improve their health. Eventually, they cannot cover their care and everyone pays by higher medical costs or bailing out hospitals." Agree The federal government has a stake in assuring healthy productive citizens. Agree We must do better at using current technology to improve administration of our health care systems both reducing costs and improving quality. At the same time we must safeguard health privacy for individuals to prevent discrimination. Agree End of life care takes too large a chunk of our health care dollars. Individuals need to understand their options and realistic alternatives to make their best decisions with respect to the quality of their life. Agree Health care costs are a drain on businesses and make it difficult to compete in global markets. People can not attain satisfactory productivity when they have health care issues hanging over them. Agree "We pay a lot for health care in which some--but not all--get a high quality of care. The goal should be to reallocate current health care dollars to provide more efficient, effective and high quality care for all." 27643 07/24/06 AZ Agree Favor expanding the Medicare Part A & B coverage concept with private insurers managed by a Federal (or State) system for all Americans. Agree Agree "Model technology from those institutions that have successfully implemented heath information systems solutions for medical records, pharmacy, clinical outcomes, etc." Agree Provide intensive health care professionals' training about dealing with patients who can/must make end-of-life decisions that will encourage quality of life rather than only prolonging life. Work to educate the public on the potential good of palliative and hospice care rather than the more-current perception that is a moment before death. Agree "Citizens should have options for a basic package and then options/additions as life changes occur. For example, child-bearing age adults should be offered pregnancy options. All ages must have a basic care and not be allowed to option out. Sliding-scale fees could help control utilization." Agree "All Americans MUST participate to make any system affordable. If only those in need subscribe the costs are too high. Just as contributing to Medicare or in most cases Social Security is not an option, health care would be mandatory participation." We must find ways through the use of best practices and technology to remove or reduce the volume of administrative costs now operating in health care. 27644 07/24/06 ND Agree Agree Agree Agree Agree Agree 27645 07/24/06 WA Agree Agree Agree Agree Agree Agree "All this should be implemented with a single ""Health"" card, issued to all Americans, fully secured and integrated within a comprehensive informational data-base. Finger prints, eye recognition or any other recognized security mechanism will insure appropriate usage by citizens." 27646 07/24/06 UT Agree The challenge is how to pay for what will become unlimited demand. Agree "It is critical that best practices be established by an independent panel of experts, using the best available science, not subject to modification of findings on ANY basis but the best available, independent, science." Disagree "* The very best place to start the health education and health promotion programs are in the local schools. Unless we begin at the earliest ages, and maintain the process throughout public education years, we will not accomplish needed goals with regard to consumer capabilities to be informed health care consumers -- that is, being able to assess what they need, what are reasonable costs, and what are best practices. For those beyond the public school years, the education and promotion of health issues has already proved extremely difficult -- just ask the myriad agencies and dedicated associations who have been trying for years to have 100% reduction in smoking, or who have been providing information about obesity issues, or the like. Having said all that, local approaches have the likelihood of being closer to the cultural preferences/predilictions of their population than a typical ""one-size-fits-all"" federal approach -- and less likely to be uniformly subject to a federal political slant." Agree "There should also be greater education of clergy -- both ordained and lay -- in how to assist their members in reaching the hard decisions to cease ""active"" treatment and instead choose palliative care. The various religious bodies need to empower their members to be able to say ""No"" to providers of care who want to undertake ""another procedure"" which has a 1% chance...." Disagree "* ""Affordable"" is not uniformly defined across any segment of the population. There is also a wide disconnect in the general population between their expectations of cost (and likelihood of use) of medical care and the actual levels of cost and use. As has been observed over and over in state legislatures, special interest groups want ""their"" disease/condition/mode of treatment ""covered"", and regardless of the impact on the general health of the population, it ends up being mandated. There has to be an acknowledgment that not all care can be provided or afforded, and that there will have to be rationing in what is part of the ""core"". Otherwise the ""core"" will be forced through the political process to include ""everything""." Disagree "* I live in Utah. What is one person's practice of healthy living (moderate consumption of alcohol -- consistent with scientific findings -- is another person's sin. I am concerned about ""sin"" taxes. The best approach is to require ALL Americans to have health insurance and maintain it in force over time -- the problem arises when the ""I don't need it, I'm healthy"" person then has an unexpected medical problem, and wants ""someone else"" to pay for it. ALL need to be ""insured"", so that the ""young immortals"" are paying into the system for those times when they will no longer be young nor immortal." "* Very few ""preventative"" services actually are (excluding immunizations) -- they are ""early diagnostic""! The last thing we need to be doing is encouraging, for example, annual physicals for healthy males between the ages of 20 and 35. Yet to cover something is to encourage its use, needed or not, as has been documented time and again by insurers -- one example is insurers being forced to pay for ""protein modified Twinkies"" once coverage for foods for inborn errors of metabolism has been mandated. Auto insurance does not include coverage for oil changes. ""Core health care services"" should not include the equivalents." "* If we are to move into this arena, because financial incentives and disincentives are so powerful, we need to be prepared to have different costs for different lifestyle behaviors, based on the scientific findings regarding those behaviors on expected health care costs -- not just current but future. So, for example, the obese would have to pay more for the same coverage compared to the individual with a body mass index of 25 or less. And maybe the cost would be higher for a BMI of 40 than for a BMI of 35, and that would be higher than for a BMI of 30. A diabetic who failed to maintain an acceptable hA1c might have to pay more than a diabetic who managed their disease well. We also have to be prepared to really examine the pharmaceutical industry, and identify those lower cost drugs that are as effective (or more so) compared to the ""newest and greatest"". A great example is the documentation that simple (and very low cost) diuretics often are most effective in addressing hypertension, when compar" 27647 07/24/06 AL Disagree "* 1. Define Americans--do you mean citizens, quasi-citizens,etc. If not there going to be loopholes for anyone in this country and the cost will be prohibitive. Very important to define the coverage pool LEGALLY up front. 2. Again what protection? individual tax deductions, government (tax subsidy, charitible pools? 3. Ties in with 1 & 2 but more specific is WHAT is going to be covered. Coronary by pass for high risk patients, correction of major medical complications stemming from criminal activity? " Agree "The ""safety net"" needs to be well thought out and defined. It should not take away an individuals primary responsibility for providing health care coverage for themselves and their family. Also need to tie in pharmacuetical coverage and payment structures. Generics should be the first tier. " Agree "Economies of scale is need to hold down costs. Individuals could select between a HMO, preferred provider, or traditional plan/hybred depending on personal need and resources. " Agree "Need to be careful that it does not result in the build up of a whole new ""end of care"" structure with increases in personnel and ""brick and morter"" at taxpayer expense." Agree "Again, define the covered group legally--exactly who. Also with out reasonable constraints it would be cost prohibitive." Agree "* Be very careful on the behavior taxes. Some of the more costly episodes of health care result from a lack of PERSONAL responsibility of human actions and not legal ingestive substances. Also I know of more than a few cases of high costs for imagining studies, corrective treatment and follow on physical therapy resulting from the pursuit of ""wellness"" life styles. Have even be associated with obese vegans. One tax stream that needs to be visited is a tax on ""wellness"" products and equipment. ""Wellness"" life styles add to health care too and are an often overlooked revenue source. (if you'll pay $200 for your custom jogging shoes so you can get your endomorphine high, an extra $20 isn't going to hurt). Also the increase in Social Security and Medicare outlays is affected by the life style ""wellness"" component. " "You need to have a lay person finance board also. Once the experts are involved conditions and treatments miraculously multiply. Funny how that happens. THere need to be an established ""bang for the buck"" fincancial clause with caps on services provided or the system will fail." I wish you well with you endeavor. I had the priviledge to review and comment on the entire Clinton Health plan in a former life and found out that afterwards I was in need of advanced services! 27651 07/24/06 CO Agree It is needed and urgent Agree very needed and urgent Agree Agree Agree This will improve the quality and health of our entire nation Agree "Yes, we need this recommendation" 27652 07/24/06 AZ Agree "* I agree with this recommendation except any one who gets health care must show citizen ship papers in other words be an AMERICAN. If not; show citizenship of a country and healthcarecoverage from that country,. This is not a ""freebe"" for the world!!!!!! Babies born in this country born of mothers from another country will be citizens of the mothers country and paid for by that country. Immigrants from another country must show health insurance or buy it at the border. This is necessary if our above plan is accepted. Automobiles require this why not people??" Agree I agree except must show citizenship papers or be persuing them. Local clinics. Manned by pa's or inturns. Agree "A system like this needs to be completely computerized, easily accessable and available." Agree Agree A person's income and financial structure will limit his health care unless his employer is required to make it available as part of salary. Ex: a person on minimum wage cannot afford healthcare so need a place like va is to vertrans for low wage health care. Agree "If at all possible get away from Health care providers that limit doctors services,. Also I do not like drugs pushed at doc's ofc and if doc pushes the drug tha doc get a premium. Drug Companies are running our country." 27654 07/24/06 NC Agree Agree Agree Promote the use of Advanced Practice Nurses by supporting/funding their education in return for a specified length of service in underserved/uninsured areas Agree Promote the use of these services instead of wasting money in experimental treatments. Place limits on the use of high cost therapies with limited survival and unproven track records. Agree Agree "We must support our people at home, instead of spending our money in underdeveloped countries. The rich, and large corporations must step forward to help address this issue." "These benefits should include vaccines. As people age, and begin to engage in unhealthy behaviors such as smoking, drinking, and illicit drug use, benefits should be eliminated. No aggressive treatment for lung cancer for the smoker. No liver transplant for the drinker, etc." 27655 07/24/06 OR Agree Disagree If there is universal access/coverage ( the first recommendation) then there will not be a need for a safety net. All persons will receive a core set of basic heralth care services and goods. Agree Agree I believe that an evidence based core benefit package would have to include end of life services such as these. Agree Redundant if the first recommendation is followed. Agree "eventually, only a single payor system achieves this." "The problem is that to be sustainable, the core benefits will have to exclude some beneficial care, at least beneficial as seen by some individuals. How do we do this?" 27656 07/24/06 CA Agree Agree Agree Agree Agree Agree 27657 07/24/06 GA Agree "People are hurting and it is not about money It is about people caring enough to help other Americans and if we won't help the oppressed then we aren't American the Land of the caring. I think Hitler, Sadam, and Alkida would have changed if someone lent them a hand yet without this we are Sadam, Hitler or someone else worse off than them." Agree The Federal Govt is almost out of money it will have to come from the people. Agree No person has any right to refuse anyone anything or they become the enemy. Agree Where will the money come from maybe the people buiding bridges when they are perfectly--greed. Agree Anyone present in America is here because of promotion of our caring. Well can each one of us saying for positive someone's life has gotten better by helping someone worse off than us. Agree "Health is wholestic spiritual, mental, and physical" 27658 07/24/06 CO Agree Agree Agree Agree Agree Agree 27659 07/24/06 FL Agree Agree Agree Agree Agree "emphasis is on ""core"" services " Agree 27660 07/24/06 CA Agree Disagree "too many recommendations tied into one. e.g. I don't know if the solution is a private/public group; I don't know what the ""Federally Qualified Health Center"" refered to in bullet point three is; yet I agree with bullet point four." Agree Agree Agree Agree 27661 07/24/06 CA Agree Agree Agree Agree Agree Agree 27664 07/24/06 UT Agree Agree Agree Agree Agree Agree 27665 07/24/06 WA Agree Agree Agree Agree Agree Agree 27666 07/24/06 FL Agree "Provide a basic coverage for everyone, and encourage as many citizens as possible to also purchase an enhanced insurance coverage to gain choices in providers." Agree Agree Agree Agree "The cost of providing national access without endangering individual or family financial security seems to suggest that these costs will be shifted to all of the taxpayers in general, which will still impact the individual family. It's impossible to do this without the cost being borne by all of the people." Agree I think that you may have erred in assuming that a large centrally controlled program will produce increased efficiency. 27667 07/24/06 AZ Agree Agree "Experience has shown that integrating services works best when health, education and social service agencies are included at the community level. Research and best practices are functions of the administering agency not an advisory group." Agree Include NCCAM in the consumer information category. Agree No response Agree "In considering a balance between private/public insurance, remember that Medicare has a really low administrative cost compared with private sector. Sadly many physicians have opted out which causes severe problems for this vulnerable population. To adapt it to a larger population would require study of the reasons for this non participation." Group identifying core benefits should include experts in complementary and alternative medicine of national stature. Who will decide what experts are needed by this group. Also there will need to be sub groups because of the complexity of the health care system and the practitioners involved. "My comments are based on experience with both non profit community organizations and initiating most of the special education and health care Federal programs of the 60's and 70's. I am retired and hopelessly out of date, but I have tried to be constructive and helpful. This is a great start and needs some fine tuning which you are now engaged in doing. " 27668 07/24/06 LA Agree "In the U.S. our citizens should have access to health care coverage for a minimum set of benefits that focus on primary and preventive care. It is important to recognize that we cannot afford to continue to provide care without regard to cost or appropriateness of treatment. We should concentrate on spending money for services for which there is evidence that patients will benefit not just in terms of quantity of life, but also quality." Agree Agree Agree "A disproportionate amount of our health care dollars goes toward treatment at end-of-life. While at times this may make sense, some of the money is spent because physicians are concerned about being sued by surviving family members if they perceive that the doctor didn't do ""everything"" that could be done. It may require malpractice tort reform to truly impact this area of health care and prevent unnecessary expenditures for people who have no chance of meaningful recovery or quality of life. " Agree Agree 27669 07/24/06 WA Agree Health care should be considereed a right. No one should be without the protections noted in this recommendation. Agree The current system is very fragmented. Efforts to better integrate it are much needed. Agree These recommendations sound good but the proof is in the pudding. Getting the various segments of the health care system to display this level of cooperation is very difficult. Agree The current system is woefully inadequate in this area so any improvements would be welcomed. Agree I agree completely with this recommendation. Agree We need a comprehensive health care system in which everyone participates. This will require fundamental restructuring and powerful interests will be strongly opposed to it. Health care should not be treated as a commodity to be bought and sold. This sounds like exactly what should be done. 27670 07/24/06 FL Agree We need Universal Health Care. Agree Local communities should be provided with access to quality care and the federal government should work toward ensuring that the care is available at the community level. Agree Agree "If the individual does not require the hospital setting in their last days they should have control over where end of life services are delivered, at home or a hospice facitity. We should not be creating a hospital setting in the home for end of life care. " Agree Agree "I agree but I am concerned about the potential for powerful interests interfering with the process. The industries that may be threatened by this change may use their influence to hinder the process and some sort of protection from their potential behavior should be incorporated in the defining the core benefit package. I would also like to see the incorporation of developmental services i.e. developmental medicine, Part C services of IDEA." Universal health care is needed. 27671 07/24/06 CT Agree Agree Agree Agree Agree Agree A national 1% sales tax destined solely for the health care system 27672 07/24/06 NV Agree "This coverage must not come from enactment of any legislation that ""requires"" Americans to participate in buying ""insurance."" This is a scam and will not produce the desired results. The government should underwrite this provision, becoming the ""purchaser"" of the insurance, if that is necessary." Disagree "It is pretty well agreed that the current system just plain doesn't work. Starting from a broken system and trying to build it up will result only in a bigger, more broken system. What is happening at federally funded clinics is a mockery. Let's devise a new delivery system that will function, and that will actually provide a high quality of care." Disagree Same reason as before: these programs mentioned are in such disrepair as far as actually meeting needs that it is rediculous to assume that they could be the basis for an improved system. Agree "In our current systems, much too much time and money is spent on interventions that have little, if any, ability to extend life, and NO ability to contribute to quality of life. This is wrong. End of life issues are not dealt with squarely and honestly in the American Medical systems, and when they are, things will be better for all concerned." Agree "This does not mean that I support a law requiring me to buy health insurance from a provider. This means that a national program is in place, funded through taxes or other broad financial means, and not through legislation that in itself will contribute to the on-going problems in America's health care problems. Core health care values must also include and allow for alternative care models, such as holistic care, and naturalist regimes." Agree "Financing must be planned in a way that does not include a requirment by law that individuals ""purchase"" their own plans. This is a corrupt system that already exists in today's world, and has been shown to be ineffective." "Medical effectiveness of treatments may be deceiving terminology, designed to exclude alternative models. Alternative healing models must be allowed; they are the best for prevention of illness." "I attended the town hall meeting in my area. It was an interesting meeting, and although some questions were very much ""guided,"" I understand that the topic is so broad that one has to confine the conversations and debates into a manageable quotient. I'm anxious to see the final report and recommendations." 27674 07/24/06 KY Agree "Agree, but catastrophic coverage should not take the place of preventive, primary and non-catastrophic acute care. " Agree "Agree, unless it becomes a separate system just for poor people." Agree Agree "Agree, but not sure I can picture the new system." Agree "Just make sure ""core"" doesn't mean ""bare bones.""" Agree Huh? This seems to state principles rather than proposals. The principles are fine but very broad. This is a discussion worth having! 27675 07/24/06 AZ Disagree "National Health Care does not give choices that most Americans desire. Coverage should be on a ""sliding scale"" basis so that those basic services are covered for all, but according to what can be paid for, even if it's only $1." Agree Agree Preventive health measures and evidence based practices are a MUST. Agree Agree Agree Agree 27677 07/24/06 CA Agree I go further by saying we must establish a universal single payer comprehensive health care system. I've seen healthcare deteriorate from the minute it went profit. We must have a comprehensive single payer coverage for all Americans. Disagree " To focus only on the vulnerable and low income is to ignore a huge middle class that has begun to stagger under their own healthcare costs. We must address the entire population. To expand existing networks is most often a bandaid for a greater problem that requires much more.Too, when healthcare is administered privately, the patient becomes secondary. " Agree "This recommendation coupled with a single payer comprehensive healthcare is what we must have. We are the only industrialized nation without it. By getting rid of health insurance as we know it, we can take the money we save in administration and spend it on the patient. " Agree "* I've volunteered in hospice for nearly 6 years and am horrified by our nursing homes. For the most part they are storage places for the elderly who have no one to care for them and those who are dying. They are noisy, smelly, often dreary places, when they should be quiet, clean and full of light. We must think seriously about how to care for the elderly and the dying in a way that gives them dignity. Again, however, I am wary of the private owner of nursing homes. I've seen too many thrive at the expense of the patients. We must have a public system with an oversight committee made up of doctors, patients and business people. " Agree "* I feel we need a universal single payer system in which every citizen has access to comprehensive healthcare. Healthcare must be a right not a privilege. When everyone participates, costs will go down and we all will win. The uninsured will no longer use ER for primary care, both saving money and freeing ER for real emergencies. With single payer, doctors wouldl no longer have to deal with thousands of different policies and the paper work that go with them. They could instead spend that time with patients. Presently, 25%-45% of every dollar goes to administration, share holders, advertising, This must stop. It is not right to make money on people's healthcare, for as we are experiencing, money becomes more important than the patient. WHO places us 37th as far as quality in healthcare and 55th as far as fairness. This is shameful. I am willing to give up my premiums, deductables, co-pays and out of pocket expenses for one single tax. " Agree "I would gladly give up premiums, co pays, and deductables for a single tax. If we adopted a single payer system, we would save 25-45% of every dollar that now goes to administration, shareholders, advertising, and 6 digit CEO salaries. I feel very strongly that we should ban TV ads for drugs just as we have for alcohol and cigarettes. This woiuld be a great savings. I would also be for sin taxes if they went to help finance a single payer system. single payer system. " "* We need to stop putting bandaids on a broken system. Everyone is hurting. The change needs to be for everyone, not children here, the poor here, the uninsured....No one ever invites the unemployed to the table when it comes to talk about heathcare. If they have healthcare they pay exhorbitant premiums for broken plans, and if they get sick, they become untouchables in the world of healthcare. The system we have now is for the healthy, not the sick. With a universal single payer system, all would be covered and we all would benefit." 27678 07/24/06 NC No response No response Agree Reduction of waste and fraud should be a priority. HIT and EMR implementation should not be limited to teaching hospitals and clinics. HIT is the backbone of all other goals recommended Agree "Most people want to die at home in peace and comfort, yet most people actually die in an institution with noise, machines and strangers. End of life care is presently the costliest and least satisfying for individuals and their families. " Agree access and afordability are key. Agree Health care is expensive but must be financed. Everyone should particpate in some way finacially. Mental health care is critical. This MUST be covered. 27679 07/24/06 IL Disagree This can't work until the Healthcare system is fixed to stop the excessive costs involved in the current system. This is the cart before the horse Agree Yes. Restore the public health system in this country for basic services. Agree This is a critical component to bringing down heathcare costs Agree Living wills should be mandated upon entry for hospitalization. Agree OK after the system is fixed. Otherwise unaffordable. Disagree ONLY CHANGE THAT IS CAREFULLY CRAFTED IN SMALL STEPS WILL MAKE THIS WORK. TIMING AND ORDER OF CHANGE IS IMPORTANT. I BELIEVE ONLY HEALTH ISSUES OUTSIDE OF DENTAL AND MENTAL CAN BE TACKLED FIRST. DENTAL AND MENTAL ISSUES SHOULD BE SECONDARY. I BELIEVE THE PROGRAM WILL OVER REACH AND CRASH. ONLY CLEAR LEADERSHIP THAT DOES NOT CAVE IN TO SPECIAL INTERESTS CAN MAKE THIS WORK. 27680 07/24/06 CA Agree Agree Agree Agree Agree Agree 27681 07/24/06 IL Agree Agree Agree Agree Agree Agree We are way past the time our health care should be free for everyone. Let's get on it now. 27682 07/24/06 FL Agree Citizens that have worked all of their lives should not have to become bankrupted by healthcare costs in order to receive medical assistance if they should sustain a catastrophic illness and/or injury. Agree The Medicare Modernization Act of 2003 should be amended to DEMAND that the Federal Government have the ability to negotiate prices paid for prescription medications with the pharmaceutical companies Agree "The Medicare Modernization Act of 2003 should be amended to DEMAND that the Feserdal Government have the ability to negotiate prices paid for prescription medications with the pharmaceutical companies, while also eliminating fraud and waste within the various programs. When Fraud is uncovered and proven, the requirement to IMMEDIATELY pay back the amount fraudulently obtained should be insisted upon." Agree Agree "AGAIN, Citizens that have worked all of their lives should not have to become bankrupted by healthcare costs in order to receive medical assistance if they should sustain a catastrophic illness and/or injury." Agree 27683 07/24/06 NC Agree "Exceptions should be made for adults who smoke or abuse alcohol. Other behavior related health conditions, such as prolonged obesity, (except those caused by hormonal imbalance) should also take a back seat to medical care for children, the elderly and the working poor." Agree A strong component of this care should target nutriional education (without ties to the marketplace) Agree A strong component of this program should be nutritional and exercise information and support. Agree Agree "As stated before, self- destructive behaviors such as smoking and alcohol abuse should incur some financial penalties, or limitation of service. " Agree Good luck. 27685 07/24/06 OH Agree "I am a college graduate who has been and still is impoverished by my own healthcare costs. Currently, I can not afford all the healthcare I need. Impoverishment due to medical expenses does happen to people like myself, who are well educated. We truly need to change our ""current system"" and cover ALL Americans, and make healthcare AFFORDABLE for everyone." Agree Agree "We do NEED to CONTROL healthcare costs. I think it is very uncaring and rediculous that the CEO's of many pharmecutical companies make billions of dollars but; some of them will NOT give medications to impoverished patients. They are driven by greed, not compassion to help patients who are sick! " Agree Agree "If ALL American CITIZENS have access to healthcare this will help prevent disease and complications that happen now. Many people don't have access to APPROPRIATE healthcare becuase they can not afford it at this time. The lack of care forces Americans to ignore healthcare issues, end up in the emergency room, and often hospitalized. This results in them being given a huge hospital bill that they can't afford to pay. " Agree I think that ALL Americans that can work should pay a premimum for their healthcare benefits; and it should be based on their income and family size. "I think all healthcare needs should be considered in the establishment of the ""core"" benefit package. It should include prevention, education, treatments for rare diseases and disorders, surgeries, prescription drugs, home care services, access to the physican of your choice, hospice care services and be affordable to all. " Thank you for allwoing me to be a part of this process. I have dealt with the inconsiderate financial aspects of the American helathcare system for many years. I hope this committee will SUCEED and we WILL put a cap on healthcare profits and help ALL Americans have the care they need in a way that they can AFFORD. 27686 07/24/06 NM Agree "I think a fair, equitable system should be developed that affords coverage for all Americans. " Agree Agree Agree Agree No response 27687 07/24/06 WA Disagree "* All Americans can NOW purchase medical coverage, either directly or indirectly through their employment. Most Americans are so covered. Low income individuals and families are already covered by Medicaid, and older individuals are covered by Medicare. We only need a solution for the 10-15% of Americans who need health care but are not now covered. It would be a major mistake to force everyone to join a single, public system of health care. Protection against very high costs sounds good; however, does it mean 1) certain high cost services are illegal, meaning no once can get them, or 2) everyone can get them, whether they are cost-effective or not, and public tax dollars pay for them all? I hope neither." Disagree "* Government-managed health care, although appealing, will create a politically-based bureaucracy with an overhead that can consume all available resources without increasing the health of the general population. It will be used to promote popular medical solutions, regard for their cost effectiveness, and distibute resources based on political boundaries and voting patterns. Should individuals living in rural Arizona have an ER as close as those living in Manhattan? If not, are they being discriminated against by a heartless health care system? No, we do not need ERs spaced every 20 miles in all drections, regardless of the population density. The ""invisible hand"" of the existing private health care marketplace efficiently creates a cost effective distribution of clinics and hospitals, without regard to political log-rolling. " Disagree "* An integrated, Government-managed health care for all will create a bureaucracy that can consume all available resources. Medicare and Medicaid are already projected to be in deep financial trouble in the future. Creating an single, integrated federal system is analogous to merging a number of bankrupt companies and expecting to get a vibrant, competitive single company; it is sure to fail. We need to fix the individual health programs, not create a much larger problem, showing ""progress by reorganization""." Disagree "* End-of-life treatment is a highly personal matter and should not be a matter subject to government controls and public morals (eg, Terry Scheivo). What evidence-based science provides any information on how much life-extending treatment is desirable for a particular patient? Only family members should make the trade off decision on what palliative care is desirable for the terminally ill patient and determine the value of its cost to the family. Government funding to pay for individual choices will not make this decision effectively." Disagree "* America would be poorly served by a tax-payer, funded comprehensive, high-qualify health care system for everyone. Such a system has no mechanisms to ration scarce resources, and increasing amounts of national income would be diverted to consumption and away from capital spending and investment, finally bankrupting the country. The only reason the the long queues of the Public Health System in the UK are accepted is that the UK has a parallel system of private health care that provides health care at a price." Disagree "* Financing health care with taxes (other peoples money) will not work. We need a national ""medical loan program"" similar to student loans available to the 10-15% without health care coverage. The patient should pay for health care that he or she uses, which the the primary rationing mechanism. If an individual is unable to pay at the time of service, the provider can be paid by a loan made to the individual (guaranteed by the Government) that accumulates interest and can be repaid over time. If the individual dies with an outstanding loan, then the amount of the loan becomes a priority liablility to the individual's estate, if any, and would be paid the same way as estate taxes are. In this way, those who have assets but little available to pay a provider can obtain the health services THEY and their family believe are necessary without being forced to ""sell the farm"". Those that have insurance or more liquid assets do not need to take out a loan to cover health care expenses, and indigent individuals" "We do not need a new group to identify core benefits for all Americans. Americans should have the right to choose their own set of core benefits. Do we want to force religious minorities to accept all treatments in a core set selectd by a committee? Do we want to force them to PAY for all of these treatments, regardless of whether they use them? No. I insist on the RIGHT to determine what services and treatment I will accept, and I will not give up this RIGHT to anyone or any group." "* Yes. I attended the Citizen's Health Care Working Group in Seattle, only getting into the meeting by arriving 30 minutes before the scheduled starting time. This meeting clearly WAS NOT OPEN TO THE PUBLIC; it was packed with proponents of a single payer health care system, who apparently made prior reservations for the limited number of seats BEFORE the meeting was publicly announced in the local press. Therefore, the conclusions and opinions from that meeting were strongly BIASED in that direction and represent only those from this segment of the population. It biased recommentations of the working group suggest that other meetings were hijacked in the same way. It is my opinion that the recommendations of this working group represent those of a SMALL GROUP OF ACTIVISTS, not those of the US population as a whole, and this group of activists has defeated the usefullness of this working group to the President and Congress." 27688 07/24/06 ND Agree "We shouldn't just fix the sick, we should educate the public and our Dr's, about preventive measures. I would rather my tax money supported a natural progesterone cream for women, than pay for hysterectomies that are needed because of complications caused by low progesterone." Agree "My only concern so far with this recommendation, is concern for too much money being spent on oversite and not enough on preventive care. I like the idea of working together with other organizations, as long as those organizations don't discrimiate against certain people." Agree Thats a great recommendation! Agree This sounds good. Agree Excellent! Agree Sounds good so far. "Does this include eye care (glasses, etc.) as well?" "...evidence-based science and expert consensus regarding the medical effectiveness of treatemnts. Those words concern me a little, as Traditional medical methods, are not always the best methods. So much has been done these days with massage, accupunture, vitamins, bio-feedback, etc. I just hope all avenues will be explored, not just the traditional (often very costly) methods." 27689 07/24/06 FL Agree "WE HAVE HEALTH INSURANCE. I DON'T KNOW WHAT WE WOULD DO WITHOUT IT. I THINK IT IS EVERY AMERICANS RIGHT TO HAVE INSURANCE. IF WE CAN FIGHT ALL OF MR.BUSHES WARS AND GIVE OUR MONEY TO OTHER COUNTRIES, WE SHOULD INSURE ALL OF OUR PEOPLE. IT IS OUR TAX MONEY AFTER ALL." No response No response No response No response Agree WITH OUR INCOME TAX. IT WOULD BE GREAT TO HAVE DENTAL INSURANCE. 27690 07/24/06 FL Agree "* Coverage ought to cover ALL disabilities, ALL effective treatments, and ALL ages. Coverage should not MANDATE specific treatment/medication/preventative measures; coverage SHOULD allow the best care for each INDIVIDUAL's needs. We pay for insurance which entirely neglects the care necessary for our child with autism (caused by her mandated vaccines) to overcome the limitatins severe autism has imposed. Her recovery costs nearly $100K, annually. Coverage should include guarantees for truly: clean water, clean air, and clean foods (nutrient-rich, not genetically manipulated, and chemical-/pesticide-/steroid-/antibiotic-free)" Disagree "Stop IDENTIFYING and ESTABLISHING GROUPS - start providing health care. Notice I did not say MEDICINE; this nation needs health, not more pharmaceutical band-aids." Disagree "* Whose evidence? Health care systems need to be flexible and open to change in order to provide the most effective care - today's evidence is yesterday's news. Who owns the electronic records? Who has access to these records? What are the patient's rights regarding their electronic information? Who determine what, in clinical settings, is ""wasteful?"" At what expense to the patient?! The consumer SHOULD ABSOLUTELY know what expense he is facing at EVERY juncture in receiving care!!!!! Nobody should have to purchase care without knowing the cost!!!!!!!!!! Promote health education, patient-provider communication, patient-centered care? Shouldn't this be de rigour?! Promoting disease prevention and health requires knowledge of nutrition - are they going to send all the physicians back to a school not funded by the pharmaceutical industry so they can learn why disease happens and the integral role nutrition plays in disease prevention and good health?! Every MD I have met thinks they are t" Agree "Duh - this one, again, seems like it should already be happening...Where is the recommendation for those who will spend a lifetime disabled and their caretakers?!" Agree "Sufficiently comprehensive? Is this like ""No Child Left Behind,"" where your child can have a Kia (Kindergarten for severe autism - allowing the child to sit in the room, but does not require the child to learn even 50% of what age-peers are learning), but not a Cadillac (actually requires your child with severe autism to learn 100% of the information of her age-peers); also, making available only 20% of funding required to make even that Kia payment?!" Disagree "* What this is not a recommendation? I DO NOT AGREE. Wait a minute...I thought every American would participate, without endangering individual or family security? Now we are talking new income taxes and ""shared responsibility?"" And how would there be ""catastrophic health care expenditures"" or ""individual impoverishment"" caused by accessing this health care that will not endanger our financial security?! Sounds like a War on Health Care - billions of dollars badly spent on invisible (non-existant) infrastructure, ensuring fat cats get fatter and Americans make-do with less. No thanks." "* So everyone who does not fit into the CORE can take a flying leap, along with their disability?! I repeat... Coverage ought to cover ALL disabilities, ALL effective treatments, and ALL ages. Coverage should not MANDATE specific treatment/medication/preventative measures; coverage SHOULD allow the best care for each INDIVIDUAL's needs. We pay for insurance which entirely neglects the care necessary for our child with autism (caused by her mandated vaccines) to overcome the limitatins severe autism has imposed. Her recovery costs nearly $100K, annually. Coverage should include guarantees for truly: clean water, clean air, and clean foods (nutrient-rich, not genetically manipulated, and chemical-/pesticide-/steroid-/antibiotic-free)" "Health and disease prevention is best served through clean and comprehensive nutrition and a holistic approach to healing what ails. Unless this new model of care is based upon these simple tenets, I have no interest in participating. Medicine is often little more than a band-aid placed over a skin ulcer casued by flesh eating bacteria; just because you no longer see the ulcer, it doesn't meanit won't fester and kill you." 27691 07/24/06 CA Disagree This recommendation ignores the importance of preventive care. Universal single payer health coverage for every resident is the only answer. VA health care has extremely high rating. Medicare for all --- not just for the elderly. Disagree "All the expanded ""integrated"" networks in the world aren't going to do s**t if the the people don't have the means to pay for them. Universal single payer health coverage for every resident is the only answer. VA health care has extremely high rating. Medicare for all --- not just for the elderly." Disagree See above answer. Disagree Same as above. Agree But only with the addition that universal single payer health coverage for every resident is the only answer. VA health care has extremely high rating. Medicare for all --- not just for the elderly. Disagree Universal single payer health coverage for every resident is the only answer. VA health care has extremely high rating. Medicare for all --- not just for the elderly. It is my understanding that this was an almost unamimous response at each of the many expensive public forums that were held in many cities. These recommendations like the programmed presentations at those forums seems to cater to the greedy medical insurance and drug industires. See above "If these recommendations are the best that could be developed, in my humble opinion, you have wasted millions of the tax payers' dollars to come up with zilch." 27692 07/24/06 WI Agree "It should be mandatory, And should have some shared cost according to income,no free rides. it should be available to U.S. CITIZENS ONLY.All others pay cash." Disagree "If it is not provided equilly acrossed the nation and not just for certain areas, how in the world is it going to work.It sounds to me we are seperating people according to class.WHO is going to be on this so called group. Sounds like the same old crowd." Agree Agree Agree I agree with this statement more than any. Agree "I have no problem with paying my fair share, I only insist that others pay their fair share too. If they want extra service's not listed, they must pay for them. Some people want everything for free." 27694 07/24/06 CO Agree Wouldn't it be nice if it coudl really happen. If the govt has any part in it you can bet it will be an unworkable mess and no one will benefit. Disagree I want nothing to do with any thing the govt gets involved in. Disagree again leave the govt out of it all Agree keep the govt out and it might work Agree wouldn't it be nice if it could work without the govt Agree It's all BS. As long as insurance companies are involved and allowed to do business only as a for profit company. All of this started when insurance companies went from Mutual companies to the bottom line companies. * I attended the symposium in Denver. A terrible dissapointment. They were supposed to listen to all of the tables in the room and the moderator was supposed to do his job from all parts of the room. Neither happened. One section of the room spoke constantly and the moderator stayed in the center. With a cordless mic that seemed rather inappropriate. Also when opinions were given the moderator would try to remind us what would happen with one choice or the other. Didn't seem like much of a place for opinions. More like he was giving us the ultimatums of our choices. SAD SAd SAD 27695 07/24/06 IN Disagree "I think that the help needs to be for middle class Americans also, not just the poor" Disagree I think that our plan should be something simple like Medicare. These ideas seem too complicated. Disagree Disagree Agree Agree I think that payment should be shared between the working person and their employer much like Social Security tax. And the cost would be based on income with a bottom cut-off ie a person with below poverty would not have to pay a percent. I have seen the calculations under single-payer and most people would not have to pay more that 3-4% of our income. And the whole plan should be easy to understand much like our current Medicare part A and B. Part D the prescription is not easy. "I am a home health care nurse and I see so many ways that our health care system is wasting money. If we make it very simple, all Americans can understand it and it won't cost us so much for our insurance and health care providers to spend so much of the health care dollars on mindless paperwork and phone calls to see if your company is covered." 27696 07/24/06 PA Agree "The program must be not-for-profit, and ideally should be a universal single payer plan for all reasonable medical expenses. Reasonable should be defined by a national board of directors." Agree There must be protections to avoid some places having more and better than other places based on politics and local whims and moralities. Agree It mu7st somehow be made worthwhile for professionals to join systems which are now viewed as antiquated and beyond hope. I am a nurse--you could not pay me enough to work in one of the city health centers in my metro area due to the entrenched bureacracy and reputation of the inferior physicians who work there. Agree "Completely agree. Patients and families have a right to the best clinical judgements regarding their conditions. Providers must be honest in telling people when the treatment available is probably not going to prolong or enhance life, or may cause more problems that will then need more treatment, etc." Agree "Insurance is based on shared risk, and the current insurance system pits the health against the sick. No one really choses to be sick, it is just luck and genetics and knowledge. Companies should not be allowed to ""cherry-pick"" and leave those with chronic illness with lesser skilled or incompetent care." Agree "I think that if all the money currently in the larger health care system were redistributed, the costs would be covered, almost everyone who wanted to remain employed in health care could do so, and patients would receive care at least as good as what they have now. Those who might lose include insurance company executives and those whose jobs are to stop patients from getting care, but I am sure they can find some other way to get by." "Completely agree. It is particularly important to listen to those in the field who do the work every day, and see how the current system prevents people form getting what they need. Also, people will have to trust sciend and research studies that are funded by impartial sources, in order to decide fairly if a procedure works and should be covered or not." Do you think anyone will actually listen? Keep me informed on when the congressional hearings come up. Thanks to the staff of this project. I know you worked very hard to get this done. 27697 07/24/06 FL Agree Agree Agree Agree Agree Agree 27698 07/24/06 CT Agree "Should be a public (or public/private hybrid) single payor system. This would achieve greatest savings nationally and best uniform, quality healthcare for all. " Agree Disagree "These goals should be accomplished within a single system, not a double standard of privately versus publically insured citizens though the agencies mentioned would be necessary particpants in transition." Agree "Again, one payor/one system AND increase public education before people reach end of life so that individuals have a broader, more prepared view about what care should be like at the end of life including facing issues such as not using excessive testing or treatment at end of life." Agree Not financial assistanc; a universal single-payor system. No response We should be clear from the beginning on the goal of universal coverage via a single payor system savings from the expensive redundancy of overhead for multiple private and public payors. This will result mort quickly in cost savings and improved acccess and quality of care. There should be regional groups which report to a national group. "This is a very exciting initiative. The most promising effort I've seen to ""do the right thing"" (I'm a physician in practice for 25 years)." 27699 07/24/06 KY Agree "* There are too many people who work 2 or 3 jobs just to live. Many of them cannot afford insurance. I pay almost 450.00 a month for insurance and I work in healh care. This is absolutle horrible. With prices the way they are today just to buy food many cannot afford the care they need. This in turn causes them to wait until they are really sick to go to the doctor. By that time no one gains because they cannot pay their bill from the medical cost, people working pay the bill and what about prisioners who get great medical care when the average, working American person cannot afford insurance. " Disagree Why just the integrated public/private community. Everyone needs to stand against the price of insurance. There needs to be help for everyone to lower insurance prices so all people are created equal. Agree Agree Agree I totally agree with this statement. Agree It seems as though if people would stop telling the doctors what to do then they could provide better services for people. I wish everyone had the same type of insurance then we could all be treated equal. 27700 07/24/06 UT Agree "This should include hearing aids; glasses dentistry (including crowns where necessary) so that the elderly and infirmed have the best vision, the best hearing aids to serve their needs." Agree We need clinics throughout the States that poor people can check with doctors without going through our Emergency Centers at our Hospitals. We need as much out patient services as can possibly be arranged. Hospitals should only be for a short period of time. Agree "* We also need to make our public restaurants aware of serving healthy servings of food for the public. We also need to stop the obesity that is prevalent in this country. For the very obese, we need a surgical program of having the stomach shut off available to them to get their weight down and then dietitions to work with them to create better habits. But if the food industry will stop high calorie foods, this will also help a great deal. Too many people have diabetes, high blood pressure and other problems caused by overeating." Agree "* As a person who has resided in four nursing homes and now a retirement center, nursing homes are not the answer for the elderly. They should be allowed to stay away from these situations and their families should have tax credits or incentives that would encourage them to have the proper caretakers to assist with alzehimers and other terminal illnesses. I have seen far too many people die in nursing homes from owners who were out for the almighty dollar and expected nurses and aides to carry a workload that was unreasonable. Perhaps in nursing homes, for every four patients, there should be two aides and a nurse or some such law. A lady in the bed next to mine was left on a bed pan overnight because there was not enough help. She died a few weeks later. Another time, another roommate couldn't breathe and it took the staff some time before they got her to a hospital. She was eventually taken to one of her children's home, after her hospitalization, and hospice helped her up until her death. People s" Agree "* This country needs socialized medicine that doctors can determine what the patient needs and prescribe the proper treatment. This is not always done in institutions where large hospitals hire their doctors and control the medical costs. Granted the medical costs are expensive, but we need to curtail this so the best doctors in the world have an opportunity to treat the patients the way they want to--not the rules of the establishment. We should encourage more doctors to train and assist doctors with their education, if necessary, when they go to countryside areas to practice. They should be encouraged to want to be a doctor anywhere we need them by these kind of incentives. At the same time, we need RN's desperately. We are importing them in the state of Arizona from the Phillipines. Anyone who wants to be a nurse and wants to live in our country should (with a clean felony record) be allowed to be a citizen of this United States and we should pay college nursing professionals more money to enco" Agree "* If the insurance companies, the hospitals, the corporations would work together, I feel this country can do anything we want to. When medicines are not needed, then we do what the patient needs. We work as quickly and efficiently as possible with the care of the patient in mind, but also we are behind our medical doctors and nurses as well. We use medicine wisely and prudently and we are always aware of the insurance companies so they make a decent profit but at the same time are not ruling the hospitals." But please use humanitarian people that don't always look at the almighty dollar but care about people like the former owner of Microsoft. They are businessmen who have money and means but who also have the needs of the people at heart. Our corporations here in the United States are behind President Bush in making the almighty dollar. They are not interested in America or how it turns out; they are only interested in themselves. "* I know your job is difficult, Senator Hatch. I don't even understand what it is like to be in your shoes. I only know that standing in my shoes, our nation is in jeapardy of losing everything we worked for. I am concerned for the Central Americans who are entering our country illegally because they too want what we have. I am concerned for the Middle East, but know that time is running out on our planet. Our maker is not pleased with us and a time is coming for that answering to how we have treated the persons on our planet. Thank you for having the elderly conference each year. I will go every April, and I will have a question for you as I have every year I have attended. Sometimes you sort of make me feel like you don't have time for me and maybe you don't, but thank you for the conference anyways. Also my son travels a great deal around the country (he is a Vice President) and he sees you very frequently travelling in first class with your staff working away at some project. He also watche" 27701 07/24/06 NJ Agree The rich (top 5%) should not be subsidized however. Disagree "The 4th bullet, funding and implementing viable mental and physical health services at the local level, is the most important, and the centralization implied in the first two bullets puts it at great risk of never happening." Agree "* 1) For mental health services, use the American Psychological Association definition of ""evidence based best practices"" rather than limiting care to oversimplified manualized treatments whose evidence base in many cases does NOT represent actual clinical practice with individuals dealing with multiple symptoms. 2) NO LONGER depend on insurance companies to ""curb abuse and fraud."" This is a failed experiment and itself a fraudulent claim - insurance companies have proved that they prioritize profitability over patient care." Agree Agree Agree "If we can stop spending trillions on war and (privately) billions in casinos, the money will be there. Up to now our priorities as a society and a country are absurd and tragic." "All mental health care (not only ""biologically-based"" mental health) must have parity with physical health care." 27702 07/24/06 FL Agree Agree Agree Agree Agree Agree "Some ideas: Many Americans do not take care of themselves. People who smoke, do not exercise, and are obese sould pay more for their heathcare than people who take care of themselves. Everyone needs to pay something, sort of like an income tax. I completely disagree with for-profit 3rd party payors. They are making money on NOT providing care, often preventative." 27704 07/24/06 OH Agree Health care coverage should be available to all Americans regardless of their economic statis. Agree Agree Agree This will allow those in an end of life incurable conditions to be treated with dignity in a caring environment. Agree Agree Health care is a right for all Americans. I leave the how to the legislators. It is time for Congress to show the American people that they are valued. Is that too little to ask of the greatest democracy in the world? 27705 07/24/06 WI Agree Agree Agree Agree Agree Agree 27706 07/24/06 MS Agree I have no comments. Agree I just hope the bureacracy will not be so unwielding as to prevent action as Medicare Part D seems to be on part of consumers. Agree Agree The proliferation of so many hospices in my community make me think there is the potential for abuse by the providing agencies. It must be very profitable for so many companies to be opening up in the area. That makes me worry about the patient care. Agree We are way overdue for universal coverage of some type. Agree I believe that everyone should have some copay or way they can participate in their health care and not expect the entire burden to lie with government. 27707 07/24/06 CO Agree A non-profit single-payer system is the only reasonable plan. Agree "Fragmentation is the main underlying fault of our ""system"" which forces us to reduplicate efforts, techniques and expenses; and fragmentation of health care loses a large proportion of patients who fall into the cracks, lost to effective follow-up because no one is paid to follow them." Agree "The most economic move is to have a single professional responsible for the coherence of care for each real individual; we don't need to lose freedom or confidentiality by having really savvy case managers who help patients understand choices, navigate a simplified system and make effective decisions in their own lives." Agree "After the American people catches on to the reality that we are indeed each mortal, tortures to stay alive will no longer be required, and counter-productive very expensive high-tech waste will wane without having deprived anyone of the opportunity for helpful treatment." Agree "It is immensely more expensive in dollars to deprive anyone of simple basic care, and it is painfully expensive in bitterness to be that deprived pariah. This is America; we don't treat people that way, remember?" Agree "* The transitions must be made as rapidly as possible, for stalling wastes resources and lives far more than harmonious unified action ever will. Our obstacles are all self-serving political and economic interests which will always be increasingly expensive in lives and dollars because that approach itself contributes to health problems and acceleration of expense. Single-party payer management by clinical and administrative professionals who are not seduced into corruption for the sake of profit for themselves or corporations will reduce costs by containing health problems, actually reduce expense." "If everyone has what is essential, let the relatively wealthy choose expensive ""snake-oil"" at their own out-of-pocket expense. From my forty years of professional clinical experience I know too well inessential health care most often not only unnecessary but risky. Let us not impose it on the sick or poor, nor withhold it from those unrealistic or superstitious consumers who want to buy whatever the profit-seeking corporations so energetically advertise." "Do something to encourage health care professionals so they don't give up completely the remnant of the altruistic motivation with which they started their careers. Once they are all jaded, burnt-out and downhearted we may never rekindle the human spark which is the heart of healing." 27708 07/24/06 CT No response "Protection should be for middle income as well. As a healthcare provider I have seen major accidents and illness take those who were in the middle and reduce their assests to poverty, despite having families & children. Plans should be non-profit." Agree Agree Agree Agree Agree "I also believe that there should be a phase in fee for enrollment based on income. There are people receiving medicare benefits who's retirement income is greater than my full time employment income. I don't mind paying for my share & people who have less, but I strongly resent having to pay costs for those who have more in the bank than I will ever have!" 27709 07/24/06 KY Agree Agree Agree Agree Agree This is the most important recommendation. Agree 27710 07/24/06 IN Agree We need a national health care program to balance the expenses for all Americans and/or those with rights to our healthdcare system. Agree Agree Agree Agree Agree 27711 07/24/06 WA Disagree No response No response No response No response No response "* here is what happened at the Seattle meeting: Health Care for ALL: No matter the cost The Citizens Health Care initiative was sponsored by U.S. Senators Orrin Hatch (R) and Ron Wyden (D). It was adopted as a little-known provision of the Medicare Modernization Act of 2003, SEC. 1014. HEALTH CARE THAT WORKS FOR ALL AMERICANS: CITIZENS HEALTH CARE WORKING GROUP. The Working Group is made up of 14 citizens selected out of a pool of 530 applicants from throughout the country plus the Secretary of Health and Human Services, Michael Leavitt. In February of 2005 the group and its members were formally announced. Since January 2006, they have been conducting similar community forums throughout the country in major urban centers. Two of the groups 15 members were present at the Seattle meeting. The Citizens Health Care Group Meeting was an astounding success… for those who were there as a part of the universal, single-payer health care crowd. If there was any early doubt as to the direction this particu" 27712 07/24/06 PA Agree "If all Americans are covered, this is a distinct possibility" Agree "Again, if all Americans are involved, it should be posible and equitable" Agree No regulations restraining negotiations in the interest of economy are to be allowed Agree Care in the home should be supported and available Agree Health Care is a Fundamental right Agree A difficult task in which we all share responsibility and from which we will benefit. Reventive and maintenance measures need emphasis. All efforts to make this workable contribute greatly the commmon good and demonstrate admirable citizenship 27713 07/24/06 FL Agree "My pharmacy needs alone exceed my income by several hundred dollars. I am disabled, therefore I can not find employment that will be more lucritive. I need to know that each month, I won't have to suffer because I can not afford my medicines or treatments." Agree I am not sure most people could understand this recommendation enough to make a comment on it. I know there are many needy people who could nto. Simplify the language if you really want input. Agree See above. Agree "The more ""local"" all help is, the better it will meet the needs of the individual, especially in end-of-life care." Agree "In the United States of America, this needs to be legislated???" Agree "Regardless of ones financial status, he or she will eventually reach end of life. It is to everyone's benefit to provide for that time for themselves and others." "Once again, how many needy people can really understand the recommendation?" 27714 07/24/06 CA Agree Agree Agree Agree Agree Agree 27715 07/24/06 DE Agree "Good, but still need some way to monitor that our health care dollars are being spent wisely. Some testing might be able to be decreased and these health care dollars used to treat others. Infertility treatment in some cases and other procedures need to be evaluated if this type of care is really necessary. Do not want abortion covered by my tax dollars. " Agree "Excellent points. Please consider using nurse practitioners in the public/private clinics to supply primary care as they are safe, efficient and caring health providers. Evaluate the problems in US medical education for medical doctors which make it very expensive and do not supply enough doctors resulting in the need to import doctors from other countries. " Agree Agree with everything. I work for the VA health Administration and the electronic progress notes are very helpful. Agree Agree with all the recommendations. Health care costs at the end of life can be very expensive and use up all savings. Agree "* Having basic health care for everyone is very important. Preventive care, diagnosing disease at an early stage before complications have occured and patient education should be available for everyone and in the long run can save money and improves the lives of many people. At this time we have 2 sons who graduated from college but are not fully employed and do not have basic health care coverage. One son has a grad-med policy which only covers major health conditions but not routine care. He was recently seen in the ER while he was back home visiting and I am afraid what the health care bill will be. He has a $500 deductible and makes a low wage. We, his parents, will probably send him money but he just sat in the ER for @ 8 + hours, had a chest xray, ekg and d-dimer blood test for mild shortness of breath. He probably had an anxiety reaction but he has not had any regular health care for so long that I also encouraged the ER visit while he was so far away from home for his symptoms he was ha" Agree Sometimes I have problems paying for others poor choices. I don't mind paying some but feel the irresponsible person if they are well educated on an issue and still choose to make poor choices should have to pay more. - maybe sin tax would cover this? "* Dental coverage would be great to have for everyone. I know many people who will let their teeth decay because they cannot afford dental care and in a country as well off as ours - having a certain level of dental care would be great. I am concerned about what kind of coverage would be available for more expensive care and think that maybe with a system described above the care my mother in law is receiving now might not be available for me if I need it. She had part of her lung removed @ age 70 for lung cancer ( never smoked a day in her life and no history of 2nd hand smoke). She had to go on chemo therapy - very focused for small lung tumors about 3 years ago which cost about $1500/month. She gets CT scans done about every 3-4 months which cost @ - $ 11,000. This treatment has helped her to continue to be very independent and a contributing member of society. She remains very active and is now caring for her husband who is ill. Will the above health care changes cut out this expensive but li" 27716 07/24/06 NV Disagree "With regard to the first part, we already have access for all Americans through safety net institutions; we just do not have universal health insurance. Universal access is essential; universal health insurance is neither essential nor desirable. The last two parts are too vague to have any meaning. " Disagree "Centralized approaches tend to be dominated by special interest groups. Due to the significant variation in attitudes and values across the regions of this nation, I favor initiatives on the state and local levels." Agree Disagree What evidence exists of market imperfections that prevent the current system from working? Disagree The premise for this is flawed. The problem is not that some people cannot afford to pay for health care services and therefore need help paying for it. The essential problem is that all people pay too much for services of unacceptably low quality. Disagree "We already pay a higher percentage of GDP for health care than any other developed country, and we have the poorest health status of any developed country. This occurs because we spend way too much on access to health care and too little on public health. Access to health care is only one of the five pillars of public health. Education, nutrition, sanitation, and immunization have more effect on health status than access to health care. " People should be free to choose whatever package of benefits they want for their situation. "I have taught health care policy for almost twenty years. I can only say that anyone who has read an introductory textbook in health care policy would know better than to make such ill-conceived recommendations. I would therefore assign a grade of ""F"" to any student who made these policy recommendations in my class." 27718 07/24/06 GA Agree Agree "The integrated community networks should interface with the private for profit facilities and provide continuity in care instead of both systems being ""separate"" from one another allowing the patient to fall through the cracks." Agree Agree "I am opposed to ""medical boards"" making decisions on ""length of stay"" in hospital settings for cases they are ""no longer able to help"" and giving the family a limited no. of days to ""remove"" the patient." Agree Include mental health funding at the same level as physical health. Without good mental health our physical health can never be achieved. Disagree Sales tax increase. "Patients are individuals.I have never found ""boards"" or ""panels"" a productive method in defining ""needs"". Generally, this has centered around ""cost effectiveness"" and as proven with HMO's this has not worked! " "* Patients should be treated individually with case management. Using HMO tactics to implement a ""National Program"" is not the answer. Everyone has seen the medical profession ""go to the dogs"" with HMO's. I am opposed to ""socialized medicine"" and ""government owned doctors"" deciding who should and should not get treatment and what is and what is not an acceptable treatment plan. Free enterprise systems have always separated the good from the bad in a cost effective manner. People will usually determine the best services for the price. Gov. Docs have ""no incentive"" as they are paid the same amount no matter how many patients are seen. State systems have always been inferior to private systems that work on the ""free interprise"" priciples of business. Something needs to happen but NOT socialized medicine. " 27719 07/24/06 IL Disagree "Too limited. We need comprehensive universal coverage for all Americans, single payer---extension of Medicare to all, certainly not limited to ""very high out-of-pocket costs; emphasis upon PUBLIC program under Medicare!!!!" Disagree Again TOO restricted--see my comments above. Agree "I agree, again, provided this is Medicare administered." Agree "Again, should be Medicare administered & available under Medicare to all Americans, except for those who choose private pay plan (& presumably are able to afford such)." Agree See all above comments. Agree "Transition should include phasing out of present for-profit ""system""; savings from current 15% administrative costs as move toward single payer efficiency can be utilized toward providing universal coverage; e.g., Canadian system costs 7%." I'm impelled to reiterate that the only really viable solution is universal SINGLE PAYER conprehensive coverage under Medicare; the validity is very well documented in the literature!!!!!!! 27720 07/24/06 SC Disagree Healthcare is not a right but a responsibility of the individual. The government should get out of the way. Disagree The federal government should not be in the healthcare business in any form. The government is the least efficient way of doing anything. That someone would trust their healthcare to the collective incompetence of the government is truely sad. Disagree Why do you think the federal government is the answer? Name one thing the federal governmnet does efficiently and effectively. ...... I'm still waiting. Government control of the healthcare system will only provide shortages and high cost. Disagree "The use of the term ""public and private payers"" is misleading and takes advantage of those unfortunate souls ""educated"" in government schools. People, whether through the ""public"" with taxes or ""private"" with premiums, savings, etc., pay the bills. The concept that a government pays for something is nonsensical. The people pay either directly out of pocket, or through the ridiculous inefficiency of the government." Disagree "You should have the healthcare you choose based on your needs ability to pay. The most expensive healthcare will be ""free"". The ""core healthcare services"" will expand as the politicians pander to different groups until everyone is covered for everything and there is no more profit motive. Then we will have the waiting periods and other problems associated with socialized medicine." Disagree "* ""During the move to universal coverage"" suggests you have already determined the outcome. Am I wasting my time trying to point out that socialism is an experiment that has failed every place it has been tried? Taxes should be levied to provide funds for the resonsibilities of government - of which healthcare is not one. To use taxes to control behavoir (""sin taxes"")is immoral. Your comments above suggest: to each according to his needs, from each according to his means. My I remind you these are the basic tenents of the failed experiment of communism." It sounds good but the core will grow until there is universal healthcare for all. Then we will have to ask the government for permission to see a doctor for a hang nail. Your belief in the ability of the govenrment is sad and will lead us to bankruptcy. "* I am extremely dissapointed to have been involved with this headlong rush to socialized medicine. The command economy has not worked for other countries, why should it work in the US? The only way to have affordable healthcare is for the end user (the patient) to have a direct and instant finacial stake in the cost and outcome. Insurance should be a contract between the insurer and the insured. The government, with all its ineffectiveness and inefficiencies, should get out of the way and let the market set the prices. Currently, the patient has little incentive to reduce costs. When healthcare is ""free"" there will be no incentive for the patient to reduce costs and ""free"" will become unaffordable. The federal government cannot meet its future obligations for medicare and social security, why then would you add a tremendous additional financial burden to the people? The financial numbers will not work without the creative accounting that gave us the social security time bomb. Capitalism is the g" 27721 07/24/06 CO Agree "However, not at added expense as suggested at the meetings. We certainly don't need to be committed to paying for premiums at our jobs, paying medicare tax, and paying an addional federal sales or income tax. We have paid into Medicare for years and if hospitals, nursing homes and hospices are accountable for inflated and double charges then the insurance premiums will come down and be inline with current economy. " Disagree "* This would not be good for Medicaid/Medicare or Veterans Health programs. Clean up the issues with poor management and care and we won't need to delete programs...we certainly don't need to deal with Kaiser programs as the only option and that is where all of this is headed. Kaiser HMO ($1,000 per month family premium) or Kaiser triple option ($1,300 per month family premium) is neither a good choice or affordable. We were just forced to choose one or the other and these premiums are the price of a monthly mortgage payment. " Disagree "The truth that came out at the meeting I attended in Denver was that to do this, all of the programs listed above would be replaced by one universal program.. I totally disagree." Agree If these programs are more closely monitored and costs are brought down this might be doable. Agree "Yes, but not at the expense of losing other programs like Medicaid/Medicare and Veterans Healthcare." Agree I would not agree to an additional tax when we have paid into Medicaid/Medicare for almost 100 years and with good management of the program it would survive rather than be in the serious deficit that currently exists. Govenment deficits must be brought into control on all fronts...no more paying $125 for a $7 hammer. Certainly this is a vision but not the only need. Until there is a unified plan that really addressed the entire nation in a quality program (not Kaiser) please forget the idea! 27722 07/24/06 CO Disagree "This national program should be public, not private. Private adds to the cost by adding the need for profits." Disagree "should be public, not private" Agree Agree Agree I STRONGLY agree with this. I am a nurse and am ashamed and appalled by the way some people in our country are treated. Healthcare is a basic need. Agree Shareholders should not enter the equation. Healthcare should not be a source of profits for investors. "Thank you for taking on this monumental task. It is time that we catch up with the rest of the industrialized world. I have lived in Australia and, althought no system is perfect, at least everyone has the security of health care when they need it. They may not have all of the bells and whistles, like fireplaces in the hospital lobby and jacuzzis in the labor rooms, but they don't have to fear getting sick the way so many in this country, including myself, do." 27723 07/24/06 CA Agree "I only support a public program, which gives coverage to all Americans... If the only option is a privatized ""universal"" healthcare system of Americans -- then I am thoroughly opposed." Disagree "I do not support the integration of public/private community networks; they degrade coverage and establish a system, which has superb coverage only for those who can afford it leaving the majority of Americans with sub-par, community networks of public/private coverage. " Disagree "* 1. What is an evidence based practice, to me it sounds like legislation dictating healthcare decisions based on uniformity and cost. 2. Electronic medical record systems must be proved as fortified, and hyper-accurate before I will support federal funding for their use. The immediate problems I foresee regarding an e-records systems are: hackers and natural disasters (ie. Hurricane Katrina)... 3. Right now, regardless of the which system is in place, we should be investigating and erradicating fraud and waste. Is this currently not being done...? 4. I do support a central, up to date consumer database that de-mystifies the price of healthcare now, which would allow individuals to use the market to get quality healthcare at a competive cost. Again, I do not think that this should be contingent upon any new legislation/revised legislation -- it should be getting done now, regardless. 5. Health education and disease prevention should be be another layer of bureacracy in our healthcare system" Agree "* I far as I understand the language presented I agree, how this translates into tangible, end of life care could be a completely different situation. I strongly support an individuals right to determine how they feel most comfortable spending the remainder of their life... BUT I am extremely opposed to the amount of money that is drained away from the healthcare system by those in the last year of life. I am much more supportive a system that mimics the British approach, which does not spend hundreds of millions of dollars sustaining a person who is very old or very sick and terminal. Those funds should be put to MUCH BETTER USE by investing in the well being of the healthy and curable." Agree "I strongly agree with this recommendation; my concern regarding the ""financial assistance [that] will be available to those who need it"" because it infers a level of cost that some Americans cannot meet, which translates to me as: a universal healthcare system in name alone. Again, my concern is that we will be constructing a healthcare system that is not a level playing field, which institutionalizes tiered levels of medical services based on individual income." Disagree "I completely disagree with the tenor of the ""Financing Health Care."" I totally disagree that new streams of revenue must be added in order to finance an American Universal Health Care System!!! We have spent almost half a trillion dollars in Iraq (a premptive war,) instead the Congress should use its vast intelligence to use the massive amount of tax dollars already pouring into the Federal coffers to pay for things that directly benefit the day to day lives, and concerns of Americans living in America." "* Again, I am concerned and opposed to the inclusion of private health care companies weighing in on American public policy regarding health care. Congress already has too much lobbying money influencing its public policy decisions (on both sides of the aisle) and I am addimently opposed to any further pandering to private corporations and what is best for their bank accounts. In addition, I feel that by including private health care in the discussion regarding ""core"" benefits the Federal government will undercut its power to negotiate in favor of the American people, possibly in opposition to private health care industry preferences." "* I appreciate my ability to contribute my thoughts and feelings on this subject. My greatest concern, after reading and responding to this survey, arises from the unquestioned inclusion of private health care companies in a plan for Universal Health Care in American. I am tired of feeling as if the interest of lobbying groups, and those of campaign contributor are paramount to the needs of the taxpayers. WE, the taxpayers, contribute the largest sum of money to the Federal government, this seems to have been forgotten. I do not want any further instutionalization of public-private health care, we are the governing force not them - we are the dollars that line their pockets and they will creatively transform themselves to compley with the majority opinion (and the majority dollars.)" 27725 07/24/06 UT Agree basic health care is not a luxury Agree Agree Agree hospice care has proven to be the most invaluable tool for end of life issues Agree Agree rein in drug companies 27726 07/24/06 SC Agree Disagree "Who can take this seriously when Congress just eliminated the Healthy Communities Access Program, the only Federal effort that supported community-wide networks and coordination? FEDERALLY QUALIFIED HEALTH CENTERS WORK BECAUSE OF THEIR COMMUNITY-BASED BOARDS; UNDER NO CIRCUMSTANCES SHOULD THE CURRENT LAW BE AMENDED TO ALLOW CONTROL BY A HEALTH ""NON-SYSTEM"" THAT DOESN'T WORK!!! " Disagree "* This recommendation is sound but the proposed method is based on several totally false premises: 1. there is nobody at CMS that has a clue how to do this, 2. teaching hospitals and clinics are the last place you should be trying to implement this, 3. we've been doing fraud and waste control long enough that we should realize by now that we are spending much more looking for it than we are saving, 4. consumers don't purchase health care, their insurers do; no amount of so-called transparency is going to make them prudent buyers, and 5. Federal funds have been so severely reduced for health education and disease prevention and health promotion that state health departments no longer have the staff needed to serve these functions (we'd have to start over) and I won't believe we're serious about this until I see Medicare reimbursing for these as medically necessary. " Agree Agree Agree 27727 07/24/06 OR Agree "I agrree wholeheartedly with this recommendation. A hybrid system in which ""catastrophic"" health expenses are covered for all citizens and all health care, including basic health care expenses, are covered for the impoverished is the best way to ensure effectivenss and efficiency. This system must include incentives for consumers and providers to choose wisely. " Agree Community networks must include less expensive providers such as advanced practice nurses as well. Most health care can be provided by non-physicians at lower cost - there is no excuse for not doing it. a paradigm shift that would tip the balance of chronic illness and minor acute illness care to non-physicians would realize huge cost savings if we could surmount the political obstacles. Agree "Easily accessible, yet secure, electronic medical records are critical to efficient health care in today's world. " Agree "In addition, respite care for caregivers should be available so more caregivers will be capable of caring for someone at home. There are models of caregiving (such as PREP) that show benefits for caregivers while maintaining high quality care for the ill person. Search the nursing research literature! " Agree "* Given this statement, it is important to convey to Americans that not everyone can have a bone marrow transplant, coronary artery bypass, or dialysis. Some treatments will ultimately have to be denied to make such a system affordable, unfortunately. The balancing factor is that fewer people will require them if we provide better basic health care, including wellness coaching, health behavior change programs, mental heatlh services and telephone or e-mail consultations that do not require visiting a physician. " Agree "One rarely unmentioned reasons for escalating health costs is that Americans are in love with technology that extends life. We must stop financing ""sexy"" new technology at the expense of providing basic health care. Why do hospitals build exquisite new patient care suites, yet millions cannot afford basic prenatal care, immunizations, smoking cessation help, etc.? We must finance the basic strategies known to prevent illness before we engage in heroics. " "I would like to emphasize the importance of treaing mental health and substance abuse probems, chronic illnesses that are often neglected by insurers and providers alike. " I find this approach to public input refreshing and encouraging! I sincerely hope the comments of American citizens will be taken seriously by policymakers. 27728 07/24/06 TX Disagree Agree Agree Agree Agree Agree "Implement costs controls and minimize the profit motive in health care. Over last 35 years the corporate business model has failed demonstrate by the creed, fraud, waste, etc. which is amply documented, and the correspondencing 'pain' to hundreds of thousands of Americans." "Universal access......for everyone. Let's give the much greater attention to structural change of US health care, and not get over-zealous in pointing the blame at the patient (consumer) for bad health related behaviors. " 27729 07/24/06 OH Agree "As one of the world's most powerful nations, it is unexcusable that we cannot solve the health care dilemma in our country." Agree Agree Agree Agree Agree 27730 07/24/06 MO Agree "This is so long overdue, it's shameful" Disagree I don't know if I really disagree because I can't understand these points Agree This probably doesn't go far enough but I think I agree Agree "No comment, I agree" Agree Absolutely!! We have to have a system where EVERYONE is required to participate. We should have a standard of care that everyone has to participate in. Those who can afford the price can pay. Those who can't afford the total price should have some public money assistance. Health Insurance companies will provide the policies so that we won't have the insurance companies getting on TV and telling everyone it's a bad idea and disastrous for them. Agree There has to be some kind of system whereby there is a requirement that everyone participates. This works in Germany--I had friends in Germany and everyone must participate. What kind of check and balance do they have? "Core benefits is what I was talking about under the ""financing"" question." We have allowed certain industries to keep us from providing this most basic need for our citizens. To me the US seems to be floundering. I believe by tackling this huge but all-important problem in our country that it will be the beginning of turning our country around to go in the right direction. More good will follow once we have addressed and solved this #1 problem for US citizens. And thank you for doing this! 27731 07/24/06 MA Agree "How are you going to ensure coverage for all Americans without providing financial protection for the middle class. I am concerned about the traditional middle class squeeze. Income is too high to get aid, and too low to afford the care or the coverage. This is currently prevelant in education, health care and other areas of our society" Disagree "* I foresee this approach as creating another monopolistic entity in the our currently overburdened system. Too much of the cost of healthcare currently goes to administration vs health care. In addition, the attempt at managed care already created another layer of adminstration that didn't reduce cost, but increased the cost in order to support the additional layer of bureacracy. Finally, how would these networks provide fair access to all types of traditional care, allied health providers and complementary health care providers? Who would be in control? How would patients be assured of equal access to their type of provider or there personal provider of choice?" Disagree "* Prior to any implementation of such an effort, there must be progress made in all the current federal programs that puts all providers on a level playing field. The patients currently do not have access through Medicare, Medicaid, Tricare or the VA to the most efficient, quality base, evidence based or cost effective care because of artificial restrictions in care based on political or private financial criteria. To truely provide the quality, cost effective care that would allow control of costs, one must provide equal access to all licensed practitioners. In addition one must promote evidence based care with the realization that it must be integrated with respect for the clinical experience and judgment of the doctor along with the specific patient complicating factors and values. One can not hold hostage all care to the literature based evidence, for it alone would preclude access to clinically valuable and efficaceous care and innovation." Agree Agree Agree "* Health has to be more clearly defined. Is it the optimal physical, mental and dental well being? Is it minimal physical, mental and dental well being or is it only the absence of disease? Should core benefits cover the any disease care, named diseases or injuries, or only crisis care? What expert consensus will determine the effectiveness of treatments? Will this be an interdisciplinary expert panel? Will it be based on Best Practice documents that rate high enough via the AGREE instrument? Will it be based on the consensus of opinions of professional organizations? Will it be based on guidelines accepted by the National Guideline Clearinghouse?" 27732 07/24/06 MI Agree Agree "There needs to be some care taken that this ""community health network"" overseeing organization does not become just another piece of the federal bureaucracy. It will be important to utilize programs already in place. Health & Human services has programs funding underserved rural populations for instance. Programs like this need to be pulled into one efficient group. Private programs that are working need to be identified and replicated. " Agree "emphasis needs to be put on the last item- education, communication, preventive care and promotion of healthy lifestyles. I'm not so sure that there is sufficient value in the ""electronic medical records"" to warrant that being such a high priority item. " Disagree "* I actually disagree with the first subpart of the recommendation. I have a real problem with ""expert consensus"" whatever the heck that is. If my family needs to have care in the home for a chronically or terminally ill member- we should be able to get it. If my family, on the other hand prefers hospice or nursing home care for such a person- we should be able to obtain that without having to deal with a ""payer"" thats going to tell us we can't do it that way because it's more ""efficient"" or ""cost effective"" to do it the way they want us to. When a family member is chronically or terminally ill, the decisions are difficult enough without the pressure of a ""Payer"" in the background saying that you can't have another week of critical care--because that's not the way we do things. " Agree Agree "Funding is a difficult issue. It should draw on streams of revenue that are set aside for this purpose. These funds must be made tamper-proof- in other words, Congress must not be allowed to ""borrow"" these funds for purposes not directly related to health care. " * Medical schools need to encourage students (perhaps via an ethics course or something like it) to serve underserved populations in both rural and inner city settings-- and not just long enough to pay off their student loans. Better use must also be made of Physician's Assistants and of Nurse Practitioners in delivering health care to rural and inner city areas. Pricing of services should be available to patients so that they know what services are costing. The use of medication and home health care services where appropriate that will allow a person to remain in his or her own home instead of requiring hospitalization or nursing home care for certain aliments of the elderly or chronically ill should be explored. 27734 07/24/06 IA Agree Agree Agree Agree Agree Agree 27735 07/24/06 NE Agree We need a single payor system. Agree "Iiving in a largely rural state, there is a great need for increased access." Agree "We need to improve and expand Medicaid, not cut it back, and reimburse Medicare participating hospitals at a fairer rate." Agree No comment Agree "I work as a Medicaid eligibility worker, and I would like to see it expanded to include working parents. They could pay a reasonable premium if their employer does not offer affordable health insurance coverage." Agree "I agree. There is a shared responsibility and everyone should pay something. It could be as little as $10.00 for a low income individual, to an income tax surcharge on a wealthy individual. We do need a comprehensive strategy, and it likely will be funded by many sourcew." "Prevention should be a key, as that pays long range benefits. " "Members of Organized Labor, designated by Organized Labor, need to have a place at the table. I say this, as the Bush Administration tends toward cronyism, and shys away from people with divergent views. This will be critical to get all stakeholders to buy into the process." 27736 07/24/06 NC Agree Please allow folks to purchase additional private health insurance as well. Agree Sounds like a very top heavy buracracy. Agree Agree Is this backdoor euthanasia? Agree Agree The medical community overcharges for their services. Insurance companies can be very crooked. It's time for all political parties get health care re-organized to benefit all americans. The current US health system is a joke which benefits arrogant doctors. 27737 07/24/06 WA Agree Agree Agree Agree Agree Agree "PUBLIC, not private funding. Cut out the insurance industry from health care. Give all Americans publicly financed health care. " 27738 07/24/06 FL Agree Agree Agree Agree Agree Disagree "I believe there should be a national health care system...no more insurance companies...no more middle-men. Keep it simple, support it with taxes out of our pay checks. Look at the european models that are successful and make ours similar. Do not compromise anything to pharmaceutical or medical equipment profits. It's time the common good wins out over profiteering in ALL areas of our lives." "Think outside the box. Universal health care period. No policies, no covered benefits vs. uncovered benefits. Who knows ahead of time what they miight possibly need?" 27740 07/24/06 WA Agree "Establish a PUBLIC national program, not a private program. If left to the private sector, it will be ""market driven"" program,and will not ultimately provide coverage for all. A private sector program will be disproportunately unfair to all Americans with bottom line emphasis on cost savings rather than quality services." Agree "Agree, the ""federal government will lead a national initiative"" and expand service integration. Do not agree with establishing a public-private group. " Agree "* Greater emphasis must be placed on more comprehensive health education and disease prevention as part of the nation's move toward greater clinical and financial emphasis on health promotion overall throughout the entire (increasingly integrated) health care system. We need to have a ""health care system"" that fosters more disease prevention and health promotion, therefore paying less in long term health costs for all the humpty-dumpties that are too broken to fix. We have been, and continue to emphasize and pay for disease care in this nation. This must be turned around or the system will be crushed under it's own weight of disease and disability i.e. the coming collapse of the American health (disease care) system. It won't take many more straws on the camels back ... then system meltdown... and then what????" Agree "* Persons dealing with end of life issues need all the support that they can be afforded!! Yes, we need to restructure how palliative and hospice care are provided, and provide the financial structures and payment schemes. This is a very important and powerful recommendation -- it should be a high priority. Yes, we need impacted persons to have access to the entire gamit of health care options, and more health care professionals need training in this area of care for chronically and seriously ill patients. The current shameful state of insufficient health care training and care providers in this arena of death care needs a 180 degree turn around. Just look around the world, and see the many examples of how different countries are doing this ""right""." Agree I totallly agree word for word with the above recommendation. Agree "* The major share of financing health care for all Americans should be the primary responsibility of the federal government. I have spent 35 years as a professional health care provider, and I have yet to see any ""efficiency gains"" get translated into creating additional dollars to offset health care costs. The federal government needs to take the lead in all of this, despite all the ""disparate parts"" issue. The federal government, through its various agencies, needs to set the goals and financial requirements just as they do currently on issues such as national defense, and military spending, etc. The political operatives need to stop lobbying for 'their interests' and get onboard with whats good for the common good for all Americans. " "I agree with this entire recommendation, with the proviso, that the private sector (health plans, insurers, all Payers) not have any undue influence over the ""independent, fair and transparent process"". " 27742 07/24/06 IL Agree They should have just given the prescription drug bill to Medicare to administer and allow Medicare to negotiate lowest prices. We could go to the drug store and buy drugs at the price Canada and Europe are paying. Agree Agree Agree Agree Agree Some percentage of the cost should be paid by individuals who can afford it to prevent mis-use of the system. 27746 07/24/06 CA Agree "* since, many of the costs, are GOING UP, due to the large population of underinsured, or uninsured; and, people utilizing ""after hours) EMERGENCY ROOM, due to not being able to ""skip work"" for scheduled doctors appointments.. i worked in an Emergency Room/Class 1 Trauma Center for 11 years... and i ""watched""... as my workload increased, with the influx of underinsured, uninsured and resident aliens utilized your facility for necessary services... NOTE: this insurance coverage, should be BLANKET COVERAGE; including, undocumented aliens!!! (i know, the name of this group has ""citizen"" in it's title... but, IF WE DON'T INSURE, OR OFFER PROTECTION FOR THEM TOO... WERE HEADING FOR A CRISIS OF EPIDEMIC PROPORTIONS)!!!" Agree "that's a LOT OF LEGALESE MUMBO JUMBO... WHAT, ARE YOU ""REALLY SAYING"" IN PLAIN... SIMPLE... ENGLISH; THAT WE ALL CAN UNDERSTAND!!! also, will this mean, MORE GOVERMENTAL BEAUROCRACY (sp); and, MORE NEEDLESS ""RED TAPE""?!?!" Agree "* first off... WHO DETERMINES... the ""Best Practices"" in health care??? Physicians, Politicians, or ""faith based"" psychic healers?!?!?! unlike, PRESENT EXPENSIVE, ""BEST PRACTICES"" METHODS... there are, NUMEROUS, ALERNATIVE HEALING PRACTICES; for example: ACCUPUNCTURE, ACCUPRESSURE, REIKI, and HERBALIST PRACTICES, that have been PROVEN, HIGHLY EFFECTIVE, YET, ARE ""NOT COVERED"" AT PRESENT, DUE TO, THE ""HIGHLY SUBJECTIVE"" OPINIONS, SURROUNDING SUCH PRACTICES!!! and, in other words, the NEW SYSTEM will be a ""tier-based system"" of access of care... with, LIMITED, cost-effective care... and, in some cases... high risk procedures; which might save a live, but are, NOT COST EFFECTIVE, will NOT BE OFFERED... merely, STANDARD PRACTICES ""PLOSEBO"" CARE... and, WITHOUT CHANGE... THE SAME AS BEFORE!!!" Agree "will this include, end of life, ASSISTED ""DEATH WITH DIGNITY"", HOSPICE, and RESBIT CARE PROGRAMS... or, ""ARE YOU GOING TO CONTINUE THE ""STATUS QUO"", OF ""NEEDLESS, ENDLESS SUFFERING"", until, the ""patient dies"" out of HAVING LOST ""THE WILL TO LIVE"", due to the ENDLESS AGONY, of the STANDARD PRACTICE, of UNDERPRESCRIBING PAIN MEDICATIONS!!!" Agree "what is your ""model""... GERMANY'S SOCIAL SERVICES SYSTEM OF CARE MODEL, ENGLAND'S ""SOCIALIZED MEDICINE"" PROGRAN, CANADA'S SOCIAL SERVICES PROGRAM, or HAWAI'I'S OHIP PROGRAM???" Agree "so long, as the Government, ""borrows"" from the Medicare coffers, to FINANCE, THIS COUNTRY'S EXPENSIVE WAR EFFORTS; EXTREME TAX CUTS FOR THE WEALTHY (who DON'T NEED THEM), and the DEMOCATIZATION OF THE MIDDLE EAST, there will NEVER BE SUFFICIENT FINANCING... to PAY FOR THE INTRODUCTION OF THIS PROGRAM!!!" "how about, including, alternative practices specialists, as well!!! i'm a certified reiki practitioner; which is utilized, for psych surgery, and stimulation of the bodies immune system, for pain control, and increased circulation, in bed ridden elderly patients; under, and alternaive elder care program, and for those who have such terminal illnesses, such as Cerebral Palsy, MS, Diabetes, Lou Gerrig's Disease, AIDS, Chronic Pain Syndrome, and a host of others!!!" 27748 07/24/06 OH Disagree "We don't need financial protection, we need to reduce health care costs! Health care should be a right for all Americans, not a privilege for those who can afford it, or for those who can be reimbursed for it!" Disagree We don't need more government bureaucracy and the targeting of special populations. We simply need a national health care policy with universal coverage and a single payer financial system. Disagree "The health care sytem needs to be overhauled, not just tinkered with. Why can't we have a national health care system like that of every other industrialized nation in the world?" Disagree "Of course this would be good, but it must be a part of a larger system that provides preventive as well as reactive treatment to all Americans." Disagree "Why provide “financial assistance” when we just need to have universal payment for all medical needs from a common pool of money? Providing financial assistance inevitably means establishing a “means test” for eligibility, a stigmatizing system of “second class health care recipients, and a tool for politicians to manipulate for their own selfish purposes." Agree " A transition to a new health care system must care for those who are most vulnerable, who might ""fall through the cracks"" of a changing system. This might cost some more money in the short term. However, in the long run, a single payer health care system will be less expensive and more efficient than the one we have now. If we can borrow money to pay for the waging of wars we can borrow money for the saving of lives." "This is sound reasoning except that we need not deal with the provision of financial help to pay bills, when they are paid out of a common ""treasury."" " "The American health care system costs us twice as much as the systems of other industrialized nations, and has led us to the situation where over 40 other nations have a lower infant mortality rate, and a longer life expectancy than we do. We are paying more and getting less. Its time that we change." 27749 07/24/06 WA Agree No response Agree Agree Agree Agree "The reimbursement health care organizations get should be tied to a statistical measure of how well they provide health care, weighted by the population of patients in all the disease sites they treat. The idea that the reimbursement health care organizations receive should only be tied to the procedures they perform incentivizes them to perform more, expensive procedures than people actually need. " 27751 07/24/06 OH Disagree "We don't need financial protection, we need to reduce health care costs! Health care should be a right for all Americans, not a privilege for those who can afford it, or for those who can be reimbursed for it!" Disagree We don't need more government bureaucracy and the targeting of special populations. We simply need a national health care policy with universal coverage and a single payer financial system. Disagree "The health care sytem needs to be overhauled, not just tinkered with. Why can't we have a national health care system like that of every other industrialized nation in the world?" Disagree "Of course this would be good, but it must be a part of a larger system that provides preventive as well as reactive treatment to all Americans." Disagree "Why provide “financial assistance” when we just need to have universal payment for all medical needs from a common pool of money? Providing financial assistance inevitably means establishing a “means test” for eligibility, a stigmatizing system of “second class health care recipients, and a tool for politicians to manipulate for their own selfish purposes." Agree "A transition to a new health care system must care for those who are most vulnerable, who might ""fall through the cracks"" of a changing system. This might cost some more money in the short term. However, in the long run, a single payer health care system will be less expensive and more efficient than the one we have now. If we can borrow money to pay for the waging of wars we can borrow money for the saving of lives." "This is sound reasoning except that we need not deal with the provision of financial help to pay bills, when they are paid out of a common ""treasury."" " "The American health care system costs us twice as much as the systems of other industrialized nations, and has led us to the situation where over 40 other nations have a lower infant mortality rate, and a longer life expectancy than we do. We are paying more and getting less. Its time that we change." 27752 07/24/06 CO Agree Agree Agree Agree Health professionals and consumers need education about end of life issues and expectations. My experiences with Hospice care for my husband was excellent. People should be encouraged to learn trom and discuss these issues with their clergy and leaders of their faith traditions. Agree Agree "All doctors are not equal. Doctors need to supervise themselves better than they are currently doing. They need to be able to set high standards for themselves and develop ways to help those who struggle, reach a level of care that is acceptable." 27753 07/24/06 NJ Disagree "People need to take responsibility for their own health and health care. It has been proven in every country with government run health care that poor quality and long waiting lists ensue. There are many ways to enhance private health coverage and these need to be implemented-- especially expansion of HSA's, allowing people to purchase health insurance across state lines and full deductibility for personally purchased health insurance." Disagree "It has been proven that well run charities are the most cost effective and personally gratifying way to take care of the poor. Charity clinics need to exist in all counties, and making them immune from lawsuits by making them part of the Public Health System is a great way to encourage doctors to participate. " Disagree "Lots of words, very little helpful activities there. The federal government needs to plan a diminished role-- not set up new costly bureaucracies." Agree "Realistic expectations need to be encouraged, so that the process of dying is not prolonged. Good doctor-patient relations are helpful here." Disagree "Sounds good, but the devil is in the details. A robust private health insurance system with HSA's and well run local charities are the best way to go. A huge bureaucratic top-heavy government system will bankrupt the nation and lead to poor quality care." Disagree "Who decides? Bureaucrats in Washington? Or patients and doctors, discussing the cost as well as the effectiveness of a given treatment. People are not currently dying in the streets, and private charity clinics exist to help the neediest among us. We just do not need more government programs." Sounds like a costly bureaucracy to me. "Government has meddled in the health care system since 1965, and we are headed toward a financial disaster. Medicare has promised more than can be delivered to the baby-boomers, and Part D will just hasten its total collapse." 27755 07/24/06 MS Agree Agree No response Agree Agree Agree 27756 07/24/06 OH Disagree "I think this is too broad. What kind of care is to be guaranteed? Can we provide everyone--yes, including me--with expensive, experimental treatments? It is sad, but I just don't see how we can afford it." Disagree "This sounds like one more layer of troublesome bureaucracy between real people and real health care. Let's spend the LIMITED FUNDS on care, not salaries for people to TALK about maybe someday getting somebody some care." Agree Sounds promising. Agree "Being VERY, VERY CAREFUL not to promote euthenasia." Agree "This is a two-way street. If I am to be provided with health care, I need to be an active participant, taking responsibility for a healthy lifestyle. There is NO WAY to make health care affordable for all unless we start making an effort to be healthy ON OUR OWN." Disagree "I already pay too much in taxes and a lot for health care. I am unwilling and unable to pay more. Your efforts should be focused on finding wasted dollars to move into this area, not finding ways to get more from taxpayers who just can't do more." "Again with putting together yet another taxpayer-funded group to sit around and talk. I'm pretty sure the insurance companies, for all of their faults, have already done this. I don't think we need to spend months defining a process for picking a group to spend years to reinvent this wheel." "* Where is the emphasis on promoting health from the beginning? I see nothing but a clean-up program here. This is EXTREMELY disappointing. One of the top priorities ought to be getting people to take responsibility for their own health by getting off their couches and eating something other than fast food! Instead, it is all about how government will take care of us once we've lost our health due to our own stupid choices. If health care were focused on keeping people healthy and helping people dealing with illnesses and injuries actually beyond their control, maybe we wouldn't be in such a financial mess." 27757 07/24/06 AZ Agree "* Today the gap between the ""well to do"" and the poor is becoming evidence of a change in the economic class of everyday Americans. Too often people are suffering extraordinary hardship as a result of expensive healthcare costs, skyrocketing insurance premiums and deductables, and ridiculous malpractice insurance rates. People are going into debt and losing their mortgages to hospitals. This is ludicris in this great nation. I strongly urge you to take very seriously these recommendations, recommendations that were designed to help all Americans receive the basic healthcare they are entitiled to. " Agree Agree An effecient healthcare plan will save money and insure a higher quality of life for American citizens. Agree "Up until now the trends have been to divide families and institutionalize people. We need a family, culturelly sensitive healthcare program that addresses end-of-life issues with dignity and respect for the individual and the entire family system." Agree "It is outrageous to think that so many Americans have to do without health care, or have to compromise health care for food or utilities. This cannot continue in this country." Agree It is about time we look at treating the whole person. Perhaps then we can prevent further complications and diagnosis. 27758 07/25/06 MN Agree "Nothing is free as it should be but the cost of a Health Care Program has to be affordable for all US Citizens not illegal. Tired of paying for there health care. So who is going to make the decision on the treatment the person is going to recieve, the doctor or Federal Heath Care Organization. Some insurace companies do refuse certain type of treatmants that the person doctor recommends. Who make the decision?" Agree "I agree with the recommendation but it scares me that the government is the one going to run the show. It always cost more when the governmant do it, to many regulations. Take a look at the drug insurance program. I have my doubts that a Federally Qualified Heath Center can be established when the federal government can't even do a national computer program for criminals so local police can access." Agree Sounds good but can it come true? Agree Agree Almost sounds like the social security program when it started. Is the general fund get totake money from it and not pay it back like it has been done with the social security funds? Agree Here we go again....the rich can afford healt care. If every citizen pays the way it can be done without a burden on a class or group of people. But if only a few are required to belong then the cost will be much more. What would be covered? Everything should be covered. Who are the people that will be appointed to this organization? 27759 07/25/06 CO Disagree It is NOT the job of the government to provide health care! Citizens should be responsible for their own health care costs and let the market decide the cost for medical care and medical services. Disagree See above comments. Disagree "The recommendation makes statements like ""controlling costs"" and ""reduction of fraud"" but these statements are contrary to government programs. Goverment involvement never controlls costs and government programs are a bastion for fraud." Agree "I support such medical care, but I would emphasize private, not public, funding of such programs." Disagree See above comments. It is astonishing that the people of this country consider health care an entitlement that should be provided by the government. Disagree My tax dollars should not be spent to care for others. It is my responsibility to take care of myself and my family. If I neglect that responsibility then I should deal with the consequences. I do not believe that I should bail out any individual who does not take the responsibility of caring for themselves or their families. Government sponsored health care does not work. Whatever happened to personal responsibility? 27760 07/25/06 OH Agree "My support is tempered by a desire to see coverage be for evidence-based care, i.e. more support for the midwifery model of pregnancy care and more support for healthy lifestyles than pharmaceutical band-aids." Agree "We have to be VERY careful not to establish a dual-level system of health care, where the wealthier in the population buy into a higher quality care and everyone else takes what they can get." Agree Electronic records need to be carefully protected to be sure the data isn't mined for purposes other than proper provision of health care. Final say over the fate of such information needs to remain in the hands of consumers. Agree Disagree "It depends VERY much on what you think constitutes health care, and how that defines the ""core services"". If the core services offered aren'yt what I've found works for me (i.e. pharmaceutical coverage as opposed to quality wellness options) I'd be VERY resistant to being forced to take part." Agree "If you switch to evidence-based care, some areas of care should see a significant cost reduction, i.e. midwifery care for pregnancy vs. the typical OB/GYN intervention fest, complete with epidemic levels of cesaerean sections." "If ""evidence based"" means according to the big pharmaceutical companies, it'll be expensive and full of bull. The ""evidence"" needs to come from peer-reviewed data that is NOT funded by someone with a financial stake in the outcome." "Our system is sadly broken now. It is virtually impossible to find affordable coverage, and liability insurance is driving a great many quality practitioners out of their field. It's going to take substantial upheaval to get something that really works. I don't have a lot of hope that it will happen." 27761 07/25/06 WA Agree Agree Agree "A new focus on health education and disease prevention, as well as healthy habits (that could confer discounted health care costs)is crucial." Agree Agree We need to decide if we are going to exclude illegal immigrants...if so that would negatively impact all of our health and destroy the gains of a new system. Agree For profit health insurance companies have no place in our new system. 27763 07/25/06 WA Agree "When you implement these high cost plans, do not take away our existing day-to-day health care medical insurance that is supplied as a benefit of employment. " Disagree There are far too many levels of bureaucracy. This reminds me of how Special Education Laws are serving children with disabilities. They are not. They only allow an avenue for school districts to pocket the money without performing or working-in-good-faith. It is a fraud. Disagree "So based on this recommendation, it is no longer acceptable to get healthcare that is proven, if another practice is determined to be ""best"". This seems to open the door to a lot of subjectivity. The further away you take healthcare decisions from the recipient the more you open up for abuse of the system and create worse problems." Agree "We need equity. Today if a person has insurance, the insurance company has made agreements to pay less. An overnight stay in the ER is $15,000. A person with medical insurance pays a $50 co-pay, and insurance pays $6,000. But a person without insurance is responsible for the entire $15,000. There is no equity. We need equity. Solve that problem. FOCUS." Agree Do not take away what we have now with our medical insurance which is provided as a benefit of employment. Agree "According to the head of the Federal Reserve, ""The top 1% have more assets than the bottom 90% of the population."" For those people without healthcare, look to that top 1% for financial assistance." "* The healthcare system should demonstrate primary responsible for the patients' well-being. Thus, it should mirror the exact same kind of healthcare practices that those who are covered by other medical insurance plans. For example, impacted wisdom teeth should be removed before they become infected, thus causing the patient to lose only the 4 originally impacted wisdom teeth, rather than 8 teeth lost due to infection (as Medicaid works today, impacted wisdom teeth are removed only after an infection occurs and thus 8 teeth are lost)." "* Learn from the Special Education Laws. The further away the decision-making is done away from the child and the family, the more corruption enters into the equation. Then not only is no one served, but fraud, abuse, and waste becomes rampent. Rather than putting these people in a place of empowerment, they become economic entities. All of a sudden they have to ""advocate"" for their own well-being. In a place where ""working-in-good-faith"" is not considered ""good business practices"", the patient becomes a victim of abuse and neglect. Give the patient authority over their own healthcare. Let the money follow the patient to the healthcare provider the patient chooses." 27765 07/25/06 NM Agree Give Medicare the right to negociate health care cost just like the VA does and Medicare has done in the past. Agree Agree Agree Agree Agree 27767 07/25/06 FL Agree No response No response No response No response Agree "I have been there and know what it is like to not be able to afford even the least expensive health care, dental care and/or medications" 27768 07/25/06 WA Agree Disagree "this national system must be well connected to the people of this country outside of the government systems.. you're efforts to come to the people have beneffited all, let us now come back to you and set policy.. let's not create another beaurocracy to just muddle along." Agree "Health promotion is critical to success in this venture and quality of life here in america. We need to encourage our people to eat well and exercise for their health and lives! Let's not say fast food is bad for america, let's get the people to choose NOT to eat fast food, for healthy reasons.. and life!! " Agree Agree Disagree "Clearly some new financing will be needed, but many states already have programs and funding streams in place that can be diverted for these programs too. We neeed all people and local, city.state governments in on this program. Let's not use Sin taxes this time, let's use Income/sales/use/property taxes to fund this program, good positive revenue for good programs." "There should be a fair way to petition this group/policies/decisions, many people today are at odds with their insurance companies.. Give the group and the individual rights and remedies against this new system." "* Health care costs are continuing to rise and companies and governments are pushing these costs onto their employees and society. It's time to take these rising costs in hand and stop their rises.. whether it's risk assessments (doctors insurance)... or supply costs.. we need to lower costs and increase benefits for our public. Any large medical system will have it's supporters and critics, group health of seattle/washington has the same.. situations will come up in medical practice where life and death are in the balance and how do we give fair support to all parties.. it will be a challenge for the country." 27769 07/25/06 NC Agree "We need a SINGLE PAYER system, and that means a system similar to Medicare, NOT involving private , profit-driven insurance companies. We also need the government to have the right to negotiate bulk pharmaceutical costs and regulate drug company excessive profits!And, we don't need to wait until 2012. By expanding the existing Medicare system to include everyone, we could eliminate all the excessive administrative costs for reimbursement." Disagree I disagree with the inclusion of private for-profits in the whole enterprise. Agree Agree Agree Agree "* For less money than the government is now paying to subsidize the Insurance companies, the pharmaceutical companies and large corporations (so that they shouldn't drop employee health coverage)we could have coverage for all uninsured citizens. With a single payer system, billions would be saved in administrative costs because we wouldn't need Tricare, VA, Fed. employees, Medicaid, etc. - just one agency responsible for payments. This would also cut costs for hospitals and physicians who would not need such large staffs to bill for reimbursments." "Core benefits must also include complimentary and alternative medicine ,which an increasing number of people are successfully using in addition to traditional treatments." "It is time to rescind the law permitting pharmaceutical companies to advertize prescription drugs directly to the public. While their profits have soared, so have fatal drug interactions. Also, to increase the safety of prescription drugs, they should not be tested by labs hired by the company whose drug is being tested. Rather, the FDA should send the drug out blind - that is to say they don't know whose drug they are testing , and the company doesn't know who is testing their product. " 27771 07/25/06 OR Agree Disagree I do not believe that Private Insurers should be involved unless there is riggerous Federal or State control over premium costs. There needs to be enforced strict cost control throughout the entire Health Care System. Agree Agree Agree Prices for all procedures and services should be uniform on a person to person basis regardless of the source of payment. Everybody should pay the same for the same service or procedure. Agree I believe America should have a single payer plan for all residents. The premium should be uniform and financed by increments to both corporate and individual income tax. 27772 07/25/06 IN Disagree their are things the government could do to protect the earth and her children. Stop bombing people. Stop relying on fear to promote their insane agendas Disagree I don't see indications the government is for the people. I don't want to see the government handling this. Disagree I have worked for governments. Anyone who actually works is ill-considered. Agree it's a good idea to know what it is people want. and not assume others are better informed to make decisions do not give your power away Agree sure go ahead. the english look healthier... but I consider their time spent walking as an advance in immune enhancement Disagree good luck I only hope science will be used and not the influence of pharmacuetical industry monies slanting research to sell their product "I have a heavy distrust of the medical profession... the way the guys have been taught, the egos of some, " 27773 07/25/06 AZ Agree Agree Agree Agree Agree Agree 27774 07/25/06 KS Agree "* Out of pocket healthcare costs are a major cause of bankruptcy. I remember my family struggling to pay the healthcare bills for years after my brother's death from cancer. This only added to the family's stress after such a tragedy. I currently have 2 children on daily maintance medication, one for epilepsy and one for asthma. They are currently covered my the state SCHIP program (thank God). If I were to cover them under my employer health insurance, it would cost almost $600 about 1/4 of my monthly income. Their father can not provide them with adequate health insurance because he is self employed. Healthcare should not be tied to employment because lack of stable employment is not true for todays employer, part-time employment often does not offer health insurance and some employers force a waiting period before health insurance coverage can begin. I don't understand why those in this country spend so much on pharmaceutical research and improved technology if many of us can not access the drugs produced" No response Disagree "* I believe in having a chose of health care providers. I chose my doctor because I can ask questions and get answers. I tried other doctors who did not listen to my concerns, who did not answer my questions and one who barely spoke English and I could not understand. I agree with reduction of fraud and waste but the amount of paper work required by many of the above mentioned programs require additional employees just to complete the paper work. I suggest we not only take an egotistical approach in looking at our current federally-funded health programs bu also a comparison of programs in other countries. A program that would incorporate the best of all programs." Agree I agree that personal choices should be available to those with terminal illness and facing the end of life. Agree Affordable is the key word here. Majority of Americans have access to some kind of healthcare but often it is not affordable or even comprehensive. No response "In reality, Americans pay less in taxes than many developed countries." 27775 07/25/06 WA Agree Agree Agree Agree Agree "If we do away with all other government welfare support to have health care, it will be worth it. People can scrounge food, clothing and shelter. They cannot scrounge health care." Agree "If we can spend a half a trillion dollars to blow up people in Iraq, then we can aford health care for our own population." "What? Mental health? Yes, mental health. We live in a sick society that must also be healed on the inside." 27778 07/25/06 AZ Agree "Universal coverage for everyone should not fall prey to loopholes in coverage, state-by-state variations, and vague regulations: everybody covered for everything, cradle to grave, publicly financed." Agree "I live in rural AZ, and the problem with access is monumental: no ER access for many communities, so-so local physicians with numerous specialities absent, etc. Native Americans need one integrated system of excellence on reservations. Don't forget: rural access to quality care must be linked to various appropriate modes of transportation that can be accessed regardless of distances or income." Disagree "* The burden and responsibility for cost containment cannot be forced onto the consumers in the system: the ultimate responsibility for price containment must be by the Federal government on behalf of its citizen consumers. Forget any notion of vouchering cash to individuals that they must somehow match out of pocket: publicly finance health care. The above sounds like mumbo-jumbo: don't try and rationalize what's out there now, change the system. Good ideas above; how to get there and who's ultimately responsible and accountable is my concern." Agree "You want to leave the door open for Uncle Sam to dodge paying for a comprehensive system. Again, good intentions above will be dashed on the rocks of a system already broken if not fundamentally changed. Don't forget mental health coverage and accessibility also." Agree "You make me wonder when you preface that ""common message"" with the code phrase ""Core HC services"". To me that means something less than comprehensive services provided to everyone. Sounds like you want to pick access winners and losers - we already have that!" Agree "* We need to fundamentally change the financing of the system to one that is entirely paid for by Uncle Sam. That will mean public financing, which ultimately means taxing all appropriate revenue sources. If Uncle Sam assumes responsibility for financing, then employers that will profit from a reduction in their current outlays should be taxed to make up for it. I'd favor everyone paying a lowered tax without caps across the board - done progressively, rather than retaining a co-payment out-of-pocket. Don't replace one overly complicated financing boondoggle with another one. Keep it simple." "* Yeah but - don't leave out the average citizen. This ""blue-ribbon panel"" stuff is good up a point. The people of this country can make up their own minds - if you want to know what should in the core service package, ask them. They may need help understanding - so educate them. Even your statements in this survey are too jargonized and imprecise for most people, the product of way too many experts already. Yeah its complicated: but spend as much time translating your recommendations into plain English (and Spanish), as you do relying on endless multitudes of health care policy wonks." Good luck. I have a hard time believing there are the people we need to solve this running the Show in Washington these days. 27779 07/25/06 FL Agree "Expand Medicare to cover all. Let there be a single payer system which will reduce administrative costs and profits to insurance companies. It is a major decision, but take insurance companies out of picture except for extraordinary insurance not covered in a generous basic health plan for all." Agree "Yes, ,change the system so that people get used to community based health centers," Agree excellent Agree "Include physician assisted, but monitored, ability for terminal patients to be able to choose to end their lives in a safe and dignified manner." Agree This is essential. Agree "It is ok to tax for what is needed, but taking insurance company expenses out of the equation will make public healthcare affordable for all." Good. 27780 07/25/06 NC Agree "It is ""time"" for coverage for all Americans and protection against very high out-of-pocket medical costs. My husband has COPD and even with insurance the out of pocket expenses are going to add up. But it will be financially even harder for young adults like my son who has CML and has to pay a $50 co-payment every doctor visit and who knows down the road how high the out-of-pocket medical costs will be. " Agree Agree Agree Agree Agree "Establish a""Health Care"" Tax that would fund the plan." 27781 07/25/06 WA Agree Agree Agree "Caveat, Except when they mention 'reduction of waste' in insurance terms that often is telling Doctor to speed up/be more efficient, hurting the patients inadvertently. Doctors shouldn't be second-guessed so much by insurance companies..." Agree Agree Agree "Just questioning how it would be provided, if higher taxation might scare off a lot of voters. And since so many of my friends don't have health care (as an artist, I'm probably in the MINORITY in that I have coverage) due to fiancial inability, they certainly can't contribute """"more""..." 27782 07/25/06 GA Agree In order for someone to take part in this system they must share some responsiblity for their healthyness. What I mean is there has to be incentives to make people live a more health lifesyle. If people do not improve their health this new health care system will bankrupt the govenment just like social security is now. In order for the plan to work most people have to stay healthy. Disagree I think this proposal is creating to much government. This problem can be fixed if governemtn allows private citizes to solve the problem. In any health care system patients either have insurance or not or have enough money to pay for services. Private clinicians are most afraid to treat the uninsurance becasue they would not get paid. All govenment needs to do is creat a trust fund that private clinicians can get paid from to treat the uninsured. Agree Allow all licensed clinians of any disclpine equal partners. For example in TRICARE I am unable counsel service members with getting a physician referral when licensed social workers do not have to do the same thing. It is time for the govenment to end professinal discrimination. Agree Agree Again people should also be responsible for their healthyness. If you take part in a federally managed health care plan you should also be enrolled in a health prevention plan with an exercise program and educational programs on healthy lifestyle choices. Agree A five cent tax on all presciptions? 27783 07/25/06 FL Disagree It leaves out the essential ingredient that must be present for the success of any health care program. Each patient must be intimately involved in order for any health plan to work. Resonsibility of all parties is necessary if health care cost are to be controled if good care is to occur. This leads to better choices and the best possible care at affordable price. Disagree "Unless the individual patient knows that he/she is responsible for his/her own choices and is intimately involved, any system is doomed to failuf re. " Disagree "Unless each patient is held responsible for all decessions, it will be a disaster." Disagree It will never be effective. Disagree Unless each patient is taught and learns that affordable depends on his/her willingness to make choices for which they will held accountable and willing to accept the consequences of their actual choices failure will be the outcome. Disagree Looking for pie in the sky is a guarentee of failure. This puts someone else in charge of making choices and accepting responsibility. Each patientmust make his/her own decisions and accept responsibility. Holding someone else responsible for one's choices is the prime cause of poor ineffective health care. Everyone must learn to set his/her own priorities. 27784 07/25/06 FL Agree Agree Agree Agree Agree Agree "* As I understand the concept of insurance, risk is mitigated through spread of risk across the largest possible population (some will require benefits but all pay their proportionate share, thus those who need benefits will receive them and the others help pay the costs because no one can predict who will need them). If this is the case, then contributions to such a system should be maximized by inclusion of as many parties as possible into the system. Apparently, the insurance industry is currently doing just the opposite in that they ""categorize"" individuals based on historical usage of services (greater risk) then work to remove these individuals from the system rather than address why these individuals have above average usage factors. I would like to see a system (and would gladly fund the same) that minimizes overall costs while maximizing efficiency and EFFECTIVENESS. Currently, my spouse and I pay over $14,000 a year for medical coverage - yet we use only a fraction of that annually, around $3,0" 27785 07/25/06 FL Agree Agree Agree Agree Agree Agree 27786 07/25/06 KY Agree employers should recieve more tax breaks for insuring their employees Disagree although some area's may be in greater need to just focus on areas/localities and not all who are in need would benefit only targeted areas. Agree education and fraud are two areas that need to be addressed. Agree "with the growing number of termanilly ill, hopspice is very needed and welcomed by families in need." Agree "anyone who can hold a job, part time or full time, should be offered some type of medical insurance for themselves and thier children." Agree "appointments can be biased, all work groups, unions, employers:both private and public, should be represented" 27787 07/25/06 FL Agree Agree Public Health Agencies are critically underfunded but an important part of the sfety net and homeland security. Public Health needs to be included in the network to fill in any missing parts in certain communities and to provide surveillance and epidemic investigations--and other functions not performed by FQCHCs or any other agency. Agree "A nationally provided electronic medical record would enhance productivity and safety and if created with cross-connectivity, could function across states for our modile population." Agree Agree Agree incentives for healthy behaviors should be included in our American system as much as possible and taxes on harmful items such as tobacco should be raised enough to decrease use. Health Care as defined in the system above will need to clearly include public health essential activities that provide cost effective disease prevention and health promotion. 27788 07/25/06 DC Agree "Yes, I agree, coverage for all americans is critical for the US to continue to be the number 1 nation of the world. We can not do that if people are sick and not able to get medical help" Agree "Some what agree with this recommendation. In almost 50 years, we have been doing the same things relating to health care, and this has not worked. Let's not continue to do the same things" Agree I some what agree with this recommendation. The programs funded by the federal government and the policies develop are the still the problem Disagree "* Funding ""end of life"" programs is not the responsibility of the health care system, in my view. That is a personal family issue to deal with. The federal government should provide national preventive and affordable health care, and medical care for the living, as well as health and personal care form early ages. Children must be educated at a young age, teens must be educated in prevention, and adults must be educated on prevention. The health problem in this contry began because people are not educated on how to be health individuals, children are not educated at all, and teens do not have a clue about what or how to live health, educated and that lack of educations creates the sick society we all live in today" Disagree "No, a set of core health care services will not work. That is part of the problem relating to the lack of health edducation. Each indivdual has different health care needs, a core will just address the small % of individuals, not the majority of society" Disagree "Again, finacila investments have been the problem, and will not help the health care crisis in America. Let's not continue to spend billions of $ and continue to have the sick society that we have today" "Again, a core benefit package will only address a small % of the population. It's like doing the same things we have been doing in the past, but under a different name. Education, Prevention, and free health care for all Americans is critical." 27789 07/25/06 IN Agree Rising health care costs are causing more Americans to not be able to seek medical attention and when they do it ends up costing more therefore increasing the strain on our economy. Agree Agree Using these as models but improving upon them will help. We really need to work more on the private insurance companies that are not being kept in check. They are what is causing the raise in health care costs. Agree Agree Per capita our country spends more money on healthcare than I think all others. On top of that we have less people covered than most industrial nations. That is sad. Agree If you look at taxing and then getting rid of premiums we will not be paying any more than we already are. Some people are just afraid of higher taxes. In the long run we may pay less for the insurance if it is pretax and if it is taken from everyone. "Need to reward practitioners for evidence based medicine which includes evidence, expertise and the patient's values. " 27790 07/25/06 FL Agree Agree "While useful, the pursuit of this recommendation MUST NOT provide the federal government with an excuse for failing to pursue the higher priorities of a policy commitmetn to affordable health care for all and a clear specification of the core and catastrophic benefit packages." Agree "Quality and efficiency are important. They may provide savings that will be of value. But I would much prefer that we have an EQUITABLE, inefficient system that great efficiency and high quality accompanied by continue unfairness and injustice." Agree As long as these services are provided in a fair and equitable manner. Agree This is the one that counts. And it should be accompanied by a clear indication that public officials of all types at all levels will be held responsible if they fail to accomplish this goal by some specified time certain. Agree 27791 07/25/06 MT Agree Agree Agree Agree Agree Agree 27792 07/25/06 KY Agree "This has to be a must, there is no reason the above items can not be accomplished." Agree Agree Agree Agree Agree The type of taxes need to be fair across the board. 27794 07/25/06 CT Agree Some kind of basic health care must be available to allregardless of ability to pay. why not a medicare type program for all? Agree "If this gets insurance companies out of the picture, go for it! the poor and sick should not have to pay extra." Agree "Prevention, not coverage for care, shuld be the goal. why not cover annual physicals to detect a problem before it needs full-blown medical attentin?" Agree The Hospice program shows how this group cn be served. Agree Will cut down on the large use of emergency services by the uninsured--should lead to a reductin of costs. Agree who will pay for this change? how about raising taxes--a most difficult matter these days when Tax cuts are king. "Minimum standards must be set, then above that limit people can opt for more costly services." high time and long overdue! thanks for giving us the impetus to do better with health care dollars. 27795 07/25/06 FL Agree "Right now my 21 year old daughter and my 47 year old fiance are uninsured. I cannot afford to put either one on my policy. My fiance is self-employed and has several medical conditions that are going untreated. Due to two uninsured hospitalizations in the past two years, his financial picture has crumbled and he is being forced into bancruptcy. No one in this country should have to worry about getting the medical care they need. It is a sin against humanity." Agree "Revamping the community health care centers is mandatory for this to work, and there must be an example-lead preception change among the public about the centers. They should be, and thus be promoted as,high quality health care centers instead of their current earned image as ""indigent health care"". And there must be a more expeditious way for patients to be seen. " Agree Electronic medical records must be extremely well-governed. Particularly in light of the recent VA information breach and the Executive branch of the government insinuating it's authority into the intricasies of the lives of the public sector. Agree A compassionate means to an inevitable end. Agree In this day and age it is despicable that America has no system in place for meeting the medical needs of it's citizenry. Agree "By taking care of this issue we are not only granting health to our citizenry, but we are relieving the minds, hearts and finances of those whom we love." 27796 07/25/06 RI Disagree Not a task for government. Disagree Bureaucracy created..expensive Disagree Private can do better than govt. Disagree Life is not meant to be perfect. Agree State programs such as RITE care in RI can be a model. Agree If the private sector can do it then the private sector using supply and demand should be allowed to move in a free market manner. 27797 07/25/06 AZ Agree Agree Agree Agree Agree Agree There is enough money alreqdy being spent in the system that leaves out 45 million that everyone could have health care with no additional spending by figuring out a way to redistribute the money 27798 07/25/06 GA Agree Agree Agree Agree Agree Agree 27799 07/25/06 RI Agree Agree community health centers should also serve those employed persons with no health insurance coverage Agree without adding yet more unfunded mandates to the providers of health care Agree Agree There are far too many employed and self-employed people in this country with no or inadequate health insurance. We have our national priorities wrong Agree "Much less should be spent on military involvement in other countries. We waste millions destroying countries, then millions more rebuilding what we just bombed!!" 27800 07/25/06 GA Agree Ensure very tight guidelines and monitoring activities to minimize fraud and abuse. Agree Agree VA model is very strong. Agree Agree "I worry that we will see the same problems that many other countries experience with national healthcare - extremely long wait times, decreased access to needed services, a class system in which those with private health insurance have access to services while those without have to wait and wait for those same services. Not sure that would put us ahead of where we are now." Agree 27801 07/25/06 IN Agree Agree Agree Agree Agree Agree The costs should be borne by all taxpayers--individuals and businesses--through a government system so Americans are not at risk from whether their employer wants to provide health insurance or not. "Health coverage is now controlled by ""deals"" insurance companies make with health providers. This practice must be removed from the national system." It is time for America to join all the other industrialized countries and have national health insurance for all. Citizen--not corporate--voice should predominate. 27802 07/25/06 AL Agree Agree Agree Agree Agree Agree 27803 07/25/06 VA Agree Agree Agree Agree Agree Agree 27804 07/25/06 SC Agree There's no excuse for the current dismal state of our US health care system. Patients AND DOCTORS are being abused. The only winners are insurance providers who are responsible to their shareholders to make a profit. Agree Agree "Medicare and the Veterans Healtcare Administration are examples of programs that work. FOR PROFIT Insurance schemes don't work. We tried private source fire departments and educational systems. They didn't work out well, either." Agree Agree This is the key issue. There's no excuse for the so-called system we now have. Agree We pay the lowest taxes of any industrialized country. We can afford more taxes to provide health care for every CITIZEN. Illegal aliens should be excluded. "I believe that the ""Oregon plan"" was an example of ""core health ser vices""." "Health care -- like fire protection, police protection, and education --should be non-profit. Now there's a hand out for profit at every level. This idea won't fly because of the insurance industry lobby influence and money." 27805 07/25/06 OH Disagree "* A National program will only work to impoverish the economy of the United States unless significant steps are taken to make Americans healthier. This means recognition of the root cause of disease in diet and sedentary lifestyle and a concerted effort to help all Americans make the appropriate changes in diet and lifestyle. A National health care plan is a band aid approach to a gaping wound. Unless we recognize the real cause of high health care costs and make the difficult and necessary changes, nothing will be gained. Health care costs will continue to rise and people will continue to suffer and die needlessly. Remember, hundreds of thousands die needlessly by their own habits each year despite having great health insurance." Disagree "Sounds like one more step toward socialism and welfare. It won't work for the same reason welfare did not work. It removes responsibility for one's own health from the individual and places it elsewhere. I see people with food stamps in line at the grocery store buying chips and soda and meats and other unhealthy foods, then we have to pay for their healthcare to boot! What you are proposing is the same old tired system that does not work, just on a larger scale." Agree "If anyone were interested in results we would already have great health care in America. Unfortunately, health care practices are based upon what pays the best currently. As a health care practitioner however, I don't like the idea of the government looking over my shoulder yet again. (Like the stupid HIPPA laws!)" Disagree "There would be few ""end of life"" issues if we worked to make Americans truly healthy though a healthy diet and lifestyle instead of focussing on afterthoughts." Agree "Again, the only way to make health care truly affordable for all, forever, is to go to the root cause of the cost. High tech ""crisis care"" is ridiculous and unnecessary. Prenvention is the answer. So far, this all sounds like academic and political BS, not real answers." Disagree Stupid. Unnecessary. Redundant. Insane. Illogical. Too much influence from food industry and organized medicine. Need new leadership with a sense of logic and morality. You have accomplished nothing and probably never will. 27806 07/25/06 FL Agree "* Though ""I am my brother's keeper"" is a very noble and idealistic goal, I believe that middle class Americans are paying for everyone and that's just not fair either. I believe that we absolutely look and care for the elderly, no matter what their financial status in life. On the other hand I see that the vast majority of those 50 years and younger who are asking for a hand up are actually taking a hand out. I think there should be a credits system for those people 50 years and younger so that they either pay forward or pay back in kind. Not neccessarily in dollars obviously, but in a hundred other ways that would help the entire community. It is a sad commentary on human nature that so many take advantage or straight out abuse what should be a stpo-gap helping hand, NOT a way of life. I absolutely believe that there needs to be.....has to be, a very strict and unconditionally enforced policy for the cost of health care. That one single asprin costs $3.35 in hospital is uncontionable. The costs MUST be k" Agree "I agree with these recommendations as far as they go but again, everyone who cannot afford to pay for their healthcare needs to contribute back to those who do. I think it is basically wrong and irresponsible to foster the idea that you do not need to be a citizen or LEGAL landed immigrant (or some tax paying status that has yet to be formed) of this country to participate in those priviledges that so many Americans have paid for in so many ways." Disagree I agree with everything that is stated here EXCEPT including TRICARE and the Veterans' Health Administration in this proposal. I think military personnel and retired military personnel and thier dependents need to stay seperate to the general public. I have very strong opinions on this and would be happy to share them with those who would like to hear them. Agree "This is a heart breaking time in anyone's life, both the patient and those around them. I agree most strongly that this is a very special and delicate area that needs special training and environments for those in need. " Agree "I agree in principle but this needs to be for legally presented individuals (in whatever form that finally presents itself) and that this is NOT abused by those who know and work ""The System"" as a way of life." Agree "You say above ""all Americans"", but is that what you really mean? The Government must develop a means that makes everyone who takes advantage of the new health care system accountable at some time or in some way, for the costs that they incur. We have seen time and time again how unmanegable and wasteful the buraucracy is. We need to run health care more like a business than like a charity, but NOT at the cost of someone's life. " "* I agree with all that is proposed here in pricipal but again you say ""citizens"". What are you defining as a citizen? Keeping the hugely inflated medical costs at a reasonable amount would be a huge step forward. I think it is immparative that the new health care system not be bogged down and rendered impotent by creating so large an entity that this would be a near certainty. We need to look at all those countries that have a universal health care in place now and learn from them by taking the best of what they offer at a price and means that is equitable to all. " * I see from the various medias and from personl observation that the elderly of this great Nation are being shuffled to the back of the compound and many times overlooked compltely. This cannot be tolerated. These are the very same people who have already paid the price for us and have contributed mightily to make this country what it is. The elderly need to be revered and shown the respect and dignity that they so richly deserve. Many of the nursing homes in America are a national disgrace and this crisis should be addressed immediately. It is not IF but WHEN this will apply directly to YOU. Thank you for allowing me to take this opportunity and I would be honoured if you would call on me in any capacity in the future. 27807 07/25/06 MI Disagree Health care insurance does not equate to receiving timely health care. It will give the high cost items priority over the more common health care needs. Health care insurance is too high because costs are too high. Disagree Get the Federal government out of health care and restore individual rights and choice to our citizens who accept responsibility by earning their benefit and who in reality pay the full cost of care in the United States Disagree "A competitive market is the best arbiter of efficacy, quality and price. Restore the control over the payment system to our citizens who earn the money and pay the cost." Disagree "We need to get rid of third party payment for all of these ""feel good"" activities and get back to two party insurance contracts that insure true risk, not prepayment for routine health care services." Disagree Socialism or Commmunism? Disagree Hold those who incur the expenses responsible for paying the cost. All else is charity. Those accepting charity should not have the same rights as those accepting responsibility "Create a market where true choice as to what is insurable exists so individuals have real choices. Third party payment IS the problem, not the solution. Place the control over the use of the health care dollar back in the hands of those who earn it." 27808 07/25/06 KY Agree I agree only if a national program places strong restrictions on the role of the federal government. This should not be a new bloated federal program that raises taxes or increases the budget. Let the private sector handle the market with some government oversight. Disagree I would be more comfortable with an initiative led by the federal government and the private sector. The federal government has no track record of success in leading these types of initiatives. Agree I agree with government efficiency. The question is if this is actually a reality? Agree Disagree Disagree Raising taxes is the wrong approach. I would rather keep my current health care plan and take care of myself than have my taxes raised to subsidize someone else. 27809 07/25/06 ND Agree No response "I am uncertain how this would play out. MUST concentrate on safety net. Could be like Healthy Communities Access Program, which was a great start on this issue and which the current administration does not support." Agree Agree Agree Agree 27810 07/25/06 MN Agree Agree Agree Agree Agree Agree I truely believe that dental should be covered by our current health care providers. Teath are critical to overall health. 27811 07/25/06 KY Agree There should be some type of catastrophic coverage for all Americans. Nobody should be left bankrupt because they are trying to save their life or the life of a loved one. Agree "However, the nation could benefit from this quality/need centered approach." Agree While we work toward a universal health coverage plan Agree Agree "Universal coverage is needed for all. Americans no longer work for the same employer for extended periods of time. Insurance should no longer be employer based, but American based and part of the tax structure, but free enterprise could still prevail by having government bid out contracts to run the plans in various parts of the country." Agree I beleive the government should be sensitive and a watch-dog for substances in our food supply that are harmful to all. I really feel Universal coverage is achievable as well. Many studies show the government currently spends more than what it would cost to run a national healthcare system. 27812 07/25/06 KY Disagree "The fullfillment of these abjectives without individual responsibilities would constitute in all likelihood a single payer government controlled system. This would ultimately lead to rationing or totally out of control cost, yes even greater then what we are facing presently." Disagree "* We had and still have the solution for this objective already in place, it is called the Public Health Department. The Public Health Department was replaced with Medicare and Medicaid by those thinking this would make some sort of difference. It did, the resultiing cost shifting we have experienced when the government does not acknowledge their financial responsibilities for the promises they have made. Shifting care back to the Public Health Department concept and having virtually all patients pay some amount for services based on their income would then bring all parties to the table in addressing the so called health care crisis; the major payer, the patient, and the provider." Agree But see my comments above before thinking I support what this will probably really look like. Agree I thought we already had this provided by Hospice??? Disagree "* Yes, this should be true to an exstint but people are amking buying decisions every day and many who do not have any medical insurance which has now been twisted to be available health care are choosing to spent their money elsewhere and then demand that the government most substidize their health care costs. This subisidy comes in the form of cost shifting by providers and direct government payments. Citizens need to be held accountable for their decisions or this country will no longer be able to exist under our constitution!" Disagree 27813 07/25/06 NC Agree "Something must also be done to make the coverage affordable. I work for the State of NC which gives me free health care insurance. However, the deductible and co-insurance are so high that I could not use the free health coverage. I was finally forced to use it when I had a serious medical problem and now I'm in debt hundreds of dollars that I can't repay and collection agencies are calling my home several times a day. It is so stressful that it is negatively affecting my health even further." Agree "I've done the evaluation for a local site of a federally-funded program to improve community-based services to children with severe emotional/behavioral issues. Enhancing community-based services so people can get care in their own communities is vital. However, funding is always an issue. These types of programs need federal support." Agree "* The public continues to need to be educated about how to live a health lifestyle as a way to prevent many expensive medical problems in the future. Too many of the children of this nation are obese and physically unfit as are many of their parents. An ounce of prevention is worth a pound of cure. Also, part of any improvement in health care has got to be a campaign to get people to go into nursing. Nurses do the vast majority of the actual patient care and there is a critical shortage of them in this country. Because of this shortage, hospitals have to pay premium salaries plus travel and housing allowances to get travel nurses to work for them. This drives up health care costs." Agree "* This country has become a place where people go to hospitals to die. This is not a good death and only increases the cost of the inevitable for those suffering from progressive incurable terminal diseases. We need to make it feasible and possible for people to leave this life in the comfort of their own homes and not in a hospital bed among strangers. I believe that most people in this country think you have to go to a hospital if you are dying. If there were more and better hospice services and they were made known to the public, that this could change." Agree "* All I can say about this is AFFORDABILITY, AFFORDABILITY, AFFORDABILITY. Yes, we will have people who don't take care of themselves and will try to constantly use the health care system to keep well enough to keep abusing their health. For them, some hard decisions will have to be made. However, I believe most people want to be healthy and to take care of themselves, they just need education on how to do that. It is a fact that healthier foods cost more money in the grocery stores so low income families have no choice but to purchase foods that are not healthful. Perhaps the food stamp program needs to be further restricted in what kinds of food can be purchased to where more fruits and vegetables are consumed instead of sugar-laced cereals and other unhealthy choices." Agree "* When it comes to health care, money makes the world go round. I know some hospitals are gouging patients, especially those with low or no insurance coverage. Others are paying premium money to travel nurses and other health care professionals. There are many ways that the money flow can change to improve health care instead of these stop-gap measures to keep the system running. I know health care needs more funding, but the funding currently going into it also needs to be redirected and used more efficiently. This country has enough money to fund health care, but it's being spent in Iraq by the military and on potato chips and soft drinks here in the U.S. We need to set our priorities better. The pathetic irony is that Bush is sending guys to Iraq who come back with horrific injuries and health problems to a health care system that can't take care of them because billions of dollars that could fund health care are being spent in Iraq." "As someone who does health research, I heartily agree with this concept and the fact that is will be based on research and science and not be a political football." It's about time something specific and actionable is done to improve health care before the whole ship sinks under the weight of the baby boomers who are aging rapidly. I can say this because I am one of them. 27814 07/25/06 MO Agree Agree Agree Agree Agree Agree There are spending policies in our governemnt that are wasteful and outdated. Some of this financing can come from cutting or restructering these. 27815 07/25/06 FL Agree "* America's strategic future both domestic and international depends, principally, on three factors: 1. National Health Care as a Fundmental Right, 2. Protection against the downside of global free trade by the establishment of core protected industry infrastructures independent of foreign countries, i.e., domestic steel, fuel, and strategic core industries that are protected to insure national security, and 3. Education and Vital Involvement of the Federal Government in increasing support for the Arts, Sciences, and Entreprenurial Incentives for all Americans especially those in the Middle Income Group. Of these areas, perhaps the easiest and wisest place to start is fundamental health care for all Americans who are unable based on income or other relevant situations to afford health care. I do not believe that persons in the Upper Income Group needs national health care. I also suggest that health care plans involved in any government sponsored, guided, or endorsed programs must not discriminate against" Agree Agree I think this is a very wise approach. Agree "Our country needs to open its collective mind, metaphorically, and allow stem cell research. We cannot allow, strategically, other nations to gain a research and development monopoly in this field. There is a balance between ethics and wisdom we need to achieve. " Agree Higher income groups should bear an appropriate but proportional responsibility for payment into a national health care fund or trust. Agree "Americans, obviously, will need to fund this program. Consequently, an income proportional tax or contribution system is essential. SSA is the likely agency to manage this new program along with Social Security." "* I agree with these recommendations with one caveat: It is essential to truly define ""core health care needs"" from a preventative perspective but the program should not initially fund any form of medical practice beyond traditional Western medicine. We need to make the program Basic in its first stages, available to all Americans but not so expensive as to simply kill the program before it has a chance to start. Health care, yes, includes physical, mental, and dental health both from the treatment and especially the preventative dimensions of health care." "Health Care is also an educational process and should begin in the earliest school grades from the preventative perspectives. Obviously, the obesity levels of American youth are one indicator of the dismal success of current awarness programs. Fitness is an integral part of our national strategy and secutity: physical, mental, and educational fitness to broaden the scope a bit." 27816 07/25/06 NY Agree The national program should be both public and private with the complete capacity of all individuals to select one or the other system and to change their mind depending on the quality and costs involved Disagree "* I think it is a bad error to perpetuate separation of ""vulnerable"" ie, medically unsophisticated and economically and socially deprived populations from the mainstream. Vulnerable populations should have access via adequate insurance to the same quality care as the rest of the population. Vulnerable populations should not be on Medicaid or Schip, separating them from the rest of us- they should have public or private insurance and access to treatment like everybody else. I don't mean that outreach programs are a bad idea, as long as they are only part of the choice of providers that vulnerable people have." Agree I think that Medicaid and Schip should be done away with and access to Medicare or private insurance substituted instead Agree Agree We should not have a separate system for the poor. Health care services should not depend on financial ability. Agree "The employer should be removed from the equation except as an administrative aid, collecting taxes. People should not have to depend on the employer's needs to provide or not to provide health insurance" "There should be no financial bar to providing basic and preventive health care, ie, no deductibles or co-pays for these services. Deductibles and co-pays can apply to catastrophic and long-term insurance, if need be." "The contest between the public and private sectors in providing health insurance could be salutory if both sectors were voluntarily open to all citizens. Medicare, open optionally to everybody would be a strong competitor to private, profit motivated insurance. It is unfair to the public to shift costs in our direction without being able to voluntarily have access to public insurance. It is unfair to the public to force it into private, profit driven health insurance." 27817 07/25/06 ND Agree Agree Agree "In particular, a new system needs to be heavily weighted toward prevention and prevention-based interventions. Our current system lacks long-term focus and tends to deal with the ""here & now costs"", not about what will work in the long run." Agree End-of-life issues do not belong in a political arena to be bantered about as part of an election campaign. Agree Agree 27818 07/25/06 KY Agree Agree "With less bureaucracy, not more so that persons can navigate the system. A healthcare navigator would be wise, someone to assist those with limited information seeking skills to locate and access healthcare." Agree Agree Agree "No one should be denied care because of inability to pay. On the other hand no one should be permitted to take advantage of our limited health care resources. Rather than sick care, we should focus on prevention and healthy lifestyles, thus reducing the need for so much illness care! " Agree 27820 07/25/06 ND Agree "I have some reservations on this. Without some realistic cost containment measures, I fear that costs will escalate out of control because everyone is provided some care. There would be no incentive to not use and abuse the system." Agree Agree Agree Agree Agree with some reservations concerning the cost. Agree 27821 07/25/06 IL Agree Agree Agree "re electronic records: I would limit what is/must be shared: there is a vast amount of info in a medical record, and not all should be available to all healthcare organizations. the shared info should be confined to a data sheet with specific info completed. However, this will require data entry time and staff..." Agree Agree "I agree that the CORE services are at a minimum level, and that beyond core, minimum care should be accessible according to ability to pay or have insurance. ALL services NOT available to all, some hard decisions must be made to allocate for the greatest good. similar to Oregon in terms of their allocation of resources from state coffers. EG: no gov't-supported heart transplants." Agree 27822 07/25/06 KY Agree We have a moral obligation to provide healthcare coverage for all. The richest country in the world is embarrassed by not yet providing such coverage. Agree Accountability for oversight of such integration of healthcare services is essential. Another bureauracy without strict accountability is not needed. Agree Agree Agree Agree "Again, an oversight group will be necessary to protect the intention of this recommendation and avoid any conflicts of interest." "Health includes a spiritual dimension also and is avoided in the above description of health. A healthy spirituality, not speaking of religious practices here, is essential to good overall health." "In all of these recommendations, I am leery of more bureaucrats, who are not servant-leaders, taking jobs for their own security and missing the importance of this project for the most vulnerable in our society. Accountability is a needed and on-going theme." 27823 07/25/06 MN Agree Agree Agree "The present administration will do none of this, and has no inclination to do so. While the recommendation is a good one, it will not be implemented under Bush - so this is more ""pie-in- the- sky"" than reality." Agree Agree Agree "The language in the recommendaton is so carefuly crafted as to not promise universal health care, or anything close to the dreaded Canadian system, which is in effect a two tier system. Politically I know you have to have recommendations drafted using this kind of language, but its effect is that I've heard it before, and the outcome willb e the same - the poor get nothing or "" what they can afford"", the rich get the best health care money can buy." Wonderful if it can be brought to reality. "* None of this can happen under the present administration.Perhaps not under any administration. These recommendatons are obviously the result of long and arduous work, and I'm grateful that there are so many people working on access to health care.If any changes will ever occur, there must be the will to make those changes at the top leveles of government. Without the will to change, nothing will happen but that another group of smart, energetic people have spent much time and money to put yet another plan on someone's shelf. " 27824 07/25/06 ND Agree "Recommend a program that allows those with greater means to seek higher cost care, but only with their own finances." Agree Agree Add the Indian Health Service to the list of federal providers above. Agree Agree Agree Add a national sales tax to the list. Check the results of the recent Mayo Symposium on Health Care Reform 27825 07/25/06 PA Agree Agree Agree Agree Agree Agree 27826 07/25/06 NC Agree Agree Disagree "Without proper quality assurance methods, I could see resources being inappropriately used here." Agree Agree Agree 27828 07/25/06 RI Agree Agree Agree Agree Reduce expensive and unecessary procedures that prolong life without quality of life that are driving up the cost of health care for all. Agree Agree "Please reduce the need for the insurance company ""middle men"" that have driven today's market. Maine's exciting model might be one for the country to examine for its fairness for the patient (consumer? - a name that belies the fact that most patients/consumers have no choice but to seek care). Our new Medicare Part D is driven by the pharma industry at the expense of the patient/consumer - how unjust is that?" "At last, a definition of health that includes mental and dental without which the whole person is left with trermendous gaps." 27830 07/25/06 NC Agree Agree Agree lower priority than recommendations #4 and 5 Agree lower priority than #4 or #5 Agree "The focus here should be on primary prevention - not just disease screening, but counseling on smoking cessation, better nutrition, weight management and engagement in physical activity. High quality care does not mean relying on high-priced medications and procedures." Agree 27832 07/25/06 MT Disagree coverage should be univrsal but yhe individual needs to share in the responsibility not a free hand out Agree Agree Agree Agree Agree 27833 07/25/06 GA Agree Agree Agree Agree Agree Agree 27834 07/25/06 TN Agree Agree Agree Agree Agree Agree "* Waste and excess in the system must be addressed . There are already multiple agencies with duplicate roles that need to consolidate. Savings must be realized before taxes increase. Healthcare should be NOT FOR PROFIT. Any Profit should be invested in the Healthcare system. Education loan repayment plans and other programs need to be in place to keep a good supply of healthcare workers,: Physicains, nurses physical therapists etc should be. I am not advocating that Salaries and wages should be controlled but current laws need to be enforced and strengthened to prevent referral for profit" "Wellness and prevention as well as prescription coverage will go a long way to reducing healthcare costs in the long run," 27835 07/25/06 IL Agree Agree Agree Agree Agree Agree 27836 07/25/06 IL Agree Agree "Community Health Centers provide are a valuable resource to those facing disparities in health care, often serving as the only provider of care in rural communities. " Agree Focusing on disease prevention and health promotion is one of the most cost effective measures that we can utilize to improve patient outcomes and reduce disparities. Electronic medical records and increased use of health information technologies are critical and should not be considered optional. Agree Agree "The burden from cancer could be dramatically reduced simply by fully implementing the prevention, screening, and treatment guidelines that exist today. Lack of access to these resources, is a major barrier standing in the way of that goal. It will be difficult to make significant further progress until high quality care is available to all." Agree 27837 07/25/06 CO Agree Agree Agree Agree Agree Agree Safeguards must be inplace to ensure that these programs are for legal american citizens and not another welfare program. 27838 07/25/06 IA Agree "I agree, but think the proposed solution is way too complex. A single system payor with universal health care vcoverage would solve this problem in a straight forward way. We would also save all the money from the entire infrastructure built around various health care coverages and the billers, fraud agents etc." Disagree See above Agree I mostly agree. Again a single payor universal system would in essence save a lot in wasted administrative costs and allow systems built on evidence based best practices. Agree I mostly agree. I just think that public private integration is very administratively wastful in terms of cost and quality Agree We are the only industrialized country that does not guarantee health care to its citizens. Agree Make it simple like they do in just about every other industrialized country. Single payor just spreads the costs in a different way and would most likely save enough money to pay for universal coverage. 27839 07/25/06 MT Agree Agree Agree Agree Agree Agree 27841 07/25/06 NV Agree Agree Agree Agree Hospice services are still too oriented to short-term care based on death. Death is inevitable. Agree Health problems are the number one problem facing Americans and deserves the same kind of support as national security issues. Agree I would much rather pay taxes into public funds for health care than profits into private funds of health care shareholders. Listen to the experts. 27842 07/25/06 KY Agree "We need to discover what continues to drive health care costs out of reason, and work to stop the continuous rise. Other countries have decent plans, why not us?" Agree "I agree, but hope that the middle class isn't stuck with an unfair proportion of the cost of the program. Drug companies, corporations, and the very rich need to pay their fair share." Agree Agree Will any of this address the issue of physician assisted euthanasia? Or will people have any choice about the length of their end of life days? Agree "I agree that everyone should participate, regardless of their financial resources or health status. The question is always: who pays for those who can't afford to pay? I think we should first look to those who profit from those who have poor health --drug companies and any other entity that profits from our illnesses. There should be enough money from these folks to supplement any tax program for this purpose." Agree "* Those who share this biggest burden should be those who profit from human illness --drug companies, health care facilities that operate for profit, etc. While we shouldn't discourage people to be in the health care field, they should surely want to contribute to the plight of those who make their own quality of life better. Luxury snf sin taxes may also contribute. If we contribute to our own illnesses by poor life-styles and habits, we should also be paying more than our fair share for health care. " "This group needs to completely transparent to the public. It also needs, somehow, to be accountable to the American people, without being accountable to whatever political party is in power. I don't know how you do that, but it needs to be fiercely independent and without indebtedness to any political or corporate entity." 27843 07/25/06 GA Agree "Healthcare is a public health matter regardless of whether the illness is contagious. The health of the nation, fiscally and physically, depends on the wellbeing of all collectively and individually. The poor and less affluent should not be rendered poor healthcare or left to die because they do not have funds for the costs our govt and medical industry decide to pass on to sick people. Leadership simply must have the will to make medical care a moral priority." Agree I agree if this coordinated system will allow for pre-existing conditions or have some degree of portability and choice of service provider. Agree I agree and believe this educational effort should permeate American culture from elementary school through corporate America work culture. Agree "Expansion of service options and funding for those options is sorely needed for compassionate end of life care. I, however, support mandatory living wills for certain policies and other legal documents that direct medical professionals on the care of the patient if and when the patient can no longer speak for him or herself." Agree I wholeheartedly agree. Agree We will need different sources and streams of revenue and I support a varied approach the links illness with its assumed causes. 27844 07/25/06 KS Agree Agree Agree Agree Agree Agree "I use half my monthly income to pay for health insurance, with $2000.00 deductible. It's outragous!!" 27845 07/25/06 NC Agree "As a student I need to know that I will be stepping into a future where, under the burden of high loans, I will be able to have good health care for a price that I can afford. Many people, especially the mentally ill, are on the streets because they can't afford medication. By creating a safety net for these people, we can reduce homelessness and increase the amount of contributing citizens in our society." No response No response No response Agree Again this will create a safety net for people therefore creating a better society for all of us from our roots up No response 27846 07/25/06 VT Agree Agree Agree Agree Agree Agree 27847 07/25/06 VT Agree Agree Agree Agree Agree Agree 27849 07/25/06 NY Agree "We should have a single payer system. It will simplify the process for all and reduce costs, freeing up revenue for other growth areas. " Agree "Definitely expand the FQHC's to many more communities to provide quality primary care. CMS should be the entity responsible for coordinating the efforts, as they are already familiar with running a large successful program." Agree "Reduction of fraud and waste are important, but they must be investigated and prevented at the highest levels (drug companies, major medical systems) as well as at the lower level of office providers. More gains are to be made by investigating the higher levels. " Agree Much more education needs to be provided to families about end of life care before it becomes a crisis. Agree "Absolutely, everyone should have health care available to them and they should not have to worry about how to get financial assistance if they need it. " Agree "I would be willing to pay more individual taxes if I knew it was going to fund a better health care system. Similarly though, major businesses and high income individuals, from whom much more gains can be made, must be required to put in a fair share to cover costs as well. I am an upper middle class family member, and I if I can give, than so can the truly wealthy. " 27850 07/25/06 CO Disagree Nothing drafted at the national level ever really works. The states must step to the plate to contract with private non profit insurers for solutions. Disagree see comments on #1 Disagree "Keep the federal government out of my health care. We are not a lump group of people, we are individuals." Agree Disagree Lack of freedom of choice. Agree I have always made choices to not spend money on things I do not need so I could pay for my insurance. I resent having to pay through a pool that pays for the freeloaders. "Allow associations such the the National Association of Realtors to offer insurance to its members and more people will be able to get coverage. Keep the choice of level of coverage available. If someone chooses the minimal coverage, the chould not get transplants at the cost of others. We all can not live forever." 27853 07/25/06 NC Disagree "Health care is not a federal responsibility, and providing medical care is certainly not an enumerated power for Congress in Article 1 of the Constitution. This is a state and local issue that can only be distorted by meddling of federal authorities. " Disagree "Once again, the federal government has no legal mandate to fund health initiatives such as this. While they can certainly study state models and provide a clearinghouse of information of what works and what doesn't, shifting resources from locality to locality based on political pull is wasteful and uncalled for." No response Agree "* Given that it is unlikely that the feds will get out of the health care funding business, increased flexibility to reduce wasted dollars on expensive, unwanted care is certainly a welcome change. But only with the caveat that this new flexibility not INCREASE access to extraordinary measures care for end-of-life patients. That is, it would certainly be commendable to allow a terminally ill patient to opt for home hospice care in lieu of expensive ICU hospitalization, but not so commendable to encourage the same patient to opt for heroic measures currently not authorized. " Disagree "Once again, the socialist manifesto rears its ugly head, with the federal government illegally cast as the great leveler of resources. Take from the hard-working middle class and give to the poor. I totally disagree that the federal government has any right to steal lmoney from citizens to pay for the health care of other individuals (who may not even be citizens!)." Disagree "Every one claims increased efficiency and cutting waste will solve the financing problem. The difficulty is that when you promise universal health care for all, regardless of ability to contribute, you have essentially unregulated demand against very limited resources. This will never work, as the exploding costs of Medicare and Medicaid (and virtually every other federal ""universal access"" program) have proven time after time." "* Since I completely diagree with the concept of a ""core"" benefit package being guaranteed in the first place as an unacceptable (and fundamentally unworkable) foray into socialism in the first place, I can't agree with the idea of ""experts"" defining those benefits. Moreover, as virtually every previous effort to define limited benfits to general programs (e.g., ADA, HIPPA) has been subsequently hijacked by special interest groups through the courts and expanded well beyond the initial scope intended by the legislation, the likelyhood that any efforts to actually deny a benefit would be successful is remote at best. The ""core"" package would rapidly grow (through court mandates) to encompass virtually every new medical procedure available." 27854 07/25/06 OH Agree Agree Agree I hope that the governmental arrangement will be better than the most recent extension of drug benefits that had so many snaffus many people couldn't use the system. Agree Agree This is so logn overdue! Agree Stop allocating so much money for the military and re-direct it to everyone's health care. But what about psychological health? That should be included. 27855 07/25/06 IN Agree Agree Agree Agree Agree Agree 27856 07/25/06 NC Agree Agree Agree Agree Agree Agree "If we are serious about financing quality healthcare for all Americans, we MUST remove for-profit insurance companies from the system. Allow only healthcare premiums to be collected by healthcare provider networks or nonprofit third parties. We must remove groups (other than providers) that profit from the healthcare system if we are truly serious about providing quality healthcare at a reasonable price. If we are not willing to do this, all of the discussion about change is simply rhteoric. " I agree only partly with the recommendation. For-profit 3rd party payers should not be a part of the discussion. They are the problem and should not be part of the solution. 27857 07/25/06 CA Agree "Single payer health care gets my vote! The 3rd bullet point would be taken care of by the first one. The 2nd one could have many meanings, depending on how one interprets the ""protection"" idea. Limiting endless treatment for people close to death would be one way of protecting against high medical costs. " Agree I like the Fed/State model because the state-alone model has led to varying quality and downright negligent care of certain populations. Agree Agree "Within this recommendation, I hope there is a funding source for these services, particularly the last bullet point. Hospice care for pregnant couples with a fetus who will not survive/ or who has died/ or who has life limiting illness and will probably die is a necessary and now not reimbursable service." Agree See # 1 recommendation Agree Financing is not my area of expertise What about eye care? 27858 07/25/06 CO Agree Agree I know it is difficult but please try to make things happen rather than being caught up in red tape and political policy. People need your help. Agree "Please make sure this is available to all and not dependent or filtered through race, ethnicity, sex, or whether a person is heterosexual or not. It must be available to ALL. " Agree THIS IS MUCH NEEDED! Agree "AMEN! ""Affordable"" should be a sliding scale!" Agree Insurance fraud penilities could help fund this cause. Thank you for doing this. 27859 07/25/06 MD Agree Agree Agree Service members (Active or Retired) and family members should be able to receive the same quality treatment at civilian facilities not in the military circut (MTF's or VA's). Agree Agree Agree 27860 07/25/06 IL Agree Agree Agree Agree Agree Agree The medical malpractice crisis needs tort reform. Health Care providers need to see more patients to cover the extremely high cost of malpractice premiums. Many many physicians and nurse midwives stop practicing obstetrics due to unaffordable cost of obstetrical malpractice coverage. 27861 07/25/06 MA Agree best if this is NOT private only. we need to reconsider our national priorities. Agree Disagree "* this has the potential to be another money-sucker, as implementation of HIPA, or employing huge departments of billing coders has been. should be already incorporated into health system services-most hospitals have QI, which could become more pro-active. also, i know electronic record systems are ""the wave,"" and we have no choice in the matter, but they need to be developed so that they don't: force providers to care for computers rather than patients, take more time during the visit than the patient's needs get, and take more money to implement than other pt care needs are allotted. (We cannot give away a free depo-provera injection, but we have millions for computers in each room and out at the workstations as well....)we have have several electronic systems for a few years now, and they are not the cure-all. ""In-theory"" optimal use is very different from use in day-to-day practice. " No response "i don't know enough about current structure to know whether it needs to be fundamentally restructured. what are the qualities of the best hospice programs, and what is missing in the other? is it a problem of provider lack of education in making referrals? " Agree "waiting to see what comes of the most recent massachusetts mandate for healthcare for all. certainly, ordering people to buy healthcare they cannot afford is not going to work. " Agree "* we need a cultural shift in order to agree that, for all americans to have affordable primary and preventative services, other luxury/nonurgent options will be given up. look at care provided in any european country-great primary care, wait lists for other needs like infertility, cataract surgery, specialist evaluations. ours is not a ""wait-list culture"" though none of the above constitute emergency acute needs. not sure americans will accept prioritization to any greater degree than they already have imposed by insurance companies. " 27862 07/25/06 OH Agree We pay higher costs when people use emergency rooms and/or get sicker because they can't see a doctor in time. Agree "This needs to be done in a streamlined manner, not millions spent on research and salaries. " Agree "Very good idea, and should gain support from conservatives." Agree "Absolutely. I've seen two loved ones die in the last year, one peacefully at hospice, the other painfully in the hospital. She was 86 years old and they were still operating on her. She never regained consciousness and moaned in pain for three days before dying. Her family was not fully informed of their options, were told what was going to happen rather than asked if they should do the operation." Agree "This is the case elsewhere in the civilized world, and there is no longer a controversy about it. We need to do it too." Agree Use money now used to fight wars. Stop tax breaks for the rich and use this money. Stop the effort to decrease estate taxes and use this money. Raise taxes on all of us to make up the difference. Prevention and self-care should be emphasized. Thank you! 27864 07/25/06 UT Agree I would agree with this approach if the guaranteed coverage were catastrophic only and developed from a private market solution only. Disagree "I don't believe the government needs to sponsor or support delivery systems. Delivery systems should be developed only where they can be financially supported through funding mechanisms which should be primarily private, supplemented with public funding for the poor." Agree "Pricing transparency, quality benchmarking, and leading edge technology for medical records and evidence-based best practice will improve American health care." Disagree I would only support these objectives if promoted through the private sector and if the emphasis was on the individual responsibility to financially plan in advance. Disagree I would only support such an initiative if accomplished through voluntary participation in private sector solutions. Auto insurance is mandatory and yet privatized...something like this for health care could work. Disagree I am not in favor of a system that is funded through taxation and run by the government. I have no faith in the ability of the government to properly project and accurately fund for the required contingencies...political pressure too often forces poor business decisions that cannot be supported in the long run. We must keep health care finance privatized. The desires of the people are too diverse to find a core package that meets the needs of those desiring comprehensive care without imposing undue financial burdens on those who are willing to accept calculated financial risks. Any kind of core plan should be catastrophic only. Thank you for your efforts to explore solutions for health care reform. 27865 07/25/06 FL Disagree Disagree " While I support the sentiments motivatling this recommendation,I find its presentation too vague and non-specific.I would have the committee work more on this before being able to support it.Among other things,I fear it would lead to an unwieldy bureaucracy that would add to the problem rather than contributing to a solution." Agree Agree Agree What will costitute the Core?That is the question. Agree " The system should combine insurance,existing govermental programs like Medicare,and new taxation.Words like fairness denote notions of income redistribution amd the like. This program should have as its central tenet that illness will not bankrupt anyone,rich or poor.Above certain limits dtermined by income tax bracket,medical costs should be covered by some combination of healthcare insurance and govt.subsidy." This speaks to some of my previous comments made above. 27866 07/25/06 MO Agree Agree "re item #2, above. The program to advise ""the federal government on safet net issues and disseminating best practices"" should apply to the entire system, not just programs for the poor. Maybe that's what you mean, but it's not clear." Agree "This is not very meaningful, but like apple pie, I like it. The only recommendation of any substance is #1 regarding evidence based medicine. Health info technology will be of most help when it allows the system to become transparent with regard to outcomes, effectiveness and cost." Agree Agree Agree 27868 07/25/06 VA Agree Agree Agree Agree Agree Agree "Should ensure portable health care, much like 401k allows portable pensions, to everyone so health care coverage is independent of a job/career decision. Focus should be on prevention, not just remediation. Reduce paperwork and increase safety via common standards and electronic records -- including financial transactions." 27869 07/25/06 UT Disagree "* I can agree with coverage for ""all legal Americans"". I can agree with protection against very high out-of-pocket costs as long as that only includes a ""core"" or basic low limit health plan allowing for more expensive medical care to be insured against individually by those who can or wish to purchase higher limits. I can agree with financial protection for lower income situations if the formula to determine low income isn't too liberal. Government is becoming much too liberal in giving away money to those who won't try rather than those who try and still struggle." Disagree "I think if the Feds want to ""recommend"" a standard, that should be as far as they go. I think the states should be responsible to detail the implementation of programs and practices and allow for develpment particular to the needs of the more local state community. I think most legal Americans agree that the Federal Government is sluggish and inefficient in being able to manage programs for the public." Disagree "* I strongly agree that the federal goverment can assist in developing agreeable intigration models and setting pricing and practice limits for acceptable health care delivery models. Anyone who studies the desperate problem of unaffordable health care and subsequent medical premium costs can easily see that the typical health care delviery model is filled with subjective and expensive delivery practices that deliver no apparent value for improvement except for financial gain. Much too often, health care delivery practices cause more harm than cure and is the cause for medical care that would have otherwise been unnecessary and therefore causes more expense to the system. Most certainly someting needs to be done to bring an acceptable standard of care and cost to medical delivery and SOON!" Agree "This point goes strongly with the previous point of best practice and evidence based care. It also needs to be included in the development of this recommendation that some types of end of life services and palliative care will be more expensive to the consumer than others, therefore allowing for some financial stake in the decision makeing. ""All"" things in health care delivery can not be priced equally or there is no chance for consumerism to be included in the choices." Agree * I can agree with this if the federal government can suggest the guidelines and allow the state governments some latitude for practice and implimentation. I also would bold print the words CORE HEALTH CARE and insist that the core be reasonably much lower limits than the current multimillion dollar plan limits that is the standard of private plans today. The current uncontrolled multimillion plan limits of today are what have given the health care delivery providers the power to grossly overcharge for random and subjective services. It has been the enabling factor that promotes greed and dishonesty in the current inefficient system. Agree "Here again, I can see the federal government overseeing guidelines for this but they need to let the states impliment the process. There is no way in heck the federal government can implement such a practice cost effectively. We would have another great big expensive federal employment ""milk cow"" for underqualified and low output employees with guaranteed pay and federal benefits. " "I agree there needs to be a ""core"" benefit established. I fear that the word core will come to mean ""all inclusive and comprehensive"" rather than core, once this team of citizens is compiled. Heaven help us!" "* I realize that this issue is a critical national concern. I agree that there needs to be some drastic measures taken to turn around our current ""out of control"" system that allows for unaccountable delivery and billing practices from providers and irresponsible lifestyles and consumption from consumers. If the federal government can suggest a model that doesn't become it's own monster to finance and feed that is bigger than the current problem at hand, then I am supportive. I ultimately argue that the position of the federal policy makers needs to be for establishing an agreeable model but I think that the states can much more cost effectively implement programs and practices for any agreeable model. " 27870 07/25/06 CO Disagree "Any program that is designed to protect against catastrophic costs must be a public, not private, program. It is time to give up thinking that private corporations that are formed to make a profit will provide fair and equitable coverage to sick people." Agree "I agree with the spirit of this recommendation, but it seems somewhat nebulous to me. I wonder whether for-profit corporations can or will give unbiased input with respect to the most efficient and effective methods of providing services to people in need." Agree "Once again, a great idea, but the devil is in the details. I agree with the spirit of this recommendation,especially using the examples that already exist and can serve as models for other programs (instead of constantly recreating the wheel)." Agree "We should fundamentally restructure the whole ""system"" of health care so that all services are provided in this manner." Disagree "Every American should have access to basic services and they should be provided by a single payer health care system to everyone. It is time to stop wasting money on administrative tasks such as deciding who ""merits"" health care and who doesn't. If we could just stop playing this silly game, we would have enough money to pay for all people to get services." Disagree "* See above. We have the money to pay for health care for everyone. We need to redirect funds from private, for-profit corporations and unnecessary adminsitrative tasks into activities that actually provide services to people. Every other developed country already does that, and they spend less than we do. We need to stop paying for every new procedure that is developed until there is evidence that it is beneficial. Difficult decisions need to be made with respect to where our money can be used to benefit the greatest number of people most efficiently. If we don't do that, no reform efforts will make a significant difference." This is already being done by several different organizations. We need to quit wasting time and money creating more expert panels. See website for PNHP (www.pnhp.org). These folks have already been working on this for over 15 years and they know a lot. We don't have time to start over. "The single most important thing we can do is to promote a single payer health care system (possibly modeled on the VA and Medicare systems, both of which have significant positive attributes) and stop pretending that we owe big business (the insurance industry) a guarantee of success. If they cannot offer an affordable and attractive product that people can afford to buy, they need to move on to find another way to make a living." 27872 07/25/06 WV Agree Agree Agree Agree Agree Agree 27875 07/25/06 IA Agree "I realize this can be highly debated. Should less be spent on the last month of life and more spent on other people. For example, guaranteed cancer care for all children vs less cancer care at the end of life. kidney dialysis could be performed less often at the end of life vs guaranteed kidney dialysis for all children no matter what income the children's parents have." Agree There should be more doctor offices for low income people near emergency hospitals. This way more money could be saved for those to visit doctor's offices and not the emergency rooms. This could clear the emergency rooms for real emergencies. Agree "Patients could be paid to quit smoking, lose weight, exercise more, etc. The health industry could pay organizations to help people quit smoking, lose weight, join health spas, etc. An actuary could figure out how much savings to pay out vs the costs of the required medical care saved." Agree Note first comment. Agree Preventative care should be awarded the most as noted earlier. Agree Note earlier comments. Note earlier comments. "Assistants could be employed at doctor's offices for patients to be able to fill a living will questionaire. Other questions could be asked patients about organ donation plans. And patients could be asked in the presence of a family member with the patient's doctor if a person would be willing to ask for less medical care ""living will"" if determined by two doctors that the patient is indeed at the end of their life." 27877 07/25/06 MS Agree Agree Agree "Without full implementation of this recommendation, the others will fail." Agree Agree "Who will determine the ""set of core health care services?"" It is critical that special interests and politics be kept out of this process, and that the decision-making process be based on scientific evidence, with emphasis on quality and effectiveness and an understanding of value." Agree "All should share in the cost. There must also be some control over prices, preferably through market forces. If the free market were allowed to work in the health care sector as it does in other sectors, price increases would be much closer to overall CPI." It will be critical that special interests and politics be kept out of this process as much as possible. "There should be some consideration given to health manpower issues. If everyone in the country were to have access to health care, there would not be enough providers in many areas to serve everyone. The recommended expansion of community health centers would help address this issue to some extent, but there should be a structured review of health manpower needs based on expanded access under the new system." 27878 07/25/06 FL Agree I have one medication that costs $1500 per shot and I take it twice a day. THIS IS OUTRAGIOUS. The Pharma companies shold take their ads off of TV and lover the cost of their drugs Agree Agree Agree Agree Agree "No more cronism, let the People help make choices, It is not easiy but it is a Government of the people By the People and For The People" 27879 07/25/06 UT Disagree "The reason that I dis-agree is because I am in favor of universal health care for all Americans,,,paid for by the Federal Government! It is simply absurd that our country is so far behind almost every first world country in taking care of all of our citizens." Disagree This is another bureaucratic solution that doesn't go anywhere. The bureaucracy has a way of re-inventing the wheel over and over again and little ever gets done! Agree "My bias is that the health care system needs to be consumer driven, outcomes based and culturally competent." Agree Disagree "It should be public policy that all Americans have ""Free Health Care!""" Disagree The healthcare system should be financed with tax payers dollars and every single person needs equal treatment. Core benefit is another politically correct way of saying that millions of people will receive little or no health care. I am so sick of this Nations policies around health care. Our National priorities are ridiculous and the current administration has taken this country forty years backward with it's focus on corporate greed at the expense of the ordinary citizen. 27881 07/25/06 MT Agree "However, in order to see proper use of the system, each American, whether by birth or naturalization, should pay something for the health care plan. It should not become a new welfare program. Even people on low incomes can afford to give something (%) towards their health care." Agree "Public-private sector should include insurance agents, health officals, and social workers. This council should be a non-paid council, with compensation for travel only. " Agree We do not need another department added to what we already have. We should use the departments already in place. Agree Agree Agree 27882 07/25/06 CA Disagree The only thing I disagree about is the (private) part There should be a public program that fits the need of the people . Private parties only have one goal and its to make money there is no cost savings there. Disagree "Point blank we need health care for all, not just who one group thinks deserves it. California SB840 comes the closes to meeting the needs it still has some kinks to work out but it is a start. The problem as I see it is the insurance companys and there profit, the group that should profit are the doctors and nurses that save the lives. I know thats not a reality but you asked my opionon. use of common sense should get us were we need to be. Health care for all is possible if we remove the red tape." Disagree This is close but it does not address all only a select few. but at least it the goverment taking charge like they should. Disagree hospice has meet these needs when we needed them Agree Yes but it needs to be affordable for all not just the highest paid or those that cant pay it should be EQUAL for all regardless of income. I do like the idea of assistance for those in need.( and that could be anyone regardless of income) Agree Yes get rid of all the reproduction of service in other word cut the red tape the money all ready avaible will make it work if common sense was used. It is working back east it could work every where if given the chance. It is a start. Look around the country and see whats working and what is not and then use common sense. 27883 07/25/06 NC Agree Very important. Agree Agree It is very important that any program be cost effective. Agree Agree Agree 27885 07/25/06 CO Agree Agree Agree Agree Agree I agree that all American CITIZENS have affordable health care. Agree "If health care will still be run by private institutions, a limit on CEO and CFO salaries should be mandated based on a multiple of the lowest employee's salary." "The group that sets up and runs the national health care system should be motivated to be as cost efficient as possible. It has been my experience that when the government sets up a program, it is not cost efficient/time efficient. Maybe the government should bid this project out to competitors in the private sector." 27887 07/25/06 na Agree "Welfare is a unfare system that encourages fraud and laziness in some reciptinats. Health care should be extended to those who are the ""working poor"" but make to much for welfare." Disagree I think this should be controled at the state and local level Agree "Federal directed, State run so each State may target specific needs for its citizans" Agree Agree Not the rich or welfare recipatiens only Agree "I agree on the taxes contrubitions listd above, additional professional should be taxes to help off set this coast." I think a universal health care system is long over due. This process should began right away with public votes to carry the process along at each major inplemention. 27888 07/25/06 MS Agree Agree Agree Agree "* Hospice care can be a tremendous support for terminally ill patients and their families. When our son, Zach, was diagnosed at six weeks of age with a terminal neuromuscular disease known as Spinal Muscular Atrophy, he spent his last four weeks at home with us. Although my husband and I provided his medical care after being trained by Zach's doctors, hospice provide valuable support by providing his equipment and medicines. This relieved a tremendous burden on us. Hospice care should be available to all who need it, including infants and children." Agree Agree "How about taxing cigarettes? Overall, Mississippi's population is one of the unhealthiest in the nation. Yet we have one of the lowest cigarette taxes in the U.S.--a meager 18 cents a pack. We could generate a large amount of revenue for public health expenditures by increasing the tax on cigarettes substantially. Unfortunately, our Governor does not believe we should raise any taxes. This is bad public policy. " "* Both the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) recognize infertility as a disease. Infertility affects 6.1 million people in the United States. This figure represents 10 % of women of the reproductive age population. (www.asrm.org) Fifteen states have passed laws requiring that insurance policies cover some level of infertility treatment: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. (See www.resolve.org). The ability to afford infertility treatments should not be dependent upon the state in which you live. My husband and I have sought treatment because we carry a genetic disorder known as Spinal Muscular Atrophy that claimed the life of our first child. We have received no help from the State Health Plan of Mississippi, not even for fertility medications. If we had been fortunate enough to live in Massac" 27889 07/25/06 TX Agree "This being said, it also makes sense that those who make very high incomes will have to pay proportionally more." Agree Agree Agree This recommendation is particularly important. Agree Agree "It is important, when determining the financing of such a system, that political action committees be prevented from swaying the discussion to benefit their constitutents. A system like the prescription drug system just enacted, is wasteful and inefficient." 27890 07/25/06 FL Disagree "This conflicts with the third policy to ""support affordable healthcare"". If a variety of mechanisms can be established to ensure access to affordable care, no matter how much care is needed, we will not need an additional catatrophic loss plan." Disagree This is an additional tactic toward the goal of affordable healthcare. It may be excellent but will it offer comprehensive coverage? Agree Great idea! Health Information Technology and the other ideas mentioned above currently receive only minor amounts of funding. How can we ensure Congress not only supports this recommendation; but funds it generously?? Agree We need to get ahead of this issue - the baby boomer bubble will hit soon and the current system is unsustainable. Agree Amen! Agree Empower the states to solve this themselves. 27891 07/25/06 NY Agree There should be one single payer system that provides comprehensive coverage to everyone. Agree Agree The most important cost cutting measure is reducing the insurance industry's administrative waste and corporate profits. Agree Agree Agree "Reduce administrative costs and inefficiency by having a single payer system, such as Medicare. Redirect the money that is currently going into insurance company coffers to actually providing health care." Core benefits must be comprehensive benefits. 27892 07/25/06 GA Agree "Build better incentives for employers to offer health insurance. Do not make it a governmental single-payor system. There must be competition among providers to keep costs down and quality up. It is not a health care system unless it includes coverage for the brain disorders we call ""mental illness.""" Agree "But do not totally federalize health care. We need private providers in competition to keep costs down and quality high. Include the brain disorders we call ""mental illness"" as the true biological illnesses that they are." Agree "Nothing will work unless people take responsibility for their own health by stopping smoking, maintaining a reasonable weight and living a healthy lifestyle. There should be incentives for those who do since we seem to lack the will to punish those who don't." Agree We need to educate the public that death is inevitable for all of us and it's a lot better to die comfortable and in our own homes than hooked up to medical equipment in a hospital for months on end. Doctors need to be trained to accept death when it is inevitable. Too many of them encourage patients to keep fighting long after the fight will be beneficial. Agree "A health care system that does not include ""best practices"" for treating the brain diseases we call ""mental illness"" is incomplete. These serious illness should be included in any plan for ""core services"" as they cause more UNNECESSARY disability and misery than any other group of illnesses, simply because they are left untreated." Agree "* There remains a lot of waste in the healthcare system. While hospital payments have been cut severely, physicians who offer office-based outpatient services that used to be provided in hospitals skim the good paying patients and dump the poor patients on the hospitals. They also take the better employees by offering them regular hours when hospitals must be staffed around the clock. Payments to physician-owned clinics for radiology, pathology and surgery should be radically cut by both private and public payors." * The cost of this will be prohibitive if we do not require evidence based best practices and electronic medical records. Doctors repeat tests when the results of recent similar tests are unavailable to them -some motivated by quality and some motivated by revenue. Having a single medical record available to all physicians involved in a patient's care will reduce costs. Physicians are not monitored like hospitals. Some of them use ineffective and costly practices in their offices. They should be encouraged to use lower cost generic drugs instead of the latest drug pushed by the pharmaceutical sales rep when the older medicine is effective. "* The use of health care services is highly inefficient because people do not take responsibility for their own health and the structure of the system encourages higher cost alternatives. Preventive and illnesss-management services for people with chronic diseases are often not covered, leaving poor patients with these diseases constantly reporting to emergency rooms and needing intensive treatment. There is a great danger that making healthcare services available for all will further the lack of personal responsibility for maintaining good health habits. As a society, we are eating ourselves to death. Society will never be able to afford the costs of universal care until there is universal responsibility." 27893 07/25/06 NC Agree Agree Agree Agree Agree Agree I can't imagine that any tax that individuals would bear would be any more than what we or our employers currently pay for insurance. Costs should decrease dramatically with a centralized system that does not have so much overlap as the current competitive insurance market place has. 27895 07/25/06 AZ Agree I agree. A catastrophic health care incident would bankrupt almost anyone. There are very few people who could afford to pay out-of-pocket for this type of care. I also strongly agree that protection for low-income individuals is absolutely necessary as otherwise they will be unable to access even the most basic care or preventive services. Agree "* This is a very important recommendation. The FQHCs and other community-based health centers are some of the most necessary and often most innovative care providers to the communities. I urge that the recommendation made will strongly advise that the input from the state and local groups that actually administer these networks be encouraged and used. To give an example, I would not rely solely on the input of the general when trying to find out what the individual infantry units need to succeed in their missions. Even though he has a wealth of knowledge and resources, he may not know that right now, warm socks would be a better choice than more missiles." Agree "Agree. These are all great ideas; however, there is a piece missing. In order to ensure the success of these ideas, there needs to be increased responsiveness, flexibility and cooperation on the part of the federal entities. There is a need for them to work better with each other as well as with the states. " Agree "Agree wholeheartedly. I have seen too many instances of needless suffering due to reactive care planning, insensitivity, and just plain pride of the provider. Clear communication that goes BOTH ways between the patient and provider is a necessary part of providing quality health care." Agree "I definitely agree. I have been blessed with access to good, affordable healthcare for many years now. However, I am constantly faced with having to tell people that in spite of their need for care, there is nothing available to help them. I do believe that we as consumers should be aware of the true cost of the benefits we receive, and that we should have some share in the cost based on income." Agree "Agree. In spite of the perception that government run benefit programs are rife with fraud and waste, many programs are run more efficiently, provide equivalent quality of care, and are more cost-effective than some private models. " I believe that this approach may be one of the only ways to resolve some of the inherent inequities in our current health care system. "I also believe that price transparency and controls are legitimate and effective ways to help these ideas succeed. There are sectors in health care that are being nickled and dimed out to death, and others who have almost free rein to charge what they want and be held accountable to no one. " 27896 07/25/06 IA Agree Agree Agree Agree Agree Agree 27897 07/25/06 ND Agree No response No response No response Agree Agree 27898 07/25/06 NH Agree "single-payor, public-private partnership" Agree language needs to be simplified Agree "greater emphasis on self-maintenance, especially exercise and diet" Agree "more emphasis on aging with grace, community and independence" Agree avoiding wasteful overtesting of worried well Agree costs cannot be controlled unless paired with ongoing review of liability issues ongoing study of addiction and obesity 27899 07/25/06 ND Agree Disagree I don't think there should another agency or network developed to network and structure to improve the care. Then we just use money for administration that can be used for the cost of health care for the people who need it. Agree I think this is better it will use existing programs in place already. Agree Agree Agree 27900 07/25/06 KY Agree Agree Agree Where do State accountabilites lie? Agree Agree Agree Everyone contributes in their own way. (shared responsibility) "Keep the process streamlined. The less hands the better. Evidenced based practice is essential for prevention as well as treatment regimes.People should always have a choice to follow or not to follow advice, but need to have astute trained individuals to ascertain that individuals truly understnd the options and are not intimidated to respond. " 27901 07/25/06 MT Agree "I was part of the original discussion group in Billings and agree with the recommendations. Offer one more alternative for the working poor. $4,000 deductible a year is still too much for those working full-time at near minimum wage. " Agree Agree Agree We need a serious national discussion on how to help people die with dignity. Agree Agree "Perhaps give a financial benefit to those who exercise and go for preventive procedures or for those who do not smoke, drink excessively. And then have compassion on those who cannot do as they know they should. " The health care system in the U.S. is broken and needs serious changes. Many other countries spend less money and have a better system. We can do it if politicians will forfeit their gifts from corporations and instead do what is right. 27902 07/25/06 FL Agree The profit based model for healthcare in America must be reversed. We can do much better than allow our citizens to become customers of unfeeling business men. Agree If you are serious about this you will need to remove the current right-wing politicians from office before this has even a small chance of happening. Agree "Again, a political change is necessary for this to take place. On a more realistic basis I would concentrate on the first, second and fifth items. These three areas are doable in our lifetime." Agree I fully support this. Agree I support this concept. Agree I support this concept. I support this recommendation as long as it remains clinical - and does not move toward the research process. If you move this into research issues you will see resources diverted away from actual care. I believe in universal healthcare for all Americans - and a fair system to provide both services and to pay for it. I also believe that the current governmnet will do everything it can to avoid ever having this take place. 27903 07/25/06 TX Agree The healthier our population the more productive we are as a community and country. If people have health care and use it it will also reduce overall cost of healthcare by reducing the number of acute and chronic incidences that end up in the hospital EDs that are so much more costly. Agree The health providers need to start thinking as a collaboration and working together as a community and not as competitors in providing healthcare. Agree These programs need to not have barriers that make appling and receiving healthcare difficult but should also have audits to insure no abuse of system and services. Agree Everyone should be allowed the opportunity live their last years with dignity and die with dignity. There should be literacy to help them prepare for what will come and what they should plan for. Agree The cost of healthcare has to be brought under control so that people can afford health care without spending their life savings to do so. Agree The more holistic approach you can take toward the person as a whole but people will need to be required to accept a certain amount of responsibility for themselves in their healthcare. 27905 07/25/06 NJ Agree "A sliding scale should be established for this purpose that could be tied to the income tax records of the family or individual. Although large health costs are tax deductable up to a certain amount, this requires that you have the money to pay in the first place. A method should be worked out though the Federal that would not require the government or the individual/family to find the needed revenue." Agree Community efforts are so essential to the success of this nation. Communities have proven themselves to be valuable resources over and over again. This is an important and vital recommendation. Agree "Emphasis on ""evidence-based best practices!""" Agree Not informed enough to comment on this area. Agree "This is, after all, the whole point. Universal health coverage should be a right, not a priviledge." Agree We can finance war and the transportation of Democracy all around the world. We can put men and women into space. Finding a way to finance the health of this nation and our future should be easy! What point is it to be protected from invasion when we can die from within? It goes with being an industrialized nation! 27906 07/25/06 NC Agree This should be the second most important aspect of any proposed national health care solution. Agree "* While I agree with this idea, the absolute truth is that the federal governement is bloated with bureaucracy and very slow to act regarding national crises (ex: the less than adequate response to Hurricane Katrina and the current international illegal immigration problem). In addition, the federal government in the past has diverted funds available and/or failed to make avaliable monies through Congressional legislation and Executive action that adequately supplies a continuous funding mechanism to support the goals of total health care access program for all Americans (ex: the recent prescription drug plan debacle). I think it is therefore necessary that the federal government create an independent and separate agency that is free of Congressional and Executive branch meddling, similar to the U.S. Post Office that independently charts and administers this important health care program. However, unlike the USPS, this proposed health care agency's service strategy and funding mechanisms and/or fund surp" Agree "I agree, however, the federal government needs to partner up with private industry to fully acheive this goal." Agree This recommendation is an absolute necessity! Agree "This should be the number one priority recommendation and be listed at the top of any health care ""wish-list"" forwarded to Congress." Agree "* I agree with the suggested financing options, however, I doubt that significant continuous long-term funding could be developed using ""sin-taxes"". As more Americans are able to access quality health care services routinely, I suggest the amount of ""sin-tax"" monies generated would undoubtably decrease each year making them an unpredictable and unreliable funding source. Therefore, I would not suggest proposing this funding mechanism in any reasonable or comprehensive solution to funding a fully public-available health care program." "Yes, I agree. There should be a full and comprehensive approach to a publically-available and publically financed health care program system. " "* I very much enjoyed participating in the public meeting action session that your group sponsored in the Charlotte, NC. I have recently relocated to Apex, NC, near Raleigh, NC. I would like to be kept up-to-date regarding the progress of any future public meetings and/or Congressional actions on this most important issue. I would also like to volunteer my services, at any time, to support this most essential health care cause in any way I can. Please rely on me in any future needs of your group and/or with respect to future groups and/or public outreach regarding national health care issues." 27908 07/25/06 MS Agree "I firmly agree with this recommendation. As a senior level health care executive in administration and health care I have seen frist hand now how a system that does not cover all Americans adversely affects the total health care system. It is necessary for all Americans to have affordable health care and it is as equally important for those providing the health care to be able to support their practices, hospitals, and stay up to date with the latest technologies. " Agree I agree with this recommendation and would encourage you to please select individuals for the group that are at the grass roots level as well as NURSING levels to ensure that the individuals who are ultimately responsible for the structuring and dissemination of this care have a voice. Agree "* Education is important and necessary. It must also be mandated within the teaching hospitals as well as rural settings that CULTURAL AWARENESS in health care must be a priority. It really is not an issue of whether the government has decided on what to do with the immigrants of any nationality. Immigration is a part of this America that we live in and their health care is as well. When they show up at the Emergency Room, we still take care of them. The focus must be on the people...ALL of the People...even if they have an out of pocket expense that they know in advance that is set and standard...make it so that they feel comfortable with at least approaching the health care system for care. If they don't they will be a much more acute and costly patient when they do come to the Emergency Room or physicians office." Agree "* If the government continues to choose not to outlaw or strongly and more intensely regulate TOBACCO and various other carcinogens that we know for a fact are health related causes of disease (i.e. salt), then the federal government needs to provide the support both mentally and financially for the families that continue to have to deal with the side effects of the products. FACT: We know Tobacco causes CANCER. Those dying of cancer...take care of them, whether they smoked or not...second hand smoke is just as bad. Pay for the last days at least! FACT: Salt at high levels causes higher blood pressure and ontributes to heart disease. Those dying of heart disease...pay for their end of life care...we were willing to allow those using Trans Fatty Oils and high levels of NA to stay in business...we should have made enough money from their taxes over the years to support at least 6 months of full care and perhaps even burial." Agree "I agree however there does need to be a payment structure that is universal and set in place for income levels based on perhaps IRS tax filings the previous year. For those not filing or without income reported, the government should at least have a reserve for health care practitioners to be reimbursed for even if it is only up to 80% of the costs." Agree "The financial structure for health care should at some level take into account that the individuals who cannot bill for their time (NURSES) provide a significant amount of care. When the government stopped allowing health care providers bill for nursing time, I believe the government lost track of how much it costs to pay nurses, an ESSENTIAL part of the health care system. If we continue to lose nurses you won't have to worry about any of this..." 27909 07/25/06 MI Agree "It is criminal, that the number one world leader and the most influential country on the planet has 46 million of it's citizens unisured and that number is dramatically rising every year. " Disagree "This looks like billions of dollars for a bunch of gov. bean counters and no service. If you remove the profit from healthcare all communities will get service, not just your affluent, insured, rich communities. The healthcare system has enough bean counters. " Agree "I agree with electronic records and computer charting. The fraud and waste will not be reduced until you have a system that is deviod of profit. Uneccessary testing and procedures will continue because it is profitable. Nothing will change until you change the fundimental philosophy. When illness and disease are no longer profitable, they will dramatically decrease. " Agree "* It is very profitable to keep people alive as longer as you can, even when their terminal. Healthcare institutions are not going to support or advocate hospice because if they do they lose a major source of their revenue. All over the country there are people, more dead than alive, literally rotting away in ICU's and critical care units because it is profitable. It costs 50-75,000 dollars a month to keep them alive. Because of advanced technology we can keep then alive for months. The boomers are almost ready to hit the healthcare system. If the system doesn't change, all the wealth of America will be spent on keeping the dying boomers alive in critical care units. The healthcare system, always ready to exploit a quick buck, is now ratcheting up, to take care of the millions of aging boomers for as long as they can. Just like thousands of new schools had to built to accomodate the boomers years ago, thousands of critical facilities are now planning expansions, and greedily counting their anticipated prof" Agree Everyone should have basic healthcare-from birth to death. Agree If you remove the profit- we can finance a system that is fare and probably will be the best system in the world. We also have to get rid of litigation. Medicine is an Art not a Science. Right now we are paying more than any other country in the world for healthcare that is inferior. "Good health maintenance is like good car maintenance. If you don't maintain your car according to the dealers reccomendations your warranty is null and void-yet we have no consistent health maintenance program available for every citizen. ""We just drive the car until something goes wrong or breaks down"". " "* In order for the system to change, you have to change the system. Currently the healthcare system is operating on a false premise- Every mission statement says it will do everything it can to keep you well etc-but the only way they make money is by you being ill and disease ridden. If you do not remove the profit-all you will be doing is moving ""chairs around"". Since the healthcare industry has the strongest lobbying power in Washington I doubt very much that things will change. But I have faith in the boomers. When they hit the system and find out how terrible it is they will raise ""holy hell"". This is the generation that stopped a war and literally changed the country. Even grayhaired and arthritic, they will bring down all the politicians that are exploiting them for profit. This is not the group that will ""go quietly into that good night"". It's going to be fun to watch. The smart thing to do would be to fix the system before they hit the door. But this country was born on a revolution. When hospitals" 27910 07/25/06 FL Agree Disagree * Community Health Centers have been providing this critical care for 40+ years and have the tried and tested know how to treat those vulnerable populations. Every effort should be made to ensure that community health center with community based volunteer boards of directors continue to receive funding to do the jobs that they have done very well at. The fact that the governing boards are also users of the services provided at the Centers insures that a mechanism is in place to assure that the right services are being provided in a qualitative manner that is culturally and linquistically sensitive to the people being served. Agree Agree Agree Agree I feel the funds to handle this need already exist but are being used to do other things. I don't think that people can afford to have any additional monies taken from them to do this financing. I think existing funds should be redirected to where they are really needed to help the hard working American people. 27911 07/25/06 FL Agree Agree Develop a standard form for all Healthcare entities filing and a universal system for medical records to include electronic data and Images. Agree Agree Agree Agree 27913 07/25/06 TX Disagree "* Ideally, no-one in Ammerica should be impoverished by anything, but reality cannot meet that ideal. Insurance (or government) coverage IS NOT the most efficient way to deliver care to the indigent or to deliver routine care to anyone. It adds layers and layers of extra administrative costs to the legitimate health care expenses. Free and low-cost clinics can take care of much of the need and subsidies to keep emergency rooms open are probably necessary. No-one should be required to buy insurance other than what is necessary to cover high-cost unpredictable events. " Disagree "I'm not sure exactly what is being suggested, here, but it sounds like a bunch of added bureaucracy and cost - NOT what we need to delivery efficient health care!!! " Disagree "* Facilitating consumer-usable information and improving quality while reducing cost is a good thing, but the government is NOT the party we should exclusively trust to do that!!! There is already demand on the part of the public for usable healthcare information (as illustrated by the high frequency of health-related web searches) and many agencies and entrenpreneurs are moving fast to fill the need (including WebMD, ehealthinsurance, Subimo, others too numerous to mention). Pushing health information technology (or any other technology) into the market place prematurely just assures inefficiencies and other problems that won't exist if the new products are adopted at the pace dictated by market forces (that is - when they are effective and efficient.)" Agree Public and private payers should do this. govt. could help with educational efforts centered around advance directives etc. Disagree "Why not ask govt. to assure ""affordable"" food or housing or utilities? This is NOT a govt role!!! These things are produced in a health economy where market forces are allowed to work. Our tax laws have inadvertently sabotaged market forces in health care - we need to fix that and allow people to exercise their own market power. We cannot provide all health care to everyone any more than we can assure that everyone gets all of anything else that they want. " Disagree "I need more control of my own health care dollars. I can make wiser decisions about my own health care spending priorities than any insurer can, and can purchase health care more efficiently if I'm freed from all the bureaucratic paperwork that adds administrative cost for all parties. " "NO - primary care, preventive services dental care and most prescription drugs are prime examples of things that generally should NOT be covered by insurance, BECAUSE the insurance ADDS to the cost of these services by adding administrative cost (and insurer profits). Insurance is only cost-effective when it is used to spread the risk of high-cost unpredictable events!! " 27914 07/25/06 MI Agree "* The March 22, 2006, edition Business Week comments that health care reform is “an enormous, complex problem that requires teams of people from different sectors.” Resolving single problems may lead us to taking solutions that, when put together, may lead us in an erroneous direction. Solving the entire problem may cause so much distress to many constituencies that it will be fought from a variety of perspectives to indefinitely delay implementation. Therefore, a program that looks at all issues and is implemented over two to ten years may be preferred. From my perspective, there are a number of key issues, including: - Medical coverage for all citizens, perhaps through a layered principal. - Job changes. Elimination of jobs that don’t directly related to health care. - A culture of cost containment within the health care industry. - Coverage for wellness and other early treatment care. - Pricing that people can understand when shopping for health care. - Quality that people can unders" Agree The program's priority should be consistent with the number of people served. Creating a program for a rural area should be secondary to urban environments where more people can be served. Agree See comments in question 1. Agree Agree Agree 27915 07/25/06 OH Agree Disagree I think this should be dealt with on a local level perhaps with Federal funding. Agree Agree It is too hard to get to talk to social workers and get questions answered in a hospital setting due to lack of enoogh staff to handle the growing need. Agree Preventive care must be included in this to help lower hospital stays and to help identify problem areas before the patient is critical Disagree "Financing can not put an unfair burden on the lower to middle class who usually suffer the most from increases in funding through taxes, etc." I feel that you need to include members of low income and underinsured in the development of this group so that the ones who need the coverage the most are heard 27918 07/25/06 ND Agree Disagree Disagree Agree Agree Agree 27919 07/25/06 PA Agree Agree Agree Agree Agree Agree "I'm willing to pay higher taxes to get universal health care. It's cheaper than insurance premiums, and more fair, for a self-employed doctor, such as myself. No profit motive to deny care, as there is with the private health ""insurance"" companies. Their ""insurance"" is no assurance at all." 27920 07/25/06 IA No response No response No response Agree Agree "This is the consensus opinion in America regardless of their political party, it is time that our elected officials listened to those who put them in office and responded to this issue." Agree Bring together the best minds in this country to tackle this issue. Other countries have systems that work for people with much better health outcomes. Must have mental and dental health parity 27921 07/25/06 FL Agree for all legal americans. depends on how high health care costs is interpreted. Agree Agree Agree Agree are we saying universal health care? Agree "again, this should be available to all legalized citizens of the USA" 27922 07/25/06 OR Agree Disagree I am concerned with modification of the successful Federally Qualified Health Center system. I need more information to agree with modification. Agree Agree Agree Agree Support expansion of Community Health Centers. Federal government should cover catastrophic care and malpractice for all publicly insured patients. 27923 07/25/06 FL Agree "As a self employed low income citizen, I cannot afford health insurance. I often worry about ""what would happen"" if I have a major health crisis in my life. This causes stress, and probably WORSENS my health indirectly!" Disagree I don't agree to anything that I don't UNDERSTAND. What does this all mean? Agree sounds good Agree Agree Strongly AGREE! Agree "I am willing to pay a bit more taxes for this... as long as there is some built in clause that the money cannot and will not be re-directed in the future to help SAVE some other part of Government... to finance war, and invasions... for example." Great! "Family Health Care Benefits for same-sex couples. I'm in a relationship of 14 years with my partner for life. He works for the USDA. He has great health insurance. I have none. His will not transfer, because we are a same sex couple. *ALL* should mean *ALL* when these new plans are brought into operation." 27925 07/25/06 MS Agree "* My family's story shows all the ugly holes in our current fragmented health care system. Coverage or protection from high out of pocket expenses are needed even for young adults. My brother suffered from a brain tumor at age 12. My father's job was ""eliminated"" shortly after the surgery because the treatments and daily drugs were too high for the manufacturing company's profit margin. People should not have to depend on employers for their health care. My brother is completely normal as a 24 year old today, but for several necessary and expensive daily medications. He is paying cobra premiums ($250)on our father's insurance because his employer does not have a health plan-- only a health savings account. My brother also must give $300 in prescription drug co-pays per month. As a young adult with a college degree--paying back student loans, he still does not make enough money to pay all these health expenses and support himself. He is highly frustrated, but also feels blessed to have access to insuran" Agree "I used to work for an association representing Federally Qualified Community Health Centers. There should be an FQHC in every community. They are comprehensive, help manage chronic conditions more effectively, and keep vulnerable populations out of the Emergency Room. They are the most cost effective solution (without universal health care) and most provide high quality care." Agree "* I think this would be great in a perfect world. We also need to make sure that Federal programs do not add too many barriers to utilizing the system. Currently people eligable for public assistance fall through the cracks. This is happening everyday with Medicaid because states can't afford it (even with federal match) in the current economic environment. At least one state with a high federal match rate is requiring face to face interviews every 12 months with eligible clients. The interviews are located in obscure areas that poor people have barriers to get to access. Also, many renewal applications that are completed are coming up ""lost"" and people are kicked out of the system automatically after so many days. Access to care is needed, but people must be able to have reduced barriers so they can receive health services!" Agree "Doctors need to be educated about the process of recommending hospice to families and patients instead of letting patients charge up huge costs on long hospital stays. We waste so much money on end of life care in this country that could be redistributed to primary prevention iniatives such as vaccines, programs to reduce infant mortality, etc where potential life lost could be significantly decreased with greater societal benefits. " Agree See my comments to the first question about my healthy brother who suffered from cancer and how it affected my parent's financial situation as well as my brother's. Agree "* It should be a joint effort of federal, state, and local governments, corporations, and non-federal grant awarding agencies. Each of these entities contribute funds to our current health system in fragmented ways. All could come to the table and figure out a streamlined way to combine resources to fund health care so that no one entity caries too much of the burden. Also, much more money (only 1% federaly currently) should go towards primary prevention. Schools must encorporate health education, better nutrition, and physical education programs, as well as skills to deal with life stress into their curriculum. What good is no child left behind if they are unhealthy into young adulthood? If we prevent or further delay diseases in new generations, then health care costs will also decrease and the workforce will subsequently become more productive." "We defintely need evidence based health care, as most treatments (73%) have no known true therapeutic evidence showing they are effective. How wasteful is this if a patient becomes sicker from modern meds?" 27926 07/25/06 NV Disagree "How will you have this funded? How will it be managed to have EVERYONE contribute? Who will manage this? Government? Corporate Medical? There has been years of trying to CONTROL medical cost escalation without success. Those with catastrophic disease, chronic diseases are the ones that use medical the most." No response "I believe there should be community centers for the needy, we are already highly taxed, so a more appropriate allocation of funds could be used to run them. You still have a medical professional problem shortage. " Agree All in theory is good. There are QI organizations but not much is ever done. Agree I agree there should be a restructure...but there is a problem of keeping patients on hospice for YEARS just to bleed the system. Agree "I agree that every AMERICAN should have access to health care...but those that self inflict diseases (drug users, prostitutes) HIV-AIDS Illegal Aliens use up our resources. " Disagree EVERYONE would have to buy into this not just a few and that is the problem. Too many self serving individuals are in this. 27927 07/25/06 UT Agree This is vital not only for the health and well-being of all but for our economy as well. Having access to affordable health care and related services should be a right not a privilage. Agree There needs to be a strong public-private partnership so that no one falls into the cracks and there is less cost shifting. Agree Consumers should have information and as a result be empowered to make cost-effective decisions. Agree "This is vital especially for children who do not fit into an adult model of hospice and palliative care, everyone deserves to have quality care!!! " Agree "Health care should be available and accessible to all Americans, especially for those who need it. Americans with special health care needs and disabilities should not have to lose everything in order to access the services they so desperately need." Agree Everyone has a stake in a healthy country and should be willing to do what they are able to. I agree as long as the core benefit package takes into account that everyone is unique and different things work for different people. We need to make sure that the benefits are not devistating to some. Access to affordable on-going health care is vital for everyone especially those who needed it yesterday. 27928 07/25/06 TX Agree Agree Agree Agree Agree Agree "* I feel that many if not all of these recommendation can be acheived if mid levle providers such as Nurse Practioners or PA's are utilized more. Primary health care, preventive health care, and palative health care can be provided at a high (if not higher) quality and at a lower cost when provided by a mid level practioner. Save the high cost care of Doctors and Specialist for advanced disease care and operative care. In addition to help keep healthcare cost down, something has to be done now- to keep malpractice insurance costs down- pharmacutial cost down- these issues have a large impact on the increasing costs of healthcare." 27929 07/25/06 UT Agree This is important as it appears to cover more than one class of Americans. Agree Agree evidence-based best practices in specific settings? Agree Well Done. It is a huge developemental step for us as a society. Agree Agree Glad to see the mental health component. "I was very impressed with the facilitators. They demonstrated excellent listening, validation, skilled computer use, and management of time. I expected the process to be boring so almost didn't go. I was surprised and felt I was a part of an important process. Thanks." 27930 07/25/06 CO Agree Agree Agree Agree Agree Agree 27932 07/25/06 CO Agree "* This goal is correct, however, I do not believe it can be accomplished via the private sector (i.e. the 'private or public' portion in parenthesis). Private sector insurance driven by profit motive is designed to encourage insurance for the healthy, to deny coverage to the sick, to design plans to remove sick clients (e.g. coverage tied to employment so that a sickness or illness with onset during coverage can be ended if the sickness or illness causes separation from the employer and group plan of the employer with the new sickness or injury then being a pre-existing condition for new post-employment coverage) from coverage and denial of services to those needing services. The nature of health claims being highly driven by a small percentage of the total pool available for premium creates incentive to deny coverage and benefits to those who need health care. " Disagree "* Only universal health care with a single payor will provide a safety net to fund the uninsured and vulnerable without removing the healthy from the pool paying the premiums to fund the system. We can not fund the claim part of the population, for example, while permitting the healthy to divert their health premiums to 'health savings accounts' for use for non-health retirement. The original point of insurance is to assess everyone in the risk pool and pay out to those in need of services from the revenue providee by everyone. Universal health care with a public single payor is the ultimate 'mutual insurance' concept with the drain of the insurance company (insurance companies provide no health care services) profit motive removed from the formula." Agree Agree I agree with comment that the 'private' part of the formula above relates to service delivery and not the money and financing of the system. Agree Everyone must participate on the funding side as well. Provisions that divert health premium dollars to 'health savings accounts' and permit healhty young people to select less coverage until they reach a higher risk age must be eliminated. Agree Legislation to limit the political power of pharmacutical firms and insurance firms must be enacted. Antitrust must be enforced. Excess profits due to market imperfections both natural and politically created (e.g. no negotiation for prices on Medicare Part D) must be addressed and corrected. 27933 07/25/06 NH Disagree "There is so much end of life spending for futile measures, I can't endorse this insurance plan. I do agree that people should not become impoverished by their medical expenses, but I also think we need to curb spending on futile measures. Please review the work of Jack Wennberg and Elliot Fischer of the Dartmouth CECS." Agree Agree I encourage the incorporation of patient-representatives (actual patients serving on the advisory boards) in the design and administration of any new system. Agree "I was ashamed by the federal government's involvment in the Schiavo case, especially Bill Frist's declaration that Terry was not brain-dead. As a doctor, he should uphold his oath and not practice beyond his expertise. " Agree Agree "We must not lose the basic component of individual responsibility. Patients who smoke should pay a larger premium or be excluded from coverage for treatment of lung cancer, COPD, emphysema, etc. Likewise, motorcycle riders should have a waiver for trauma-related injuries subsequent to not wearing a helmet. These risks of these behaviors are well-known among the general public, so I feel this is a reasonable expectation of people to protect their health." 27937 07/25/06 WA Agree Agree Agree Agree Agree Agree 27938 07/25/06 OR Agree This is the minimum we need. Agree Keep political and religious biases out of the system. Let people choose what they feel is best for them. Agree Agree Agree Agree We are a rich and diverse society. There is no reason financing universal health care should burden on anyone in need. "The core should be applied wide and deep, not limited to specific sets of citizens or groups." 27939 07/25/06 KY Agree Agree Agree Agree Agree "In the most highly advanced country in the world, no American should be denied health care, including medications ordered by their physician." Agree 27940 07/25/06 CT Agree Agree Agree Agree address how communities will receive funding at the local level to provide support services in end-of-life situations Agree Agree 27942 07/25/06 NY Agree "I agree, but the private insurance industry has proved that they can not carry out this mandate since their primary responsibility is to the profitability of the company. This must be a public program. We should recognize the inherent conflict of interest and move to a single payer system." Disagree Segregating vulnerable populations to a second-tier of care provided by Federally Qualified Health Centers guarantees that they will not receive the same level of care as the well-to-do. It will lead voters and legislators to chronically underfund these health centers. We should have a single payer system with private providers and allow all individuals full access to all providers. Agree "I agree with the goal, but why should we set up seperate and inherently unequal systems of care. Shouldn't we all have access to the highest level of care available?" Agree "I agree, but the commercial insurance carriers will continue to deny payment so as to enhance profit at the expense of patients. This should be done with a public single payer system." Agree "I agree strongly and believe that the insurance industry has demonstrated an inherent conflict of interest and taken actions that jeopardize this goal for many individuals. This should not be ""financial assistance for those who need it"", but univeraly available for all without a means test." Agree The biggest waste that should be eliminated is the redundant bureaucracy of multiple plans from multiple insurers backed by scores of workers denying claims and countered by scores of workers for providers appealing the denials. We should have a single payer system which would give us an immediate 30% increase in cost efficacy. I would recommend a generous package of covered services since I believe it is immoral to deny necessary medical services to individuals based on their ability to pay. I would exclude only unnecessary services that are entirely optional such as purely cosmetic procedures. "Funding of a national health program will alwasys be a contentious issue. However, I would rather trust elected representatives who must answer to the voting population than to insurance company executives who only have a fiduciary responsibility to their stockholders." 27943 07/25/06 IN Agree "* Employed in the healthcare industry as a social worker, I favor making coverage available for everyone. In my profession, I am continually meet with the overwhelming needs of individuals and families who cannot afford healthcare, and the current system leaves a huge gap between private insurance and those who are benefit eligible (Medicaid and Medicare). As a private citizen, I carry health insurance through my employer primarly because of my husband's health needs and have been grateful that it has been available during a catastrophic health need. However, because of the high deductibles, co-payments, and out-ofpocket expenses, I cannot afford to utilize health care for myself. Although my health care needs pale by comparison, I have worked in health care long enough to know that I have some conditions that could lead to major problems if not taken care of in the next few years." Agree "This MUST be a nonpartisan effort. Too many social issues have become politicized, and therefore only ""half-funded"" due to personal agendas. Adequate funding for any public initiatives is critical or the effort will fail and our nation will fall even further behind other industrialized nations in its efforts to responsibly care for its citizens. This is a human need, not a political agenda upon which elections will be won or lost." Agree "I would refrain from monetary incentives for any programs. All ventures in this area must have an equal playing field or this will soon be history repeating itself. When managed care organizations became the mainstream in the 1990's, access to care was dramatically decreased, the quality of care in many areas dramatically declined, and costs soared beyond imagination. Take away the profiteering for ""covered lives"". These are REAL people with REAL needs." Agree Hospice care should be a part of any defined benefit. Too much emphasis is put on trying unnnecessary medical interventions that may not be wanted by the patient or family. This is in part responsible for increasing health care costs. Agree "Take the profiteering by health insurance companies and large pharmaceutical companies out of any solutions. Managed care has become ""mangled care"" in many instances when profits are at stake." Agree "Use some of the profits generated from forfeitures and seizures, and taxes on liquor and cigarettes. The taxes on these luxury items are not being appropriately directed to treatment now." "Fundamentally I agree, but the proof will be in the implementation." 27945 07/25/06 OH Disagree "I disagree that any program should be privately funded. I also disagree that high out-of-pocket should not be paid for those that can afford them. Finally, I feel that ""financial protection for low income individuals"" could not be offered without a sliding-scale (without low upper limits), publicly funded system." Agree Disagree "The Federal government has been ineffectual in the operation of healthcare systems, and disparities between care offered in different locations contributes to overall poor health within government systems. Systems should be integrated, should be federally funded, but should be locally administered." Disagree "The federal government should not yet address palliative care issues, as the issue is not related to ""healthcare"" in the sense that it is necessary for a healthy community, but it is an option for those seeking such services. I do not want the government to address these issues without first identifying opportunities in primary and long-term care. " Agree Disagree "The idea of ""core"" benefits flies in the face of the pace of innovation in healthcare. A ""core"" benefits package will stiffle innovation and lead to the lowest common denominator in quality, convenience, and provider performance. " 27946 07/25/06 CA Agree Agree Agree Agree Agree Not just all Americans but all who reside here. Agree Tax those who can afford it more heavily. And it should be free to those under a certain income level. It would also help to reprioritize our national sense of purpose--look at the money we're pouring down the Iraq sinkhole that could be used to give the best health care in the world to all our people. "Bring to an end any sense of ""punitive"" care--those with less money get less entitlement to care. Excellent health care for all is good for everyone." It would help enormously to get the idea across that people's health care is not a profit-making sector of the economy. It's an infrastructural investment in our future the way roads and schools and national defense are. 27947 07/25/06 KS Disagree "Generally, government controlled programs of this size and scope are not managed in a fiscally responsible way. To support this initiative, I want to be confident in the organization and administration of the program. Perhaps, private administration is the answer. " Agree "Again, I want assurance that the programs are planned and managed well and that there are effective performance improvement systems in place." Agree I want a private policing component built into the process. I want organizations to compete for the administration of these programs. Agree With the caveat that living a quality life at home with professional and compassionate assistance for as long as feasible is the goal. Disagree I would like more detail. It sounds very expensive. Disagree No increase in taxes. "This appears to be very expensive. I agree with the concept, but need more information before I can agree with the plan." 27948 07/25/06 OH Agree "* I would also like to see that idea specifically directed to the Pharmacy end of the costs also. Big busnesses are charging employees for part of their coverage for Dr./Hospital/RX and even with co-pay they are now placing ""Deductibles"" in excess of 2,600 every January and to add insult...say they will only pay for preventative treatment. Who goes to a doctor that doesnt need one??? I personally will have to find a way to pull off my medications by january because I dont have the money to pay up front 2,600 for my rx's that run 1,200 each month! I am disabled and on meds that are controlling my pain as well as hormones....but will do what I have to do, if it kills me!" Agree Agree "This idea is long overdue in my opinion. Too long has it been all or nothing with regard to low income getting help. If they have some level of insurance but not enough to meet the need, they earn too much or are disqualified due to haveing some coverage even if meanial." Agree "Having an illness that is possibly fatal, this idea cannot arrive soon enough! Why should those that are ill have the added stress to them in worry about how they will manage or be cared for when they cannot do for themselves much less pay for it." Agree What Family financial security?? It's a start though! Agree "I would like to see it be a tax of a percentage of earnings. Sin tax has not be ""fair"" thus far as Alcohol is not taxed like cigarettes are and yet both are legal substances. Those that smoke should not have added ""sin"" tax laid upon them again until other resources have been exhausted to be fair that all are contributing!" "As I stated earlier, this cannot be adopted soon enough in my opinion. As for me, it is a dire emergency that something is done in this area as of Jan 1st, 2007, I will not be able to afford my medications due to added deductible and am on addictive substances for my condition. Living in this land of the free and brave, nobody should have to live as I do because I became disabled while our boarders are open to aliens that walk in and get free care!! This is unacceptable and depressing!" I am happy to see some movement in revision of health care in this country. We have long enough taken care of others and left our own to suffer. I planned in highschool for my trade in contributing to this countrys wealth and just because I am now in need doesn't make me less of a person or less intitled to some help. 27949 07/25/06 CO Agree This is essential! Agree Coordination of health care efforts is a MUST! Agree Quality must be guaranteed and uniform. Agree "In this sensitive tome of life, understanding and caring are quite necessary." Agree I have no idea why it isn't already public policy - it's certainly long past due. Agree "Whatever needs to be done to make healthcare for everyone not only affordable but possible, must be done immediately." Health care must be all-encompassing and involve people from all groups and all walks of life. It's encouraging to see this keep moving forward... let's get this done as efficently and expeditiously as possible. 27950 07/25/06 WA Agree We need a UNIVERSAL system like every country in Europe and Canada! Disagree "This is nothing but a ""study it do death"" waste of time. Such a committee will NOT BE LISTENED too. They will make a report and it will be filed away. Just like the 9/11 report." Disagree These is make work that attacks minor problems in the health care system. No response Agree "UNIVERSAL plan is the only viable system. Until then, these tiny steps could help." Agree Health care needs to be PORTABLE and not tied to a specific employer. 27951 07/25/06 NV Agree No one living in the United States should second guess whether they should go to the doctor or not because of cost. Agree "I agree that these solutions, in part, are better than what we have today, but will not be adequate. We need a comprehensive system that not only insures the over 48 million who are not, but to provide better quality of care to the 200 plus million who do. The target in any health care system should not be saving costs, but providing quality care. Effectiveness with efficiency, not the other way round. Any system of health care must remain in the public not private domain." Agree These are very good strategies. Agree "I agree with implementing these strategies BUT we need to face the fact that more health care costs--not only actual dollars, but other resources, time, engergy, etc.--go to keeping the dying alive than are spent on the young. Just because the technology is available, does not mean it should be used. Quality of life should always be preserved and young or old, life should be protected but appropriate care should be given. A discussion of death is soarly needed." Agree "I strongly agree. A scaled user charge could be applied based on income. Regardless of the strategy, this MUST be the goal." Agree "* Yes. Once health care is taken back from the control of private insurance companies savings will be seen quickly. The enormous administrative costs associated with determining eligibility will vanish. Re-focusing energies on preventive care will keep more Americans from needing high dollar health care. By bringing drugs into the public domain, then those costs will decrease significantly. And, controlling the impulse of doctors to prescribe something for everything is a must. Doctors need to develop real relationships with their patients strong enough to say, ""You have high-blood pressure because of what you eat. I'm not giving you drugs, but a diet plan."" Financially, Switzerland's health care system might be a model, parts of which include having non-profits run the insurance end. I am no expert on financing health care systems. And still believe that health care should always be in the public sector and strategies within government should be devised to increase cost-efficiency." Health should be defined to include eye health as well. "We have universal public education, so why not universal health care? You need the latter to perform the former. Unlike education, however, health care must be delivered at the national level, not state level, in order to assure access to quality of care to all. " 27952 07/25/06 OR Disagree "* I am unsatisfied with two elements of this recommendation: 1). I do not believe that the private sector can establish a national program which is not profit-based and which is equitable. I believe that universal coverage must be established through a public program. 2). I am curious about the language ""very high"" costs. To my way of thinking, access to health care is a fundamental human right. Shouldering even ""high"" (as opposed to ""very high"") medical costs is a burden which does not affect people equally. Poor and low-income people can not afford even ""moderate"" costs. Using language such as ""very high"" leaves it very subjective. Let's be more specific such as, no individual should have to pay more than XXX percent of their annual income on health care." Agree "Yes, very good." Agree "Additionally, I suggest the promotion of creative models such as group education/treatment for chronic conditions, more use of RN's and paraprofessionals in education/case management." Agree I also believe that our health care providers need to be given more clinical supervision and support as they assist individuals and families through this difficult transition. Agree "* In Eugene, Oregon where I participated, the main thrust of the conversation was that healthcare is a basic right for all. The truth of the matter is, everyone DOES pay, regardless of what type of system we institute...either through premiums, taxes, cost-shifting or in many cases, poorer health outcomes. So, yes I agree that all should contribute, but this needs to be done in a way that is rational, equitable, that does not penalize the poor and marginalized and that does not allow some groups to profit obscenely at the expense of others. " Agree "I agree with your above comments. I do believe that taking out the administrative middle-men will result in significant cost-saving in the long run. I also think that we need to re-evaluate our relationship with the pharmaceutical industry. Bargaining and bulk purchasing at a federal level will result in savings. I also think that we need to be willing to reduce the proliferation of unnecessary (but profitable) technologies when there are other, less expensive options." Don't reinvent the wheel. Take a look at the original Oregon Health Plan's prioritized services. Talk with Dr. John Kitzhaber-one of our nation's preeminent thinkers around health policy and health care reform. Thanks for the opportunity to participate. 27953 07/25/06 IL Agree Gov should look at why health care costs are so high?? Lots of countries provide good care with good outcomes at a much lower cost Agree "Medicaid has lots of loopholes and abuses, it needs to be overhauled and streamlined to prevent duplication of services. Use a charge card type system that tracks where Medicaid dollars are going." Agree "Use and pay for more nurse practitioners, they are a very efficient and effective provider of care." Agree Agree Agree "Stick to evidence based care, not physician mandated care." 27955 07/25/06 FL Agree "Need to ensure that there is a strong resource for this instead of using ss dollars to fund. Also look at critieria for use and not allow for everything possible to be done, maybe some restricitons to prevent abuse." Agree Need to ensure that this agency is reviewed by credentialling bodies besides the government so it matches the remaining health care system Agree this is currently starting to happen as part of the NPSG and CMS standards. Would be great if each state had similar rules for regulation of medicare/medicaid dollars. Maybe need to have fininancial incentives offered to non federally run facitilities to fast track the evidence recommendations into practice or at least a resource body to tap into. Agree "currently being done, need to focus on education of existing services. under utilized" Agree I believe the health care system does have access. the problem lies in the follow up for all patients. Maybe people think an emergency room is the doctor and how they should be treated. If we allow access we need to focus on prevention instead of by illness and make availalble 24 hour services outside of a hosptial to assist with access Agree Fainancing is fine but need to ensure all americans pay into the system not just if you are above a certain level of income. maybe needs to be a sliding scale based on income. Fear that many people will come to the us for healthcare and not pay and deplete the federal funding that is not avaialable where they are from Focus on prevention not illness 27956 07/25/06 KS Agree Agree Agree Agree "In addition, the federal government should support a national dialogue on expectations of families regarding end-of-life care. Rather than spending the majority of our healthcare dollars during the last six months (because families are unprepared to ""let go"" of their loved one), additional funds would be available for preventive and primary care." Agree Agree 27957 07/25/06 NV Agree "The program must include prescription coverage,and not just medical and hospital care." Agree "A network must be widely distributed, with many health centers in a city including smaller satellites that may provide limited services. Being able to get to a center must be easy for seniors and those without private transportation." Agree The Medicare Part D program must be reformed to allow the program to bargain with drug companies for volume discounts. Agree The federal government should stop trying to restrict states from allowing physician-assisted suicide. Agree "If this must involve rationing, so be it. Universal coverage for basic medical care is THE paramount objective. " Agree "And raise taxes on everyone, but especially the wealthy, to pay for a transition to a universal coverage system. This is a moral issue which AMericans are willing to be taxed for. " "This group MUST be absoutely independent - no ties to corporate America, however remote - can be tolerated for members of this important committee. And no chance to leave the group and join business or become a lobbyist. Establish from the outset that this group will not be influenced by political and financial issues." "Yes. This is issue #1 for this country. The cut-over to universal coverage will be painful no matter what - so do it now! Raise taxes, insulate the advisory body from outside influence, and make the hard rationing decisions." 27958 07/25/06 WV Agree Coverage must include not only finances but access to services. Agree "States should be able to vary in their implementation, with pilot projects." Agree Agree The same respect for personal decisions and the resouces to do so should be available to the disabled community as well. Agree Agree Reform should include reform of the medical delivery infrastructure as well. Health based approaches not health industry based approaches. 27959 07/25/06 FL Agree Agree Agree Other not-for-profit healthcare organizations should also be included as models for integration. Agree Agree It is a basic human right Agree "It is a multi-party responsibility: individual, business, government." 27960 07/25/06 NC Agree Agree Agree Agree "Community based services respect the choices of those who want to receive care at home and are much more cost effective than institutionalization. I work in Adult Medicaid, I know." Agree "I strongly agree with this recommendation. Health insurance premiums are out of reach for most people, even for basic coverage. " Agree "This is difficult but we must find a way to do this. It should not be based on ""the more you have, the more you get to keep"" concept." "I think it is imperative that we look at ""physical, mental & dental"" as a whole." I think it is imperative to think of all people when considering health benefits. Affordable health insurance for working people is a necessity. WHen the costs are so unreasonable they are unable to pay for the insurance and then end up having to use the system and this costs us all. 27962 07/25/06 UT Agree Agree Disagree Thepeople need to be able to choose their providers. Not the people that get paid with tax dollars. Agree Its wrong to steal a persons last assests before they die. Disagree Anything thats legislated becomes inverted and used against us. Agree "If we had good food without antibiotics and pesticides and other unknown agents, if we had water that was clean, if we had clean air, if we had self education and improvement.. we wouldnt need health care. Its our lifestyles that make it the way it is." Thank you for all your hard work. I enjoyed the conference in Salt Lake City. 27963 07/25/06 NM Agree "* While I agree with the recommendation in theory it is a much more complicated issue that simply stating this is what will occur. Specifically, costs of doing business are constantly on the rise. Who then will foot the bill for rising costs of providing healthcare to ensure this recommendation is realized? Will it be taxpayers in general? Will there be ceilings on what providers – physicians, facilities, pharmaceutical companies, etc., will be able to charge and collect from patients? Will there be some sort of tax break? Will this just be another system of robbing Peter to pay Paul without any real change? These are my concerns…" Agree "Again, my concerns are with the detail of the recommendation. What exactly will this look like? The issues of cost and availability of providers as a basis of developing the infrastructure that will serve the underserved does not go away by simply stating this is what will be. What will be the “incentives” created to encourage this type of outreach and participation by providers, insurance carriers and state governments, etc. Is this just another layer on top of an already complicated system? " Agree "Where is the involvement of the private sector? All things considered, government agencies are not the model of fiscal responsibility or efficiency. There must be greater accountability of existing federal and state resources if this is going to have half a chance. To simply say existing programs will be expanded only magnifies the inefficiencies and lack of internal controls that currently exist." Agree "* In my opinion there is too much waste in dealing with the end of life population. While I am not an advocate of limiting access to needed care or services particularly in this setting, the provision of services is sometimes excessive and in the mold of one size fits all. Not all, but some, providers of these services will provide a landslide of services that may not be needed given the patient’s condition and in some cases not wanted by the patient or his/her family. But because the level of reimbursement follows the services – one size fits all. That will need to be addressed. " Agree "Details, details, details. That is where the the true impact of these concepts will be determined. " Agree 27964 07/25/06 CO Agree This MUST be limited to legal US citizens. Disagree sounds like too much bureaucracy which adds to our costs through fees or taxes. this is too vague. This MUST be limited to legal US citizens. Agree This is ironic. The government by definition is inefficient and lacking in quality in all of the services it provides. How would this be any different? Agree Agree "This is not for ""Americans"", it is for U.S. citizens. Get that corrected!" Agree I am against raising taxes. Our government takes too much already and gives away too much to other countries. Keep our tax dollars at home! The set of high-cost protection health services will also go across the continuum of care throughout the lifespan. I don't want to see a health system like what Canada has. 27965 07/25/06 IA Agree Universal coverage that does not segregate the high risk into a separate category is the only way to provide coverage. Elimination of private sector administration charges and profit margins must be eliminated from the health care system. Disagree "Private providers of health insurance coverage are too expensive for a truely affordable system. When federal agencies are able to operate and manage their system for 2% instead of the double digit administrative and profit charges in the private sector, merging the systems will only result in higher costs instead of lowering private sector costs down to the same percentage as the public sector." Disagree Electronic medical record systems are too vulnerable to misuse and wrongful dissemination of the information contained therein. Vulnerability to criminal entry to the electronic systems by unauthorized individuals is to great a risk to make electronic records part of a national system. Disagree All services should be available to everyone regardless of who is paying for the service. We should eliminate almost all private payers. Agree Universal coverage will be more affordable if the private sector is not allowed to charge for high administrative costs and their profit margins. Agree "High administrative costs and the profit margins in the private sector contribute to the high costs of health care. when people who can't afford health insurance coverage, they utilize the most expensive sources of health care." Elimination of private sector coverage providers must be achieved by eliminating their participation in the health insurance system. Private sector profits and high administration costs must be eliminated from any universal coverage system. 27966 07/25/06 OH Agree It should be a public system! More than 60% of the people who responded to your surveys want a public system. Why won't you give us this? Agree Agree "Of course everyone supports this, but it is not very important." Agree Agree "What we _most_ want is to expand Medicare to cover everyone. We don't want ""financial assistance"", we want universal healthcare. If we cut out all the administrative bureaucracy and financial shenanigans, our country could actually provide healthcare to everyone and at lower cost than the current system. That is what we want!" Agree "If we had a single-payer health system, we could cover everyone for less money than it now costs because all the money wasted on paperwork could be eliminnated. Why won't you give us this system? The most important efficiency gain is to eliminate the current bureaucratic system and make healthcare available to everyone." "I don't remember any questions in the survey about ""private-public"" groups. We don't want the pharmaceutical and insurance companies deciding what benefits we should get. This should be decided by consumers, doctors, and the government. " Most people in this country want Medicare to be expanded to cover everyone and for it to be made comprehensive (a Canadian-style system). I am very frustrated that you did not ask more about such a system. I am also very frustrated that you have not recommended this even though most of your survey respondents said that is what they want. 27967 07/25/06 NC Agree "I believe that this should be a public, single-payer plan." Disagree "This would be one way to do it--but I believe that this should be a Federally funded and delivered program--similar to Medicare, but available to all." Agree "Again, this should be a single-payer plan." Agree Agree This is the best plan! Agree 27968 07/25/06 RI Agree Agree Agree Agree Agree Agree 27969 07/25/06 TX Agree Agree Agree Agree Agree Agree 27970 07/25/06 FL Agree Agree Agree Agree Agree Agree 27973 07/25/06 TX Agree "* I have a problem with the President's ""ownership"" system for health care. Although it has not advanced in reality, it almost proposes that we are a societey with many hypochondriacs who seek unnecessary care and with a system of consumer choice based on personal cost rather than need, the unnecessary will be reduced and care become more cost effective. In reality, who is going to shop for doctors, hospitals and other providers based on cost comparisons? Perhaps for insurance coverage if one can realistically compare coverage and associated costs." Agree No additional comments. Agree "The federal programs listed, although expensive, cover a large number of citizens and are in my view cost effective. Expanding these (type) programs would definitely be in the public interest but for financial support would require some form of ear marked income (e.g. Medicare)." Agree "An effective and continuing education program is needed to encourage all people to state in advance and in writing their end of life choices/instructions in the event they are unable to do so at or near that end. Without such, courts have been responsible, politicians not." Agree "Health care providers need and are entitled to a living/reasonable profit. Those costs for individuals without insurance and who have to pay out of pocket on their own, should be billed and expected to pay no more than that ""allowed"" by insurance, Medicare, etc." Agree "Unfortunately, with the extraordinary and continuing increases in health care costs, I believe we will eventually (probably sooner rather than later) have to go to a single payer (government managed) system. What a political mess that discussion will be - but necessary for all Americans to obtain needed and effective care. Not a commercial business choice where the ""bottom line"" takes precedence customed need. " Excellent recommendation. I have nothing to add. Just hope it can and will be done. "Excellent, accessible and affordable health care is in my view not only necessary but a right of all American citizens. I have an excellent health care system that is supported by Medicare and, because I am a military retiree, Tricare. All Americans should be able to receive comparable care at comparable cost. Single payer??" 27974 07/25/06 KS Disagree An open market free from government regulations will help keep costs down. We need more protection against needless costs through lawsuits and the threat of lawsuits. Americans need to take more responsibility for their own health through preventative measures. Disagree Quit expanding the federal governments role and adding additional costs on to our health care system. Help local communities with funding not regulations. The combination of public and private dollars in each community is a great idea. Agree "This I agree with. There is no excuse for all goverment programs not working together to achieve economies, efficiencies, and service." Agree We can't control how we enter this world; we should be able to control how we leave this world! Agree Only if Americans take responsibility for their fair share. I take care of my family and do my share for the community. I expect the same by everyone and am tired of excuses. Agree Efficiencies must be found before more dollars are wasted. A perfect example is the waste in Medicare Part D. Who will establish this group? What kind of timeline? "I know this effort was massive and credit goes to those who worked so hard. BUT, I don't agree that government regulation is the solution - I believe it is the problem." 27975 07/25/06 CO Agree Agree Agree Agree Agree Disagree 27976 07/25/06 IL Agree "All Americans should be covered. It is a disgrace that they are not, currently." Agree "There is a bit of mumbo-jumbo in these statements. But basically, I agree that existing systems need to be expanded to cover vulnerable citizens." No response "Agree that using bevidence-based best practices is useful, IF done correctly. Great to emphasize education, communication, patient-centered care, disease preventiion and health promotion. Questionable whether electronic record systems are good. A great sytem would be valuable, a poor system a huge time-waster. Am concerned that ""reduction of easte and fraud"" could be used to deprive needy people of needed services, in the manner of Missouri's current programs." Agree Agree "Agree, agree, agree..." Agree We must sacrifice something to receive something. This is worth some sacrifice. "Although this will be a difficult task, choices must be made to ensure that the basics are available to everyone." 27977 07/25/06 FL Agree Disagree Agree Agree Agree Agree The doctors need the last say - not the administrators 27978 07/25/06 OR Agree "* I hope your final report will make two things clear. First, health care spending is highly skewed. Approximately 10 % of the population accounts for 70% of spending on health care. (My numbers are from memory. The actual data is available and in this ballpark.) The program you speak of should be described as a mutual aid program. Those of us with low health care needs contribute funds to support those of us with high health care needs. The frame should be explicitly about ""us"" creating an environment of health security for all of us. Second, the threat of impoverishment is relative to wealth. Contributions to the pooled resources should reflect the ability to contribute. Attending to how the burden of contribution will be distributed is as important as how the benefits will be distributed. " Agree "* ""Safety net"" is a metaphor. It projects an image of people falling from from somewhere into it. The reform that flows from your report should include safety engineering at the ""somewhere"" people keep falling from. That ""somewhere"" is the current public-private system of health care coverage. After the new systems are developed, fewer and fewer people should be falling into the safety net. The current system of FQHCs rests on assumptions that should be challenged in the new designs for ""somewhere."" The lessons already learned about how best to serve people who currently fall into the safety nets should be used to shape practices in the new ""somewhere."" " Agree Value for money in health care requires evaluation. This component is essential for wise spending by public and private purchasers. Agree "Yes, this is important. But the pattern of integration and best practices need not focus only on end-of-life care." Agree Participation means community. Community means common good. This frame proposes that we do something together to enhance the quality of life of our community. All benefit when the commong good is enhanced. Agree "* Try to strip away illusions. Quoting U. Reinhardt--the money for this always and only comes from households. Government and business have no money that doesn't come from households. Government doesn't give ""eligible"" people health care coverage. Neither does business give insurance benefits to employees. They both collect money from houselds (by taxing or selling) and then redistribute it. The financing task is to fairly distribute the burdens born by households with varying levels of income and wealth. But we have to see through the illusion that government and business ""give"" people health insurance coverage." This is essential. No guarante can be unlimited. Limits should be as rational and fair as we can make them. There is no absolute norm. Process is the best guarantor of rationality and fairness. 27979 07/25/06 MS Agree "Basic services, with an emphasis on preventive care, needs to be available to all citizens." Agree Need to spell out how it is determined where the greatest needs exist. Agree Community health workers (lay health workers) need to be included in the provider mix for the last component Agree Lay health workers should be included in the mix of health professionals whose training is supported Agree Agree 27980 07/25/06 NM Agree Disagree "* While I agree with the basic premise that he federal government should lead a national initiatiave to develop and expand eintegrated public/oprivate community neworks of health care providers aimed at providing vulnerable populaitons with a source of high quality coordinated health care..."", I admantly oppose the recommendation contained in your THIRD bullet: modify the Federally Qualified Health Center (FQHC) concept to accommodate other community-based health centers and practices serving vulnerable populations. The FQHCs are a set of providers defined by the Medicare and Medicaid statute that are designed to serve those most vulnerable--low income populations who reside in public housing units, the homeless, migrants and reimbursed to cover the costs incurred by the FQHCs in order to reach these populations and make the FQHC the medical home for these populations. FQHCs have become the ""safety net"" for these populations and to open the program to ""other entities and practices"" without sustaining all t" Agree Agree Agree "STRONGLY AGEE---ABSOLUTELY, and this philosophy should be front and center as a ""core value"" of a newly designed health care system. I was present at the Albuquerque Town Hall and this was the core theme." Agree "I concur with the above principles of financing strategies. It appears that there must be a shared responsibility of public, private and patient responsibility. " "Strongly agree. I believe that we must move resources ""up-stream"" and hae a strong foundation of wellness, preventive services and primary care, acute care and prescription drugs as part of the basic core services. Unless we invest in ""upstream"" preventive and primary care and wellness can we ""break the cycle"" of future generations of diabetics, hypertensives, substance abusers. We must invest in these critical areas if we are to make an impact on ER, hospitalization, specialty care." 27981 07/25/06 OR Agree Agree Agree Agree Agree Agree 27982 07/25/06 KS Agree The wealthiest nation of the world is notorious for delivering poor health care services for which it refuses to be accountable. Agree "This sounds wonderful, as long as this group doesn't become just another bureacracy one needs to dismember to really accomplish anything. To whom will this group be accountable to prevent special interest factions & possible ""witch hunts."" " Agree "* Medicaid & Medicare need complete overhauling & the policymakers (not legislators but bureaucrats) on a local level need to be held more accountable for the decisions they make. The agency which governs Medicaid in Kansas is now divided between Social Rehabilitation Services & Health Care Policy; this lack of direct program accountability is further diluted by the fact that these agencies & their policymakers are rarely available to really discuss or problem solve any issues with providers or beneficiaries. They are in constant meetings where no one takes notes & no one remembers from one week to the next whose even been in attendance, much less what was discussed or determined. THIS NEEDS TO CHANGE. The public needs to know who is making decisions that affect their healthcare at the state level, what parameters these policymakers use to make their decisions, & who, in any meeting, with any state health care policy group is accountable/responsible for refining & implementing the suggestions of the grou" Agree "* I believe in holistic approaches to health care, so this, too,sounds like a wonderful idea to me, but it is also one that may be too greatly influenced by the fear of Medicaid/Medicare fraud or ""duplication of services"" issues. For instance, I work with a KS Medicaid Program for medically fragile children from birth to 21 who are dependent on some sort of life-sustaining medical technology to enable them to live at home with their families instead of in a hospital/institutional setting. My group of Advanced Registered Nurse Practitioners or Bachelor's prepared RNs provides Case Management to this very needy population of children in our state. There are many examples in our state of how the system would lead you to believe that it is interested in holistic approaches to health care but in reality does its best to thwart those efforts. A good example of how the system fails to allow for real service integration, is that although some of our terminal clients have a need for limited Hospice services, our s" Agree Agree "I realize that with any reform, funding is a requisite but I firmly believe that enlisting the aid of private enterprise & limiting government bureaucracy, particularly at the state level, will achieve a far better & more cost-effective outcome in meeting the health care needs of our populace than relying so heavily on the bureacracies of Medicaid & Medicare themselves. " "I totally support these goals; I'm not sure how to get there, but I totally support them. One thing I'm certain of with any health care program proposed: There needs to be less emphasis on bureacracy & more on human need." 27983 07/25/06 LA Agree But there needs to be some balance - people at the end of life should not have expensive therapies that only prolong the inevitable; parents of very compromised newborns should not be allowed to keep them alive when they have no chance to survive -- need some health ethicists to address these issues. Agree The federal role should be to fund local coordinating groups -health care is local and the coordination of it should be local. Agree The volume needed for these activities is available in federally-funded programs and should be used advantageously for everyone. Agree Nursing homes should be better prepared to care for end of life rather than automatically sending patients to hospitals to have an expensive death. People need more choices and we need to change our attitudes about death being a health care failure. Agree And this can't be accomplished if we depend entirely on an employer-provided system. Agree "Employers that don't play should pay something --- OR --- we should completely eliminate the employer-sponsored health plans for something that can be applied to everyone. Sin taxes aren't the answer since, if we do what we want, we will diminish the sin and eventually eliminate the funding source. " "Need to assure that behavioral health issues are addressed as part of the basic package. Also, need to assure that children's specific needs are met." 27985 07/25/06 TX Agree Absolutely. I am disabled and it has taken everything and I do not know how I am going to pay for another surgery without going into a nursing home. Agree Agree Agree Agree Agree "* I question having Medicare/Medicaid handle this due to the difficulty they have with the prescription drug program as well as the apathetic, untrained, uninformed, unsupervised, inability to comply with the current rules, lack of organization, ""employees"" I have encountered in the past 6 years as a disabled person. It seems to me that all of that only adds up to a very ineffective and inefficient system and what is need is a professional well-trained well-informed group of medical personnel involved rather than what I have seen from Medicare/Medicaid. These are people who cannot give out a consistent answer to any question - rephrased another way, anytime one talks to someone from Medicare/Medicaid, one gets a different answer every time." 27986 07/25/06 KY Agree Everyone needs to be covered and everyone who can afford to should be enrolled in a health insurance plan. Agree Agree Disagree Too high a percentage of health care dollars are spent in the last few months of life. Access to all diagnostic and theraputic endeavors needs to be limited when it is clear that there is a high likelihood of eminent demise. Only palliative care and comfort is required in many cases. The money saved can be spent on the the underserved populations. Agree Health care must be provided by lesser trained individuals than doctors and nurses. Preventive care does work and can be delivered by educatated and trained people without advanced degrees. Agree see above. Spare the spending on the last months of life and direct it to others in the prime of life. Do not pay for non-indicated and medically proven techniques and proceedures. 27987 07/25/06 CO Disagree "I could only agree with this recommendation if all Americans receive basic or ""core"" coverage, as ""very high out-of-pocket medical costs"" is too subjective a term. " Agree We continue to need quality primary care physicians that are willing and able to practice in the rural communities to address health care needs where there is limited access to specialty health care. Agree "Prevention of illness is key to reduction of morbidity and mortality rates. This can only be achieved if prevention education becomes a priority, and includes support staff to assist patients/clients in caring out the prevention guidelines." Agree "This recommendation is key to support patients and their family members in accessing the education they need to make informed decisions regarding options available to them. This education should include realistic expectations in prognosis and assistance in care for ""end of life with diginity"". " Disagree "I disagree not with the concept, but the underlying implied principle that ""financial assitance will be available to those who need it"". Given the current cost for health inurance even middle class families where both parents are working but have no heatlh coverage through their place of employment cannot afford health insurance. More corporations are reducing the amount of financial assistance they provide towards health insurance, increasing the amount their employees pay for insuarnce. " Agree "Universal coverage does not necessarily translate into health care coverage for all if the above strategies are implemented. A ""single payer"" system such as the current Medicaid system should be available to all. Such a system would streamline billing and reimbursement for the provider. ""Fairness"" in our current taxation system is anything but ""fair"", and I am concerned that perpetuating this system would not lead to equitable health care access. " "If this recommendation truely includes ""independent"" representation and is evidenced based." "We certainly cannot continue with health care access as it currently stands. However, I do not believe that ""small fixes"" will address this major problem. A total revamping is in order." 27990 07/25/06 CT Agree "When more americans have health care insurance our medical expenses will decline because there will be fewer emergency room visits (heart attack,stroke,etc),fewer rehab visits and fewer nursing home residents." Agree "be careful about allowing pharmaceuticals and private health care providers to much influence in this area,it is full of opportunities for self interest.In general a good idea." Agree "public education of ""good"" health practices is essential for improvement of our health care system" Agree "agreed,we need to be able to have a choice about our final days.Amen" Agree "healthy,working Americans contribute to our prosperity.Sick out of work Americans who cannot go back to work because of inadequate medical care cannot help our prosperity.They need medical help for themselves and the USA." Agree "We all need to work together(public,private,government)to finance health care for all of us." "we need highly qualified,independent physicians in this area." "Our present health care system is a mess,reform and improvement is essential.The period of yes or no is gone,the only answer now is ""yes""." 27991 07/25/06 IN Agree I favor a single payer health insurance system. Agree "Preventative health care including immunizations, pap smears, mammograms, and other such efforts need to be included in these networks that allow people to access comprehensive health care near their homes." Agree We should use the bargaining power of all the federally and state funded health programs to negotiate for lower prices for prescription drugs in this country. Agree providing financial support to families for in-home and in-hospice care is critical. Agree "If we had a single payer health insurance program with benefits for all, we would be able to afford a comprehensive health care program in this country." Agree "I do not agree with this assessment of the finances. If we had a single payer system, then our taxes would increase somewhat, but we would still be paying less than most of us currently are paying in our antiquated system of private health insurance that is tied to a specific job, not to a notion of universal coverage." "What about vision care? I assume that reproductive health care in included in the ""continuium""." "* If we are to have a workforce that is competitive in the world marketplace, then we must develop a comprehensive health care (not medical care) system in this country that is accessible to everyone. This is as much an issue as our national security as is monitoring our ports and airports. We may win the War on Terror only to lose the war at home when our citizens continue to suffer from preventable diseases that put them at risk of losing their employment, their life savings, and the health care gains we have made in science. If we cannot access our own health care system, it does us little good to be at the cutting edge of new medical technologies." 27993 07/25/06 NC Agree Agree Agree Agree Agree Agree I agree with all recommendations. Don't stop or delay this work as it is one of the largest problems we face in the U.S. 27994 07/25/06 FL Disagree "Break down the statement: No one in America - Meaning illegal immigrants Impoverished by...costs - impoverished is very strong wording High out-of-pocket medical costs - define high Financial protection - sounds like insurance Low income - define low income I am not in favor of another entiltement program. Whatever system recommendations are made, personal accountability must be incorporated. " Disagree "Anytime the federal government gets involved it opens the door to partisan politcs. I know this initiative is billed as nonpartisan, but if acted upon, it will soon become a pawn for the parties to debate and point fingers. " Disagree "I do not believe Medicare, Medicaid, etc...(you can include Social Security) are effective programs. They lead to partisan politics. So, to put this program under the control of the federal government like the ones mentioned previously would be a big mistake. " Disagree Compassion yes - but a disproportioanate amount of healthcare spending is spent on people in their final days. Disagree AMERICANS - yes / Illegal Aliens - no; If a work program is developed than it should be the sponsors responsility to pay for base coverage By providing fiancial assistance we're developing classes of people. This will lead our politicians to use the group in political/class warfare. Disagree "Taxes - We have an inefficient tax system now. I don't want to make it more complicated, thus increasing the delivery cost of any federal program. IF a base healthcare system is provided, should it lower the losts for those of us currently paying our fair share into the system? I have heard/read nothing that addresses this. " Indepandant non-partisan;I don't believe it exists; Sounds like the program is trying to include everything and be an end all to everyone. It will be very expensive. "In concept it sounds like a good program. The devil is in the details and unfortunately I see no way to exclude all the special interest groups. Wellness, vision , dental, chiropractic...it will be never ending. " 27995 07/25/06 VT Agree Agree Agree Agree Agree Agree "I strongly feel that ""alternative"" treatments and modalities should be considered for coverage. They are often less expensive and as or even more effective than ""standard"" medical practices." 27997 07/25/06 KS Agree "I agree with the principle, however, I think there is a population that goes with their needs unmet due to the lack of education of providers and funding sources: Special Needs Persons." Agree Agree Agree Agree Agree 27998 07/25/06 WA Agree This recommendation is very important. Agree Agree Agree Agree This is number 1 in criteria on how I will vote in the upcoming elections! Agree Take the insurance companies out of the system and use all funds now being spent on health care for direct service of health needs. 27999 07/25/06 MO Agree It should be illegal to discount services such that uninsured patients pay more than insurance companies Agree Agree Agree Agree "Access to quaility health care should be an understood ""right"" of all Americans regardless of ability to pay." Agree Invest more in Americans and less in other countries! 28000 07/25/06 WA Agree I have a son who makes to much money for DSHS but not enough to pay for health care on his own. I fear each day that he may get sick or be in an accident. Agree No response Reduction of fraud and waste will never happen due to greedy people who run these agencies. Agree Agree AMEN!!!!!!!!! Agree Every person should have health care no matter what they income. 28002 07/25/06 KS Agree Agree Agree Agree Agree Agree 28004 07/25/06 VA Disagree My approach to federally assisted mandatory lifetime HSAs for all will enable folks to get the coverage they need. See www.his.com/robertb/hlthplan.htm No response No response No response No response No response 28005 07/25/06 NC No response "* Part of this I agree with. I work with MS patients who have very expensive drugs and when they accept Medicare, Part D, many of them have fallen into the category of the black hole where they are having to try to pay for their meds after the first initial $3000. Also, we in health care are spending all of our time trying to justify continuation of meds they have been receiving that help to manage symptoms to maintain quality of life. Many of these treatments are not FDA approved for MS, because there is not enough money into doing new studies for these and therefore not an interest in the drug company. However, there has been limited research to support the use of these drugs. No one covers the excessive time required to continue the process, sometimes as many as 4 letters to get past denial. This has to be done after hours of seeing patients. Not a good use of our time." No response Agree "See comments from first item as it includes much of this. Also, what is required for evidenced based. If only the FDA approves, is that evidenced based, I think not. If there is reasonable research to support, we have to start somewhere." No response Agree But this never works out. Just look at the new MEdicare part D!!!! No response 28007 07/25/06 UT Agree Agree Agree Agree Agree Agree 28010 07/25/06 CA Agree I believe it must be Public Agree Agree This recomendation will also have to incorporate accountability of the providers Agree Agree This seems to be athe most basic human right and the fact that America has dismal healthcare is reprehensebale Agree I believe the Lewin report RE:SB840 (Khuel) in CA is a viable option Vision should be included Quit the damn poloticking and make universal health care happen! 28011 07/25/06 KS Agree Agree Agree "Also, the federal government should encourage incentives to save precious health care dollars by allowing competitive bidding for services and medications. " Agree Agree Agree 28013 07/25/06 IL Agree "Using the premise of health care is a ""right"", I would support a national healthcare system that provides basic and ongoing care to those in need. I would not support ""non evidence based"" treatments as a part of this care.I would also add that there be guidelines regarding the ""right to live or right to die"" that are clearly outlined in ongoing care. " Agree I support these networks as long as they provide the quality and diversity of specialized care to the poor as are provided to those who can pay. Agree Agree Agree Agree 28014 07/25/06 UT Agree "but with this caveat: cost must be proportional to health status, specifically healthier people--those who eat healthy & exercise--should not be penalize rather bear the cost of healthcare for those who choose to be unhealthy." Agree stressing partnerships is crucial Agree ramp up efforts to increase use of tele-medicine in rural areas will greatly aid in improving quality of care Agree totally agree. end-of-life care must be patient's focus and culturally appropriate. Agree "again, incentive based to encourage individuals to change health behaviors--similar to current practice used by car insurance companies." Disagree no comment "similar to most government sponsored programs--the definition of a ""core"" benefit package is subject to interpretation and the change of convolution is highly likely." 28015 07/25/06 OR Agree "Coverage for all Americans should include a basic health plan, with the option for consumers to pay for additional health care services based on choice and available packages. In the basic plan, prescriptions should be covered for generics or other essential medications not available in generic form. Catastrophic coverage should be included for all income levels." Agree The federal government should require all licensed physicians and medical professionals to participate in integrated community health networks and accept all such patients. The federal govenrment must allocate additional funds to support biomedical and medical research into diseases such as CFS and other chronic diseases. Agree "Electronic medical records should be the parctioner standard for participation with federal patients. Patient information can be utilized to streamline evidence based practices, promote efficacy studies and understand and manage costs." Agree There are ethical dilemmas in defining advanced incurabe conditions and end of life and establishment of standards for pallative care. Extreme cuation should be used such standards in respect for life. At what points does medical evaluation and treatment cease? Who makes the decisions? Agree Promote fundamental reform in health care delivery by transitioning away from fee for service medicine to compensation for patient medical conditions and wellness. Vest patient participation in good health through financial incentives if they attain fitness standards and actively participate in prescribed medical treatment when ill. Agree Financing strategies should also focus on the elimination of redundant and inefficient expenses. "The independent non-partisan groups should exist at multiple levels: communities, state and federal. Evidence based science and medical effectiveness standards should rapidly consider new research discoveries into to core benefits." "Invest more in science now so that providers, patients and businesses will support these recommendations and not see them as an additional adminstrative and cost burdens to Americans. We need wise health care leaders who will identify the opportunities to actually improve health and care for all citizens!!" 28016 07/25/06 CA Agree "This is truly the only solution to this huge problem - and it must include the elimination of private insurance and create a single payer, public insurance system." Agree "I currently work at a urban, public, FQHC clinic which has been consistently underfunded throughout the Bush days." Agree "As a health educator, I can't stress enough the importance and benefit of patient education, particularily with the management of chronic illness. Most often patients are diagnosed with an illness, given an Rx for medication, and never provided education nor self-management skills." Agree Agree "Health care is considered a human right by the United Nations Declaration of Human Rights, signed by the United States. To abide by this agreement, of course our public policy should guarantee that every person have affordable and comprehensive health care. The US is the richest country in the world; spends more than any other nation per capita on health care; and is, shamefully, the only ""developed"" country in the world that does not make health care a guaranteed right!" Agree "The overall costs of a single payer system are much lower than the current system, while covering all, because of the elimination of private insurance profiteering and outrageously high, executive salaries, a major decrease in paperwork and bureaucracy, and the ability to negotiate prices based on bulk purchasing power." "It is important that we include ALL residents of the US in the proposed coverage and services, regardless of legal status. It is neither cost effective nor human to exclude anyone. Disease does not discriminate and sound public health measures include protecting the entire public." 28018 07/25/06 CO Agree Agree "While I wholeheartedly agree with this recommendation, there must be sufficient federal funding support to enable these integrated networks to adequately serve, advocate, and continue with research on the needs of these vulnerable populations. Support without dollars is misleading, lip service, and discouraging." Agree Will AHRQ or similar federal agency watchdog this recommendation? Agree "While I agree with the spirit and intent of this recommendation, I believe more spending must be allocated to the young, medically underserved, and low liteate populations. I agree that palliative, hospice, and other end-of-life care must be fundamentally restructured, but not at the cost of diminished services for the young, working, medically underserved." Agree Agree "* Healthcare costs continue to rise, as do energy costs, but the healthcare industry is not making the same relational profits that oil, gas, and energy corporations are globally. Creative thinking must include thinking outside of business sectors, non-profit sources, and increments. No singular mechanism will be ideal; no simple solution is readily available. I'm not sure the value of this point as a recommendation, rather, there must be a format for continued discussion and an auspice/cross-discipline dialogue & mechanism created to continue these debates/discussions." "A core package may entail 3 alternatives within the core package that emphasize a mix, reliance on different essential components, major and minor emphasis." 28020 07/25/06 IL Agree Financial protection for low income individuals and families should be a concern that our government solves. Agree "Integrated community health network should not be bogged down by the amount of paperwork, coordination, etc to make this work. KISS" Agree Agree Agree Affordable health care is a right for everyone. Agree 28021 07/25/06 NM Agree Disagree Disagree only because there is no actual data to support the idea that emr will improve the quality of healthcare. the best way to do that is to reimburse doctors for spending TIME wih patients Agree Agree Agree tax-based or similar to the German system i support a single payor system that is run by independent boards or groups of experts elected not appointed 28024 07/25/06 IL Agree this shouldn't limit the treatments available in order to reduce costs. Each person should have access to the most current treatment available. Disagree this sounds like a beauracratic mess and may best be developed by private sector with federal financial support. Agree the problem is triage - who gets care first if there are long waiting lists. Does this cover only life saving measures or elective measures as well. Agree care should be focused on acceptance and quality of end of life and not on sustaining hopeless cases. Agree "idealistic - how will this be paid. as in every other country, those who can pay will receive more and faster care. who determines how much care is sufficient for those who cannot pay." Agree this will only work in a government climate that is willing ot support the community at large and not the special interest groups. Insurance companies need to be on board. 28025 07/25/06 CT Agree I would prefer a public to a private program. Agree Agree I think this is important because it utilizes existing resources. Agree Agree "If only one recommendation is heard and followed, let it be this one." Agree I am willing to pay more so that others with fewer resources will have access to appropriate health care. I think the role of natural medicine ought to be investigated because it has fewer negative side effects and tends to be less expensive. "The forum I attended was well run, and I think this current means of collecting information is well done, too. Thank you for the efforts you are putting forth on behalf of all of us." 28026 07/25/06 CA Agree The United States needs universal health care... Agree The United States needs universal health care... Agree The United States needs universal health care... Agree The United States needs universal health care... Disagree This does not go far enough... The United States needs universal health care... Disagree This does not go far enough... The United States needs universal health care... This does not go far enough... The United States needs universal health care... The United States needs universal health care... 28027 07/25/06 IN Agree "I would recommend a diverse population empowered to define ""very high out-of-pocket costs"". I attended the healthcare forum in Indianapolis, Indiana, and it seemed to me that many of the participants there were focused on routine, doctor's office type of expenses, rather than catastrophic kinds of expenses. Yes, there is a place for well-baby visits, vision plans and annual physical exams, but not ahead of an emergency expense safety net." Agree "Please, please ensure a network with many choices of providers. " Agree Please do NOT require a PCP to act as gatekeeper to specialized services. Agree Agree Agree "I am completely willing to contribute financially to my own healthcare coverage, and in agreement with some of my tax monies contributing to coverage for the more financially challenged. " 28028 07/25/06 AZ Agree It seem swe will all be in a big database with what we have for income versus what our spending is and what we should be paying. I fear the red-tape and feeling of degredation that can occur. Agree Agree Agree Agree Disagree "I do not want Federal health insurance, I want Federal (universal) health care for all Americans. We should all pay taxes for this -- individuals as well as businesses and remove all health insurance costs." "I don't know how you can have ""core"" benefits as we each have different needs. I have a ""pre-existing"" condition and I would want my core benefit to be related to this condition. Others might want innoculations, tests, etc. I cannot see a core set of benefits to fit all." 28029 07/25/06 NC Agree "I believe taht all american's should be able to have some kind of Insurance, My Deductable for medicaid is over 1800 dollars ever six months. I'm a widow raising two daugthers, and it's very had to have insurance on my self.As I can't afford it." No response No response No response No response No response 28030 07/25/06 IL Agree "Our taxes should ensure health care for everyone because disease, suffering and impovrishment affect all of us. Health care should be a basic right in this country!" Agree Agree There is too much profit at the top of most managed care systems. Our general population is experiencing a decline in quality and timely quantity of health care. PEOPLE ARE DYING due to our profit motivated and production-line health care programs. Agree Our senior citizens who are not wealthy deserve to know they can count on decent care in their homes or communities. This also applies to the disabled and poor. Agree Agree "Without a nationally meaningful system, our nation will fail in it's mission to ensure our inalienable rights to life, liberty, and the pursuit of happiness." 28032 07/25/06 WA Agree "I agree, but it should definitely be public. The major problem with health care in the US is that it is private (ie: for profit)." Disagree "we need one National, government run Insurance program, not a bunch of programs. That is just expanding the current quagmire." Agree Agree Agree Agree "It should be funded with tax dollars, Corporate and personal." 28033 07/25/06 TX Agree "As long as a high level of healthcare is maintained, unlike the system in Great Britain. People who live healthy lifestyles should not have to shoulder the costs for those who do not. Those people should pay higher premiums. Preventative measures should be covered as well as alternative care." Agree We need to move away from the current drug/surgery resolutions to health problems and find safer lower cost ways to address health problems. Disagree This verbage could mean a lot of different things. The description is useless. Medicare for the people who paid into the system is disintegrating while Medicaid for those who never paid anything and who didn't even live in this country is far better. It does not make sense and should be stopped so that those who paid in are provided with the care that they paid for and were promised. Agree Agree "This should only apply to legal citizens and everyone, except the very poorest should have to pay into the system or else they lose their right to covered healthcare." Agree "Everyone should have the option of participating in this system or keeping their current Medicare or private insurance. Again, this is all very vague." "Every precaution should be taken so that this does not become a bloated system, otherwise I am totally against it." "I am very concerned about a national healthcare system. It has the potential to become a mess. I am in favor of a responsible system with responsible people participating. Otherwise, I want nothing to do with it. It is important to me to be in charge of my own healthcare and to have the freedom to pursue alternative methods. I don't trust any system to tell me what to do concerning my health. Our current healthcare model is flawed and expensive pushing drugs and surgery needlessly. It needs to be reformed." 28034 07/25/06 CO Agree Agree Physicians need to be available that will accept Medicare and Medicaid payments in every community. Agree "As a health care provider with over 30 years of experience, I have found that the greatest amount of fraud does not occur in clinical practice but DOES OCCUR IN THIRD PARTY PAYERS, eg. HMOs." Agree Agree Agree "I and my family are willing to pay more in taxes to help our less fortunate family and neighbors, but we are UNWILLING TO SUBSIDIZE HMOS AND THEIR CEOs to provide unnecessary oversight." 28035 07/25/06 FL Agree "While very high-financial-risk coverage for all Americans is a start, the largest drain on our health care budget is the for-profit, health insurance sector. With responsible government oversight in this area alone, we could reduce our national health care expenditures by 20% or more, thus freeing up resources to provide the ongoing educational, preventive and primary care services that help avert very high health care costs in most cases." Agree "* The recommendation is well stated. The methods identified by the bullets are mostly more of the same: a two-tiered system of care in which low-income people receive little attention, and those of us with financial resources pay premium-priced premiums to buy into segregated risk pools managed to ensure high returns to shareholders of insurance companies. FQHC expansion is fine but the rules of this program have, so far, led to much less development of FQHCs than needed. The last bullet is the most important (whether by federal support or other means), except that focusing on populations and localities where today's providers and insurers have little or no interest dooms it from the outset. Risk pools and integrated networks both have to span across socioeconomic boundaries or they won't serve the intended populations well." Agree "This is great, except that (a) there's more waste just in the way we underwrite our health system than there is in health services and this should be a first target and (b) under our current financing system consumer information on prices and cost-sharing is not likely to be usable in any way that will produce as much value as it does confusion." Agree "Very interesting, as I don't recall seeing this so high on the priority list of national policy before. Great recommendation. Good luck." Agree "My full support for this recommendation. A courageous national leadership that takes the time to educate the public on health system financing could achieve this. But, honestly, I don't see this being implemented in the comprehensive and meaningful ways that it is expressed here." Agree "Universal risk pool. Take for-profit insurance industry out of health care financing, replacing it with regional contracts to manage certifications, enrollments, utilization review, performance reporting, billing and payments." This would be a great step. Good luck. "Simultaneous with taking for-profit insurance industry out of the health system, permit integrated provider networks to take on ""service-risk,"" the promise to deliver specific services to enrolled or assigned populations." 28036 07/25/06 FL Agree Agree Agree Agree Agree Agree 28037 07/25/06 IA Agree It is time for America to join the rest of the civilized world and adopt national health insurance. Agree This will be needed even under national health insurance. Agree This can only be successfully accomplished under a national health insurance program. Agree Agree Health care under a national health insurance will be less costly than the current system and it will make health care available to all. Agree "Dump the employer-based financing arrangement and adopt a national health insurance program. Of course, person income taxes will go up, but corporations will be freed of the expense for health care, making them more competitive in the global economy, and their products will be less costly. In balance, the system will cost less, due also to elimination of a ton of administrative costs." It essential to a national health insurance system. "With national health insurance being the highest priority, the second highest priority is to deal with the pharmaceutical industry (preferably by making them public utilities." 28039 07/25/06 AZ Agree Financial protection for low income individuals and families should read finacial protection for all Americans. Many working middle class families are also uninsured or under insured and can lose all they have worked for with a single major medical problem. No one should be excluded from FINANCIAL PROTECTION Disagree "Although I support the concept of community health networks, there is much in this statement that can be interpreted as to increase the bureaucracy of an already overburdened health system, and will also work to segregate healthcare. " Agree "I agree with the above, however much will need funding presently not available." Agree Agree This is the same as the first recommendation stated much better. This should be the Position statement Agree There is a tremendous amount of health care dollars that are wasted because of the “system” and throwing more dollars at the problem will only add to the waste without a complete revamp of the financial system. 28040 07/25/06 IL Disagree "There are tremendous ideas that will encourgage individuals to seek best quality and even best price above insurance deductibles. The technology is here to allow these things to happen, and the market has begun to innovate. PLEASE, this ""guarantee"" to keep people 'safe' is very dangerous, and antithetical to our nations principles. I agree with low income vounchers for individuals to purchase insurance or for state risk pool premiums." Disagree "There are no incentives in low income areas because or the tiered 3rd party payer system. Medicare and Medicaid is the #1 Network, BCBS is #2, etc. The bigger the network, the greater the negotiated discount. There is a shortage of Medicaid providers because reimbursements are low. We need a system that vouchers our dollars to low income individuals to buy free market healthcare." Disagree "Doctors are not in favor of cookbook medicine. P4P leads to providers sending high risk patients downstream. ""Best Practices"" will be enforced and do not allow for innovation. Who wants to be a medical provider in this environment? YES, price and quality transparency are a wonderful idea !!!" Disagree Disagree "Yes, all American should have access. Financial assistance should be available, but DO NOT mandate coverage. The core benefits idea is a good one in theory that will lead to tremendous economic distortions and political abuse!" Disagree "* I have been in the healthcare finance business for 13 years and studied the problem extensively with an economics perspective. The greatest thing that could be done to gain your new federal revinue is to pull the plug on the employer exclusion for employee health benefits. However, I am in favor of extending the tax exclusion to individuals who purchase individual policies or are paying state risk pool premiums. It is unfair that individuals get unequal tax treatment as opposed to corporations. This, along with a modified Rep. Shadegg bill will go a long way to aleviate the uninsured problem." "Political abuse, moral hazard." 28041 07/25/06 KS Agree "* I agree only if there is a sound fiscal plan to finance it. As a semi-retired nurse of almost 50 yrs, I have seen the costs of health care skyrocket. Sometimes the reason is evident, but sometimes the cost could be much less if some old time, simple strategies were used. As a Case Manager for Special Needs children, I can say we have too many people (many with much less educational credentials than the person in the field) making decisions based on circumstances they have no idea about and can't understand when professionals have completed numerous required forms to explain those circumstances and medical conditions). Throwing more money at the problem may not be the solution." Disagree "* This sounds like more, more, more, which will cost more, more, more. We already have too many ""networks"" to deal with, each having their own staff and requirements. I say simplify, simplify, simplify. A sound eduction program for health care providers re their impact on health care costs with accountability built in (number of successes vs failures with such variables as income group, type patients--terminally ill vs chronically ill vs minor illesses vs preventive visits)controlled and factored in would increase the quality of care and decrease all these ""middle men"" in the SRS offices, who keep requiring more and more information--mainly because they don't have a clue about the situations they are making decisions about. For example, in KS the current Prog Man for the ACIL program is an LPN with a BME degree. Yet we RNs and ARNPs have to get her permission to accept a client (vs our coordinator who started our program in KS). Then she is the one who approves or disapproves the number of nsg hrs each" Agree "Only if this is not going to cost more, more, more. Get rid of the separatist agency concept, or even separatist department concept." Disagree "Again, big government is to come in to solve all of the problems. I would agree if communities could be assisted to build a locus of support with existing agencies." Agree "* I think we have this. Our local Health Dept, where I once supervised and taught nsg students as a part of a university experience, serves everyone, many who are not American citizens. However, I do think those who have not planned and paid for health care needs do not need the amenities that are not medical, but personal luxuries, such as a TV in the room and more expensive menu selections when hospitalized. I also think everyone should have to pay something, such as a dollar or $10 per visit, based on their financial situation. Something free is often not valued." Agree "As a senior citizen who is still working when almost 70 and who pays for pvt insurance in addition to Medicare, plus now a Rx plan, I would like to stop working. Yes, we do have some retirement, but with the inflation an now the higher taxation when spending those tax-deferred dollars, I would ask you how much more must I pay for those who have never contributed? I certainly do think we need to see that everyone has medical care, but only if everyone is willing to contribute to the cost of that care." "Again, let's not give away the store here." I wish you all the best in this endeavor and thank you for the opportunity to express my opinion. 28042 07/25/06 WA No response No response No response Agree Agree No response There is a financing mechanism that is optimal: single payer public financing through taxes! "I have TWO reservations on many of these recommendations: THEY DO NOT ADDRESS ELIMINATING THE PROFIT-TAKING (at 25% to 30%)OF HEALTH INSURANCE COMPANIES. (this includes marketing and lobbying as well as profit, all of which are unnecessary in a single payer system.) NOR DO THEY ADDRESS THE PROFITEERING OF DRUG COMPANIES!" 28043 07/25/06 CO Agree "I agree to a certain extent. Let's face, not everyone is willing to do what it takes to have good health. There should be basic healthcare for every US citizen; not every person in the US. People who take care of their health (no smoking, drug use, regular preventive check-ups, weight,etc) should be rewarded somehow. Some that have money can purchase more. What is new with that? What is wrong with that? That is the way it has always been." Agree Agree "I especially like the consumer-usable information. It is important the healthcare consumer knows how to ""shop"" properly and according to their desires and wishes." Agree Finally. Agree Agree "US citizens that pay taxes, only! " 28044 07/25/06 IA Disagree "If we, the taxpayers want to take on a financial load for an aspect of health care, it could be federally funding very expensive, experimental research that currently drives up the cost of health care costs." Disagree "Low, or no cost clinics could be established which would be funded federally or locally. Proof of income should be provided to obtain low or no cost services. [I believe this is currently done in many states at the ""county"" level." Disagree Financial assistance could be given in the form of grants to Medical students in exhange for them serving a period of time (2 years?) at a low or no cost clinic such as mentioned above. Disagree "The current hospice situation seems to be working very well. We must realize that if one cannot afford to pay for services ""in the invironment they choose,"" they will need to take what they can get. In a free-market society there is incentive to save for one's own end-of-life care. If, for whatever reason, the person is not able to afford the care of their choosing, then the currnet hospice system is more than adequate. (and is in fact very good end-of-life care)." Agree "All Americans should have ""access to"" care. And we currently already have that. It is important to understand that the statistics we hear about Americans ""without insurance"" is much different than the statistics of Americans without health ""care."" " Disagree "Universal coverage needs to be defined. This sounds like ""government health care"" and I am strongly against that. Our health care system needs to remain private. As I said above, if the taxpayers of this country want to participate in the health care expenses of their fellow Americans, the best use of our funds would be those at the top of the ladder that are making our health care costs excalate the highest." "The private health insurance industry is finally offering more choices on benefit packages. Moving away from ""employer"" provided plans would be a positive step in putting health care decisions back into the hands of the people who use them." "* My husband and I own a small business. 10 years ago we had a ""group health"" plan with about 10 people in the plan. One of our employees became very sick and all of our premiums went throught the roof. We discontinued our group plan and paid our employees a sum to purchase their own health care policy. We helped them research options and suggested local agents to talk to, with the final decision on plans and benefits being up to them. My family chose a high-deductible catastrophic plan. Our monthly premiun for a family of three went from $750 per month to $250 per month. This meant my deductible was over $2,000 at that time, which I will gladly pay, since I am saving $500 a month, or $6,000 a year on health insurance premiums. By paying my own health bills I saw first-hand how expenses had gone up. 10 years ago I paid $30 for an office visit at my doctor's office. Today I pay $85. My brother has ""top of the line"" health insurance coverage. I asked him what he pays for a doctor office v" 28045 07/25/06 NC Disagree Access should be provided. Coverage is not the governments responsibility nor can we pay for it. Individuals must have some ownership in their own health care which comes when they some bear responsibility for compliance and cost. Disagree This is a disease based model and we cannot effectively do this. We should use a public health model and focus on primary care availability for all citizens who want it. Disagree Tricare doesnot provide the best of care. You are putting more people between the patient and provider which is one of the main reasons things cost so much. Disagree You can't give everyone what they want without socializing medicine. See Affordable Health Care on DrAdaMFisher.org No response In concept I support this. What happens when smokers won't stop smoking or alcoholics continue to drink and consume a disproportionate share of cost. No response "Co-Pays to insure ownership, compliance initiatives to insure folks use what is given, healthy American discounts, Reinstate HCFA so you know what things really cost." Already covered on my website "Position Statement on Affordable Health Care will work, is fair, and makes care accessible and affordable." 28046 07/25/06 WA Agree Agree "Under any system there will be special populations requiring services enhanced by social service support, integrated mental health and substance abuse treatment that are best provided by agencies experienced and motivated to care for these more needy groups." Agree "While all of these recommendations are valuable, they miss the central problem that drives the inefficiences and allows for the inequities of our present system: the presence of multiple payors that serve to segregate the population into the low-risk healthy and the high-risk ill. Until we're all in the same risk pool, we can't possibly have a system that will be incentavized to prevent illness and truly cut costs." Agree Agree Agree "Financing health care should be separated from employment status. Rather, we should all be taxed in a progressive way based on income." "At the meeting I attended in Seattle, and, reportedly, at the majority of other community meetings, the overwhelming cry was for a single payor system. It is disappointing that this report fails to reflect what the majority of attendees expressed. We must get the insurance companies out of the business of health care if we can hope to insure all Americans and have a system of care that puts health outcomes before profits." 28047 07/25/06 CA Agree "There needs to be an emphasis on preventive care in addition to any covergae for major incidents. There should be a provision to increase health education to improve diet, smoking and other personal behaviour that leads to increased disease." Agree This is a function that could and should be a part of the mission for the Centers for Medicare and Medicaid Services (CMS). These folks have much of the data and a large netork that is present in most major cities in the country. Another new Federal health agency would be a huge waste of money. Agree "This all sounds very good, but I wonder if the government will mess this up by infighting and turf battles between agencies. Private health providers, pharma companies, and other suppliers will be very reluctant to cooperate on pricing. It is laughable to think thatthe government will be able to reduce waste and fraud!!" Agree "I agree as long as this aspect of care is not funded by public money alone. There is a wide variety of opiions on the life end period. Religions, cultural factors and personal preferences are variable -- one size does not fit all!!" Agree "This is the goal!! Everyone has their own opinion on what is high quality care. How will the ""core services"" be detrmined? How will services outside of the core services be paid for. This sounds like the Canadian system which Canadians really don't like very much!!" Agree Finacing strategies must take into account the impact that the cost will have on business competitiveness. Many of our corporations are loosing their edge in world markets due to high healt care costs for their workers. A study of practices in major competitor countries should reveal some good ideas and some to be avoided. I think that providing guidance on an accepted minimum standard is a great idea. There must also be alowances for physician judgement to be used in each individual case that will sometimes lead to additional care and cost. 28048 07/25/06 OR Agree Agree Agree Agree Agree Agree 28050 07/26/06 WA Agree No response Agree Agree Agree Agree 28051 07/26/06 WA Agree "It's a tragedy that so many people go through bancrupcy, especially those who in good faith have health insurance." Agree No response No response Agree This is the key. Agree "If we could get away from insurance carriers and drug companies having such a great impact on our system, perhaps it would make sense. It's awful that we have one of the most expensive systems, with some of the poorest health outcomes. I'm a great believer in a National Health Care system." 28052 07/26/06 IL Agree Agree Agree "Look at model of maternity services in the Netherlands. Midwives provide maternity care for all healthy pregnant women; women with complications are referred to OBs, the high-risk, surgical specialists. Not only does this utilize resources better, but outcomes are better when low-risk women are cared for by low-risk specialists. Also, need to look at credentialing direct entry midwives to increase numbers of care providers." Agree Agree Agree "Providing health care for all, including those citizens with special needs, should help ease the malpractice crisis. " I would like to participate in any meetings in Chicago area if they are still happening. 28053 07/26/06 WA Agree "It should be publically financed not via insurance companies, this was a strong recommendation by our group and many throughout the country. We need for you to tell Congress that a very large percent of the US citizens want single party payor universal care. " Disagree "Carving out particular groups defeats the entire process. We want universal care - the same affordable benefits package for all, members of Congress and the unknown victim in our emergency room after a severe auto accident." Agree "Of course great changes will be needed in the rendering of health care. But only when the huge sums are not going to the insurance industry can these dollars be turned to improving quality.The current system pays for piece work and favors procedures being done. This incentive must change and will with one form, one payment, one benefit package." Disagree Again the need for better end of life care more universally practiced over the US is needed. It will be best served with a single system via a publically funded clear evidence based benefit package. Agree "These recommendations have avoided the 600 lbs gorilla in the room. The public in several of meetings I have studies did not. Employer based, private insurance based systems have given us a non-system. It must be publically funded by progressive taxes on everyone." Agree "ERISA waivers will be needed for states opting for universal care on a state level. Insurance overhead is 3 times that of medicare, and that gain will be immediate. States will have the will to do this even if our congress does not." "A commission overseeing this package must, must be independant of the government. It will also need to have a branch that will regociate with various providers concerning levels of payment. " "Any process that makes tiny feel good adjustments to our current non-system is a recipe for failure.Some legislative group must gather the moral courage, and will to do the right thing, recognize we are the only major industrial country without universal care." 28054 07/26/06 OH Agree "* Except, I hope you also pass on the belief that no one should have to need money to get health care. Health care is a right that everyone is entiltled to. Some people bring up the issue of lost employment by those who now work for the HMOs. This is not even a specious issue. Many of the people now employed by the HMOs would still be needed in a ""single payer""system but at much lower salaries. So be it. How many critics say anything about people who lose their jobs because of poor management? And what about companies like Enron? It is unbelievable that so many people claim to be Christians, in this country, but still worship money. Dan Kanoza " Agree "Except, why do you continue to insist on the ""private"" sector beong involved? I strongly feel that a ""single payer"" system, without the wealthy HMOs, would not only save money, but allow 100% helthe care coverage." Agree Agree Disagree "Whw, why, why, do you continue to use the word ""affordable""? Money should never be a factor when it comes to a person's health." Disagree "Payment of the health care progrm should be made by increasing Income Tax. To allow people who are getting millions of dollars each year, to only pay just under 40% of their adjusted gross income in taxes is pathetic. During WW2 the highest tax rate was in excess of 70%. Why not bring it back? " "This implys that we will continue to pass out health care to people, with those who have money getting the best care. Still unfair and, certainly, non-Christian." "Health care should be available to all people, uniformaly. Having HMOs has not improved the health care in this country. We still have a life expectancy that is lower than all other modern Industrial countries, and a higher infant mortality rate than one finds in those Nations." 28055 07/26/06 AL Agree "In the case of self inflicted illnesses, healing processes are not always the ones that are easiest or desired, but perhaps the only ones that should be available via the government." Agree "* I would like to see an established group to coordinate healthcare welfare. However I believe that there should always be capitalistic competition between professionals in order to progress. There are a lot of children without insurance and that isn't tolerable in this nation of wealth. I would like to see checks and balances on this group and their funding. I DO NOT want to pay for abortions through my tax dollars. This is very important to me. I Am Pro-Choice. However, I am also a mother. And I DO NOT want any part of paying for someone elses choice." Agree This should go without saying. Agree "* Please respect and honor the choices of the individuals in their final days. Our bodies are merely vessels for our souls. It is important that family members are made aware of care and options for their loved ones and counciling for themselves. It is important to understand that we have to let go. That being said, I don't believe that ""funding should be made available for support services to assist individuals and families in accessing the kind of care they want for last days"" if this request is in excess of dying in the lifestyle already established by the individual prior to diagnosis." Agree Our Armed Services provide so much protection for our liberty and our freedom. So should our healthcare system. Agree "Incorporating all Americans will inevidably reflect in our tax dollars. Don't spend money on keeping old bodies alive. Spend money on keeping them comfortable for sure. But don't deny the inevidable. Childrens healthcare should come first. If your focus is on children, the money will come." Take care of your citizens and they will take care of you. "Should this ""healthcare reform"" be a flop, like social security (which in its day was a wonderful IDEA), people will further lose faith in the government. And quite frankly, I believe that this issue is lost in the beaurocracy that is the government. I think that the people would receive better treatment from churches and charities, and that an effort should be made to instigate good citizenship via charitable works." 28057 07/26/06 OR Disagree "ALL OF THESE CAN BE ACHIEVED WITH UNIVERSAL HEALTH CARE. REMEMBER THAT MICARE IS A VERY EFFICIENT PROGRAM. THERE ALSO HAS TO BE AN EMPHADIS ON PREVENTION WHICH HARDLY EXISTS IN OUR CURRENT ""SICK HEALTH CZRE SYSTEM""!" No response "WITH UNIVERSAL HEALTH CARE, THE 4TH ITEM ABOVE IS GOOD AND ESSENTIAL." Agree "SURE, ALL OF THESE CAN BE PART OF A UN IVERSAL HEALTH CARE PROGRAM." Agree SURE Agree Disagree "I LIKE THE CANADIAN SYSTEM WHICH MY RELATIVES HAVE AND LIKE VERY MUCH, EVEN THOUGH THEY WERE BORN AMERICAN AND LIVED IN THIS COUNTRY FOR SOME YEARS. " "I FEEL THIS WOULD BE VERY BUREACRATIC, AND THAT THE CANADIAN SYSTEM IS LESS BUREACRATIC. THEIR PLAN COULD BE TWEAKED FOR US, BUT I FEEL THAT PAYING TAXES BASED ON INCOME, WITH PERHAPS A VERY MINIMAL CHARGE FOR FOLK WHO ARE EXTREMELY POOR. " WE NEED TO GET RID OF THIS DREADFUL MEDICARE D DRUG PLAN WHICH IS SUCH A B OON TO THE PHARMACY INDUSTRY. 28058 07/26/06 OR Agree No response "* You need to define 'quality care"". Set standards that are measurable. Some patients do not think they receive quality care at the largest hospital in Eugene, Oregon. I think my ability to provide quality care to Home Health patients has been constantly eroded during the three years I have been in the agency. Home Health agencys actually know quite a lot about the way people really livem and their responses to health care. They would be a good ""unit"" to ""coordinate federal efforts that support the health care safety net.""" No response Agree "I think we share these goals at Sacred Heart Home Health. There are two obstacles. Medicare reimbursement and regulations, and doctors. ( who undoubtedly do not have the time or resources to participate in achieving these goals because of Medicare reimbursement levels and regulations." Agree "* But it needs to be a streamlined process, that is easily understood, and n\one that is not mired in regulation. Have you know of an American who needed medical attention while in Mexico? You go to the nearest clinic, if they are equiped to treat your problem, they do so, you leave with a very modest, few dollars, charge. If you need more you are sent to hospital, where your family is as welcome as you. So is your dog. your get good food, clean linens, baths, sunshine and rest after your surgery. You heal quickly. Your charge. a few dollars." Agree You know damn well we have the resourses to fund universal health care. We spend it on the military! War is more important the healthcare. It always has been in the USA. Are we ready to change our priorities?? How do we get all Americans involved in changing our priorities? "The Oregon Plan tried to be like this, but ran out of money. It is a shadow of it's original plan. The priorities were not changed by consensus of American voters." "I've said enough, I think." 28059 07/26/06 UT Agree "In order to acheive this lofty goal, we must get the ""cost"" of healthcare under control. " Disagree "I disapprove of any government run ""single-payor"" program. Our current system of competition is the best solution. Our problem is the cost of the care (as mentioned above). Once we reduce the cost of the care then competition will work very effectively. " Disagree "All of these federally funded programs is stepping closer to a government run system (single payor). What make any of us think that just because the government takes over one-seventh of our nations GNP that doctors, hospitals, technology advancements, Rx cost, etc etc will drop in costs? Either the cost of the care will be reduced or we must ration care as it is done in Canada." Agree "It is fact that a large majority of healthcare funding occurs during the final stages of life. At what price do we ""keep people alive""? Oft times providers of care will keep a person on life support systems until their insurance maximums have been met. Then they go to the family and say ""There is nothing else we can do"", once the money runs out. Thus, milking the healthcare dollars un-neccisarily." Agree "This recommendation says it all. How do we get ""affordable healthcare""? There are ways to reduce medical costs, thus insuring more Americans. The future vision is ""how do we reduce these medical costs""? Let's all come up with 1 idea that could help reduce current medical costs. . . " Agree "I keep referring to my underlying concern . . . the ""cost of healthcare"" My own mother had an accident 2 years ago. While in the hospital a medical error was made causing her to move into the ICU. She was on life support for approx 3 weeks. Fortunately she is in fair condition now. However, the cost of this 3 week ICU and several months of Rehab is nearly $500,000. W H Y ! ! !" "Even with a highly educated panel to derive this ""core"" benefit package, I'm afraid you still won't have a concensus from everyone on what a core benefit should consist of. I'll be curious to see what the benefit would be." "Let me quote . . . ""Health Insurance is not expensive, . . . HealthCare is expensive"" Health Insurance is only a function of the cost of the care." 28060 07/26/06 OR Agree Disagree Agree Disagree Disagree health care should cover catastrophic expenses only Agree "those who pay for their own private coverage should not be subject to federal taxation that supports public coverage, nor should those people (who ""opt out"" of the federal system) be eligible for public coverage" 28062 07/26/06 HI Agree Agree Agree Agree Agree Agree "As long as the ends justify the means and it is fairly based without bloated government waste and inefficiencies, I'm fine with the mechanism put in place to collect payment and cover cost." 28064 07/26/06 NV Agree Disagree The successful Federally Qualified Health care center model will be risked by competitive forces if privatized - hospitals will use them to draw patients rather than meet primary care needs. Agree Agree "Caveat is that public funding should not be focused on for profit care providers - it should be reserved for not for profit care providers - otherwise, the taxpayers are paying the shareholders " Agree Agree Financing of for profit health care cannot be sustained. financing should focus on Not for profit care providers and/or caps on profits in order to participate. "Trying to provide health care to a nation cannot work in a health care for profit model. health care cannot be treated as a normal market economy, and limits need to be set on profit in order for comprehensive and affordable care to be sustained. " 28066 07/26/06 NY Agree Agree Agree Agree Agree Agree "less on military, more on health care" 28067 07/26/06 OH Agree Congress should have to pay their fair share toward their own health care costs. Congress should be on Medicare when they retire. We could use the money saved from tax payers paying for Congress's health care coverage & the money saved from tax payers paying for Congress's retirement health care & use thi tax money to help make health care available for lowincome US citizens. Agree "Congress should have to work more than one term to get retirement benefits, just like the rest of the U.S. citizens." Agree Agree "* Our Medical care in the U.S. has become like the government run programs in other countries. It is difficult to find a caring physician who is covered under our health care plans, & once you find one, our privatly run insurance plans switch to a different insurance co, to save money, so these plans can continue to provide health care benefits at a cost that employers can afford. When our employers switch to a new insurance carrier, we loose the services of the doctors that we feel are providing the care that we need. We should look for a way to be able to use the services of our doctors, even when our employers switch to a new insurance carrier to save money. " Agree "I have personally had to go bankrupt because of medical expenses. This should not happen to anyone. We must find ways to reduce the cost of health care coverage, so that people will not risk their financial well being so they can get good health care. " Agree "* Again in my earlier comments Congress should have to pay their fair share toward their own health coverage, just like the rest of the employed U.S. citizens, that money could be put into a fund to assist families that are uninsured or underinsured. When our government officals retire their health benefits should go to Medicare, just like the rest of U.S. citizens. This would help to save money which can be used to help U.S. citizens who need financal assistance to provide health care for themselves & their families. " We should find a way to help our citizens who are not insured or underinsured. 28069 07/26/06 LA Agree Agree Agree Agree Agree "Though many quake when the term ""socialized medicine"" is mentioned, we are heading in that direction anyway. There should be a national health plan or service that guarantees that everyone receives at least basic care, including preventive care that will save money in the long run." Agree 28070 07/26/06 MT Agree Agree Agree Agree Agree Agree I believe a pretax payroll deduction in addition to social security should cover the basic medical costs to an individual maybe expanding on the medical flexible spending account idea perhaps. I think the whole project has opened Americans minds to the necessity of medical coverage for all and this forum hopefully will bring forth a new sense of security in our health concerns. 28071 07/26/06 IN No response No response No response No response No response No response The Indianpolis meeting voted 58% in favor of the idea that a single payer health care system was the most important step to take in health care reform. I gather that other meeting also favored the same ideas. This financing recommentdation is a watering down of what people wanted. I suspected that the final recomendations would not capture the insistance of the meetings on putting private insurers aside for a single payer system. It is unfortunate that the organizers have distorted the spirit of the meetings to please their congressional sponsors. 28072 07/26/06 PA Agree Disagree "We need less Federal Government, not more" Agree "How can someone say ""no"" to this recomendation? Clearly we all want to improve quality and efficiency of care. However, as above, I do not want to see more money spent at the Federal level, i.e., a new ""Office of Medical Care"" when it should be spent at the user level, i.e., the sick person" Agree Agree Agree "Be careful. I already see us (the citizens) paying for this up front, and when some effeciency is realized, it sounds very much like the money saved through that efficiency will not be returned to those that paid the up front costs, but instead will be used in addition to those up front revenue streams, which will lead, ultimately, to this being a permanent tax on the citizens because we all know, once Uncle Sam gets in your wallet, he doesn't like to come out." 28073 07/26/06 PA Agree "As politically challenging as this will undoubtedly prove to be, this action is essential for all of us." Agree "Although I don't fully understand how this would work, it sounds like it is needed." Agree Eliminating health care costs attributable to unnecessary overhead or fraud and abuse is a worthy goal and an important component of restraining increases in health care expenses. Agree "This sounds like a good idea, although possibly not as high a priority as some of the other recommendations." Agree This is a another concept that seems to be essential if our country is to make meaningful strides toward an economically sound system of universal health care. Agree "I believe that most Americans (including myself) would agree to paying more for health care that works(in the form of insurance and/or taxes) (including greater emphasis on preventative methods)so long as the use of these funds is limited to this purpose and doesn't find its way into other parts of federal, state or local governmental budgets. " "This will be a tough nut to crack, but is clearly necessary if we are to use the core health services approach. The members of the group making these decisions should change on a graduated basis and everyone must recognize that, over time and gradually, the components of this core are likely to change as well. " "This is a very thoughtful work product that deserves the careful attention and support of our legislators and the executive branch, as well as the wide-spread grass roots activism that will probably be required if anything along these lines is to occur." 28074 07/26/06 FL Disagree "When you speak about health care coverage for all Americans I agree. There should be no difference between the rich (or what the government says is rich) and the impoverished. It is typical of the government to make the middle-class pay, the rich can afford it and the poor are already getting it for free!!!!!!!!!!" Disagree See above comments. My spouse is 62-unemployed and I am 59-unemployed. He has a Masters Degree and I have a Bachelors degree but believe me there is age discrimination! Our health insurance is our largest expense. We were on COBRA paying over $1300. per month. We could no longer afford it and now have terrible coverage for nearly $700. per month with a $500. deductible. We have money in the bank so are not poor by government standards. Disagree See above comments. No response Disagree Again you want to give to the poor and punish the middle-class. Disagree See above comments. Until the government decides to treat all citizens equally no matter what their income is this entire plan is terrible. 28075 07/26/06 FL Disagree "While it would be ideal to provide all neees for everyone in our country, I believe it is unrealistic. We have to create a supply-demand with regards to health care and not spend enormous amounts to keep the terminally ill and all the illegals who receive excessive benefits at the expense of the hard-working American." Disagree "The government should not be in charge of a persons medical needs. Too costly, too bureaucratic and too expensive." Disagree Fix Medicare and Medicaid before trying to expand into other programs. These current programs are being abust and services are being provided to people who do not financially need them. Disagree End of life issues have traditionally been provided by families. The gov't does not need to spend much need dollars on people who are terminal. Disagree Government does not need another entitlement. Disagree People have to learn to provide for their own. This is the system we live in. Government should not provide yet another entitlement. TOO MUCH WASTE AND FRAUD IN GOV'T. KEEP HANDS OFF HEALTH CARE. 28076 07/26/06 GA Agree Agree Best Practices is a relative term. There are Best Practices that focus on saving money which sacrifice quality of care while inversly there are Best Practices that ensure quality care but have a high price tag. Agree Health education is paramount and should be broad in reach across cultures and specific to each individual. Agree Agree Agree 28078 07/26/06 CA Agree "Low quality and high costs in the health care system will never change as long as the system is set up to operate on a profit basis versus a medical evidence basis. Universal, single payer health care system is the only solution. Medicare clearly shows it can works and work well." Agree "This is a good first step towards a universal, single payer health care system." Agree For the richest nation in the world to rank 37th in overall health care quality is an abomination. The federal goverment MUST do something to deal with the low quality of care in this country. Agree This only makes sense. The health care community needs to coordinate better particularly at a time when an individual and their loved ones rely so heavily on the system to provide information and options. Agree "Health care is a human rights issue - as the federal government provides for an education system and the defense of our nation for all it's citizens so should it provide for accessible, affordable, quality health care regardless of ability to pay." Agree "There is more than enough money in the current system to allow for all American citizens to receive health care we simply need to spread the costs around in a much fairer way with a combination of employer/employee payroll taxes, like social security and Medicare, and an small increased income tax on those making $200,000 or more per year as well as a tax on unearned income. Whether or not you receive health care when you are sick should not depend on your ability to pay." "* It's important to include in this discussion the fact that the health care industry (hospital, insurance companies and pharmeceutical companies) have experienced record breaking profits over the past decade which is a huge contributing factor to the cost of health care. Removing the middle man and the administrative costs they inflict on the payer, be they a business, government agency or individual, accounts for almost 40% of every health care dollar spent meaning less money is available for actual health care - that is unconscionable when 45 million Americans are without health insurance and therefore forego care when it could save the system dollars in the long run if they got care on the front end of their illness before it becomes much more serious." 28079 07/26/06 IN Agree "* Creating a national health Insurance program is the only way to guarentee full coverage and access to all americans reguardless of financial status. The system however needs to be a public system, one which will allow for good cost-containment messures, aqffordable health care, portable coverage, comprehensive care and quality health services. We have already left our health up to the private sector, it's not working. Multi-payer systems such as the one in GGermany do cover all citizens, as well as work with in the private sector to do this. However they still have high admninistrative costs and lots of buracracy." Disagree "Strenghthaning the Nations Safty net system is important, how ever this approch does nothing to adress the rising cost of heath care, comprehensive coverage, affordability of health services or cost-containment. If the government really wants to strenghthen the safty net system than all Americans must first have affordable comprehensive health care coverage which prevents emergancy late term health conditions. The safty-net system is failing in part due to the high uninsured population." Agree "* i partially agree with this approch. Expanding the current public programs and creating integrated health care systems in an attempt to control costs I can agree with. However this dosnt address universal coverage for all americans nor does it guarentee comprehensive affordable coverage. Its not clear as to what reduction of fraud and waste in the administrative and clinical practices means. Currently Medicare operates with only 3% administrative costs, while private insurers operate with 25-30% admin costs. if federaly funded programs are expanded and used to create integrated health care networks we should get rid of the profit motive by converting the nations health system to a not for profit system. Lastly, the notion that patients can ""shop"" around for health services like thay shop around for a new coffee pot is rediculus. patients don't shop for health services they rely on highly trained and skilled doctors to guide them and help support them in their health care needs. " Agree "This is definatly important, however this should be a part of an overage health care reform approch wich guarentees affordable, comprehensive and quality health care foe all." Agree A National Health Insurance approch which the government acts as insurer is the best way to acheive this. Agree "A National Health Insurance system can provide all Americans with comprehensive Health Care coverage, control cost and guarentee quality of care without dramatically increasing current expenditures on health care. By maintaining all of the federal goverments current expenditures on health care and incorperating a payrool tax on employers and a sliding tax on employees would be more than enough to cover all americans inprove access and modernize the health care system with computers." "* I agree with this for the most part, however private insurers should not have a say in the benefits package. Any publically finaced and administered coverage sould be dictated by the public not private intrests. Once a ""core"" health coverage package is determanined private insures need to be forbidden from dupicating thoses services covered under the national health plan. This will ensure that all americans are enrolled and covered equally while shareing costs equally. I also belive that vision should be included, I wear glasses my self with out them I can not see two feet in front of my face. Proper vision is important for the health and security of society. No one wants a blind man driving." "* I belive it is clear as to what American needs to de reguarding our health system. We need a not-for-profit, single-payer system to provide universal, comprehensive, affordable, quality health coverage which is portable reguardless of employment. Our nations leaders know how to acheive this. It's not an issue of financing or will it work. Of course it works just take Canada, Finland and Austrailia for example. The problem is the private insurance companies and their lobbing eforts to block single-payer. This approch is enevitable. The insurance companies and policy makers know this. How many more will have to die, file bakruptsy, or go without needed prescriptions or health screenings befor this becomes a reality? " 28080 07/26/06 IN Agree Agree Agree Agree Agree Agree 28081 07/26/06 NH Agree Agree Agree Agree Agree Agree 28082 07/26/06 OH Agree Disagree "Too much federal involvement. I would prefer to see more local oversight, probably at the State level. I view the above proposal as an open door to create another mega-department in the federal government." Agree "While I generally agree with the concept, I would hope that these activities are controlled at the State level. I am concerned about ""electronic medical record systems."" Who has access for what? And while I am all for ""reduction of fraud and waste,"" to think that the federal government can really effect this is somewhat ridiculous, given that they have failed to do this in so many other areas. " Agree Agree Agree "Working individuals and employers SHOULD NOT have to bear the burden of increased financing. I would prefer to see a general sales tax where everyone, rich and poor alike, contribute to the cost of health care." 28084 07/26/06 MN Agree "While this is fine, we need to move upstream and address why we have an epidemic of chronic illness ... the quality of our food." Agree I'm somewhat concerned with centralized power. That can lead to control of healthcare philosophy by monied interests. We need some grass-roots local innovation that can escape some of the corporate taint. Agree "Education always sounds good, but if it's the same old mis-information from industry, it's counter productive. We need some independent science, like that from the Weston A. Price Foundation. In this country that kind of non-industry message just doesn't get much traction, so I doubt this process will really get to the heart of the matter." Agree Agree "Good luck controlling costs. One way or another, we pay big-time as long as we think reacting to illness is the way to go ... with surgery and drugs. " Agree The only real solution it to lower costs by making people more well ... that means local sources of fresh foods and fewer processed foods from big industry. We need to create tax incentives for the production of local foods from healthy farms ... not factory farms. "Hydrogenated oils, vegetable oils, the propaganda against saturated fat, margarine instead of butter, the move away from fresh milk in favor of pasteurized ... those are the types of things that are killing us and killing the economy. More statin drugs anybody? Take another pill for GERD, too. Oh, and when your liver or heart fails, we can operate! Bypass! transplant! You'll never be the same, and you'll die sooner rather than later, but all we have to do is figure out how to pay for it! " 28085 07/26/06 OH Agree "* Everyyone should have good health care - People should not lose their dental and vision coverage when they retire and need it most. People who own their own business should not have higher health care payments for their employees because they are a small company. People who work full-time and part time should receive affordable healthcare. People who find a job with benefits should not be down immediately from public assists - they should receive some assists until their have enough money to support them self and their family. People should never have the choice between health care, food and clothing." Agree Why are drug companies and companies that produce health care equipment permitted to charge such outrages prices. Agree Address the unbalance cost in health care - why do cost vary so much from a hospital base test to one done in a doctors office/clinic? Agree Families should be supported when caring for a loved one in their finial days and have their wishes support inaccordance of how a person chosse to live out their finial days. Agree Health care is a must for all Americans Agree The major point here is seamless and smooth transition. We cannt afford to have people falling through a system that is full of holes. 28086 07/26/06 FL Agree "The cost of health care must be held down. If unwarrented tests, and harmful drugs are the base of health care, nothing will improve." Agree Agree Agree Agree Agree "If we spent as much on our own population as we do in forign countries, we wouldn't need this conversation." 28087 07/26/06 AR Agree Agree Agree Agree Agree Agree 28088 07/26/06 TX Agree Agree Agree Agree Agree Agree 28090 07/26/06 TN Agree No response Agree Agree I agree.You are right on target. Agree Agree I am concered particulary in regard to small business.The cost is much too expensive and often inacsessible to ee's who have health problems. 28092 07/26/06 IA Disagree "Who is going to pay for this, and what will it cost? Why not just give every American a new Hummer to drive?" Disagree The safety net already exists - those without insurance are subsidized by the States and the Medicaid program - also the communitiy heatlh networks around the country dont need the govt sticking their noses in where it does not belong Disagree The private health insurance system is light years ahead of your recomendations - so you want to duplicate what already exists? and then charge more for it I'm sure? spare me! Disagree again you are recommending duplication of what already exists Disagree "Americans already have it - hospitals cant turn people away - if you want to make ""affordable"" health care to ""all"" then please define affordable - and - explain your rationing program and then ask for a vote on your idea!" Disagree I am paying enough today - and I am terrified by the prospects of what your proposed system would cost - but even more terrified by the long term effect on the quality of the heatlh care system your program would have. waste of time and money we have the best health care system in the world today - if you wnat to ruin it - by all means federalize it - 28093 07/26/06 MN Agree Agree Agree Agree Agree Agree 28094 07/26/06 NY Agree Agree Agree Agree Agree Agree 28095 07/26/06 TN Agree It is hard to argue that this is a worthy goal. The impossibility is the cost to provide such coverage. Those who do work and pay taxes will not support the significant tax increase this will cost. Disagree Agree As long as this effort does not cross the line of allowing people freedom of choice of medical providers. Agree Agree Everyone needs to participate in the cost as well as the access of core health care services. Agree 28096 07/26/06 MN Disagree People must have some degree of self-responsibility as regards their health care. The above recommendation sounds like a nice concept but it still must get back to self-responsibility. Government gifting of benefits will NOT work over time. Look at Social Security. Disagree The above system puts government in control of health care. Let private enterprise and competition work. Disagree "At some point in your discussion, you have to address what the cost of your program will be and who will pay those costs. We are already doing most of the activities noted above now. Where will the expanded program funding come from?" Agree Disagree People must understand that they themselves are responsible for their health care--NOT the government. Disagree Keep government out of health care if you wish to have a government which is manageable. Nationalized health care will bankrupt the United States. Allow the private system to serve the paying public. Provide a more restrictive and smaller core benefit plan for those on welfare. 28097 07/26/06 IA Disagree I think we now have a national program. If anyone needs healthcare they go to providers who treat them whethery they have insurance or not. Those of us who pay for the insurance are also paying for those people indirectly. The providers have to get paid somehow. Disagree Disagree Disagree Disagree "There are people who choose not to pay for healthcare coverage, even though it is affordable, because they choose to spend their dollars somewhere else or feel they don't need the coverage." Disagree 28098 07/26/06 AR Disagree "* I am a 62 yr old saleswoman for life insiurance, health insurance and Presc D plan. I have been in this business for 23 years and see every weeek how a person gets into deep financial trouble with health care costs. BUT they often, most often, create the problem thru irresponsibility. I am called often by women who have no health insurance for years, didnt need it, now they have breast cancer. Had their last check up six years ago, Hello, is that repsonsible. I have men who leave thier job to follow a dream and COBRA cost $700.00 a month so they didnt do the paperwork, then get sick and oh my not their fault. Before we tax US to death lets teach responsible spending. The last three examples of stupidity to call on me for a miracle, too late, had $40,000+ new vehicles, and plenty of other non-essentials, but Wouldn't pay for health insurance. I have no synpathy, I will NOT pay their way!!! " Agree "It has to be a public-private cooperation, and it MUST Include EDUCATION/prevention/information" Agree "one more time EDUCATION from birth to grave, THEY dont know and they are too proud to ask for help or explanation. Yes, tell them ONE MORE TIME." Agree "* I have watched arrogant doctors continue to medicate and treat WAY beyond the need, to keep that patient alive when in my opinion it would have been more cost effective and HUMANE to bring in Hospice earlier and let the patient and family maintain some dignity: I speak from experience with my mother, my two best friends and my 96+ yr old living mother in law. The Doctor, a trained geriatrician continued to give her b12 shots and iron shots in the behind, when she was in the hospital with congestive heart failure and pneumonia, until I said what are you trying to achieve here?? " Disagree some wont use it in an appropriate manner or appreciate your efforts Agree cost share employee and employer 28099 07/26/06 SD Agree Individual medical consumers don't have a fighting chance dealing with large medical providers. Agree My concern would be for how this will work in a rural area like where I live in South Dakota. Agree "Looks OK to me, but the cost of the beaurocracy might be prohibitive." Agree Many of the end of life programs now use trained volunteers to help meet the needs of patients and families facing end of life issues. It is a good cost effective approach to a serious need in our nation. Agree "I am convinced that people who avoid health care set themselves and others for more expensive care situations in the future. If we can make routine and preventive care accessible to all, we should save some money in the future. " Agree I concur. "I am pleased to see that mental health and dental are included. A complete plan requires coverage for these two areas, because if people neglect issues in either area, there may be more expensive claims in the future. " 28101 07/26/06 MT Agree Agree "I believe the uninsured can best be helped through utilizing already existing systems - Medicare, Medicade, VA, etc.; I'm not in favor of throwing out what is working reasonably well today unless there is a system that is undeniably going to be a better system. The Canadian model won't work in the US, if we have a nationalyzed system, where will the Canadians go?" Agree "Oversight & regulation of health care delivery capacity must be managed. The incredible expansion of delivery capacity - Ex. - new, bigger, expanded hospitals attempting to ""be all things to all people"", this needs both a statewide & a national oversight. In MT where I live new &/or improved schools are few & far between yet new & improved hospitals are an every day occurance. Premiums, in order to be controlled, we must consider the impact of the medical industrial complex." Agree "Is there data relating to health care expenditures for the terminally ill, regarding the amount of money spent & the results/outcomes of those expenditures - do the costs relate properly to the returns/results? " Agree "I believe people should be willing to manage the ""well-being"" of their health similar to what we do managing the well-being of our other assets, none nearly as valuable to us as our health. Our car insurance does not pay for: 1. oil changes; 2. tire changes; 3. new windshield wipers; 4. new head lights; etc. I believe individuals need to have some skin in the game & the process/design must require some individual investment/resposibility. " Agree "The system needs to remain employer { er } financed - if er's don't/won't provide insurance, a tax can be assessed so as to help fund the coverage of the uninsured." Please see earlier comments - Other Peoples Money { OPM } must be considered & some level of personal responsibility needs to be built into any new program. When I spend my money I spend it more thoughtfully than when I spend OPM. "* I believe a primary & important element has gone entirely unaddressed - the ""cost of care"". I live in Montana & the expansion of hospitals, new wings, new technologies, etc., etc., goes on unabated. This must be the situation accross our country. New hospital wings, new technologies, etc., must be paid for & this is done vis providing new & more services. There must be a national oversight of health care delivery capacity & it must have the ability to regulate building & expansion. The system today is illogical & excessive - all hospitals trying to be all things to all people." 28102 07/26/06 AR Agree "Every civilized society in the world already provides these basic services to their citizens. It's well past time the U.S. got with the program! Moreover, the relative term ""very high"" has to be measured by the patient's subjective standard , rather than some one-size-fits-all figure that would put the Walton family of Wal-Mart and the Walton family of ""Walton's Mountain"" the same category!" Agree "My support for this measure is qualified by my deep concerns about possible corruption inherent in any effort involving ""funding streams""! WHO will staff this network? WHO will appoint or hire this staff? Until the idea of HONEST PUBLIC SERVICE is revitalized in our society, bureacratic expansion is suspect! But I support virtually ANY plausible idea for fixing our current broken system." Agree I find it staggering that these common sense policies are not currently in place! Agree "* Laws dealing with paliative care and other end-of-life issues should be made standard at a federal level. At present, while Oregon supports assisted suicide, in other states patients die in agony because of laws restricting treatments that MIGHT ""shorten life"". A basic right to adequate paliative care is fundamental to humane end-of-life care, but animals in our country often have more protection! I respect the fact that many people cannot support assisted suicide (I have serious reservations, myself), but the salient principle should be, UNIFORMLY, that of ""double effect"". The principle of double effect (PDE) is used to justify the administration of medication to relieve intractable pain even where the medication may lead to the unintended, although foreseen, secondary effect of hastening death by causing respiratory depression. It should also be noted that a review of the medical literature reveals that the risk of respiratory depression from analgesics is more myth than fact; there is little" Agree This is so obvious that it is astounding that the idea is controversial. Agree "Re-direct our public resources (i.e., tax dollars) from weapons of mass destruction to health & education for all Americans. There is no excuse for delay. Why should it ""take time"" to transition to universal coverage? We've had fifty years to think about it." "While I generally agree with this recommendation, I would provide more flexibility to acommodate the needs of the patient. I recognize the good sense of emphasizing ""evidence-based science and expert consensus"" in health care, but the patient should be the final arbiter---while still excluding support for outright quackery, of course." "* War is the greatest threat to public health throughout the world. Nothing else wreaks so much havoc to everyone exposed to it as war. We need to confront that simple and terrible truth. Until we channel our collective will into finding solutions to international problems that do not involve institutionalized violence, then any improvements to our health care system will be difficult to finance, and ultimately somewhat moot. Why raise a healthy child and then fling him or her under the juggernaut of war? " 28103 07/26/06 IN Agree I support quality coverage for all Americans including alternatives to the uninsured having to visit the emergency room for mental health issues because they have no other options. Health cost coverage must include mental health and addictions services for all Americans. Agree I prefer oversite by the Federal Government as opposed to individual States. Agree Quality of care should include a weight management program including reduced or free health club memberships or development of programs at local community centers. Agree Agree Not sure. Some concern that those with more financial resources will eventually pay the price to support those with little resources Agree Not sure. 28104 07/26/06 MI Agree "Make sure it is private, keep the gov't out of running the program." Agree Agree Agree Agree Agree "Make sure it is run by private industry, where competition will have a role in providing the best care and best value as new innovations are developed." 28105 07/26/06 ID Disagree "* I do not believe a capitalistic economy can strive when government puts artificial restraints on any industry. A good example of this is the farming industry. A farmer cannot make a living now with out the governments farm package. The influence of govenment only continues to grow after they are involved. It is tough for americans including myself when cost go up. decisions have to be made. americans are more likely to but a new vehicle and incur additional debt than to buy the health insurance they need. In Idaho, where I live, it is estimated that 30% of our insurance costs are due to the uninsured. We say that people can't afford health insurance, but they can afford a new car or bigger house. The constitution does not guarantee a house, car or health insurance. It is not an american right to have any of these things. Choices are made. We need to make the right choice without asking everyone else to pay our bills. I say no to guarantee financial protection. " Disagree "Due to my comments to the first issue I would have to disagree with this also. The federal government has to jurisdiction under the constitution for health insurance. This is a state issue. We cannot and must not rely on the Federal government, who bogs down life, to solve our issues. If states decide to join together to accomplish this that is wonderful, but if not the federal government cannot make them under our land's law. " Disagree The federal government is terrible at efficiency. We want them to try to create greater efficiency in our system? Then have them stay away from it. Ask the veterans or medicare recipients if the government is efficient. No to this also. Disagree Once again I don't think federal government should be making these decisions. Disagree "* With a growing baby boomer population, the truth of things is that the boomers will be able to vote in anything they really want. They have had the power for many years and will continue to have the voting power as time goes on. The financial assitance given to people in this reccommendation will be on the backs of those that will carry the largest burden this nation has ever known. I belong to the generation that will pay for my parents social security payments and medicare bills and now health insurance for everyone else? Too much. our generations and society cannot and will not support that. It will bankrupt not only the nation but it's individual citizens. Is this what is meant by the government protecting life, liberty and the pursuit of happiness? Americans do not have a right to health care. It is a choice and oppotunity in America not a right. The rights are spelled out in our law. " Disagree * There are no good avenues for financing. It would have to be funded with additional tax dollars that do not exist today. That only means an increase in taxes. The federal government does not have a constitutional right to increase taxes for health care. Please find it for me. It does not exist. Do not place the burden on my bcak when I see so many making unwise financial decisions and complaining about health insurance costs yet they contribute to the problem because they choose not to purchase it. It is time to educate people not make the choices for them. People are not stupid but we treat them like they are. There is no such thing as a non-partisan group involved in health care. This whole notion of government involvement is partisian. Why are you trying to lie to us. Again people are not stupid. I do not want the government dictating to me what benefits I can choose so the plan stays in a price range. "* Why do we want to become like Canada, England or the other social medicne countries? Can we not see the problems with them. The problems out weigh the opportuinity. They are high cost low result plans. Technology is hampered by the governments ability to purchase it for everyone. Citizens in those countries purchase private policies to make up for the inefficiencies of the health care. What does that tell us? We will be paying for a plan through taxes and still wanting to buy a private policiy with the few dollars we have left over so our families will be taken care of. Doesn't sound good to me. I have clients that do this. I sell health insurance. I have clients from Canada and the UK. This is their story to me. I see no advantage to what is being proposed except a political ploy for elections. Stop the madness. " 28106 07/26/06 FL Agree No one with a chronic illness should have a lifetime cap. Agree Agree Agree Agree Agree 28107 07/26/06 IL Disagree "* All law needs to be written to accomplish National Health Care. ERISA needs to be repealed in its entirety to give all citizens the same protection under the law. Government exempt from ERISA and has been defrauded of $TRILLIONS necause of ERISA. Medicare and Medicaid need to be repealed in their entirety forever. We need to completely change the current system! The new a single payor system would require a minimum of 5% high dedictible - escalating to 100% depending on gross income -as an out of pocket expense before ""Insurance"" paid any part of the cost. No citizens reglarless of who they work for, or how old they are would be exempt from the law, and no Insurance could be legally sold to cover the deductible, and no employer could pay the deductible." Disagree Market for health care would stabalize as the consumer puts pressure on the system for reasonable cost providers. Disagree Only a consumer driven system wouls stand any chance at all in accomplishing this goal. Disagree Goal is pure fiction of any system where a bureaucrat - judge or lawyer intercedes to impose their religious and social beliefs on those they do not think are as good or smart as they. Disagree Once the high deductible is met - social policy will dictate who gets what. All government AKA law AKA social policy is about one thing and one thing only - WHO GETS THE MONEY. Disagree "Statement is simply not true. We already have ""National Health Care""- but only for the poor - the government - and the old all paid for by the consumer." If a Doctor can prescribe and its in the best interests of the patient the it should be paid - period and no exceptions. "Your group is National Disgrace. Nothing but special interests are represented. The same people protecting the ""Madical Cartel"" from being disbanded. " 28109 07/26/06 CA Agree "But , how are we going to afford this? Medicare is already setting itself up for bankruptcy." Agree I think that we will need more state coordination with this. Another enlarged federal government unit may just spend money on its fact finding and not really get the money and services out to the people that need them. Agree There are many programs out there that are under utilized because the poorer neighborhoods are not aware of the services available. Agree Agree Agree "We need to look for where there is waste in the system. However I'm afraid that the cost for universal health care will be prohibitive. We need to quit spending so much money on foreign wars and invest in ourselves and in sustainable energy , which might create some money for universal health care." 28112 07/26/06 WI Agree "This would be possible if the perfect world. Cost sharing by the insured, insurance company and providers will be necessary. I do not think that public health is the answer. " Agree It will be necessary to have private sector input to be part of an advisory group to the federal government. Disagree The concept is correct buy I do not feel that the Federal government is able to manage and monitor effectively the quality of care and efficiency. This needs to be done competively by organizations that exist because they need to keep cost of operating a business in check. This would make the best use of government funds to improve health care. Agree I have recently had my father exposed to this situation and felt that the provider did an excellent job. Since much of this is funded by donations I feel it works well. Agree "I agree that all should have access to health care that is affordable, but, The problem is that many choose not to take the health care availabe even though they could afford it. We can not make it so it is given to them without them sharing is a reasonable part of the cost." Agree "I will repeat what I said previously. The cost to finance health care needs to be shared. Insured, insurance company, health care providers and a cap of settlements that drive up health care cost." The more emphasis we can put on welness and preventive services the more effective we can be at controlling need and use of treatment. 28113 07/26/06 VA Disagree "The government has no business taking money from the citizens to pay for other peoples health costs. We do it now with Medicare, Medicaid, Social Services etc. and that is more the problem rather than the solution." Disagree We have the best health care and safety net in the world we just don't like the price tag for working citizens to provide it. So you think the answer is to create a highly efficent government agency or program that will reduce the costs. What are you guys smoking? Disagree Reduce Federal government programs! Are you telling me you have not been trying to promote quality of care and efficiency? I am sure you have been trying you just need more money right? I am not buying it! Disagree "Help me here, now I don't know how to die with dignity I need your expert consensus. It sounds like a good idea if you are an expert (free money)." Disagree All Americans do have quality health care. If people cannot pay the hospital has to take them anyway and does. Disagree Don't do it. You are bound and determined to tell me what I need and then force me to give up my property to give it to me. The good news is the overhead to do that will be efficient (or not). Thanks for the help. "After you fix the affordable healthcare problem with more government spending you might want to reuse the solutions above and use them on education. That isn't working either. Oh, I forgot you already have! My bad." 28114 07/26/06 MD Agree "There could be conditions: 1)Height/weight ratio and working on a plan to attain goals 2)If chronic illness is present, have a plan to maximize treatment" Agree Agree This one helps the first one make more sense Agree Agree Agree 28116 07/26/06 WI Agree Disagree too confusing and costly Disagree "overeaching the basics, access is key but there can't be too much government involvment. keep it practical" Agree Agree "make sure it is a fair system, open access with ability to pay, provide private competition to lower costs" Disagree "financing can be done by wringing out the current inefficiencies, there should be little or no additionla income, payroll, or excise taxes for this." "Dental should be an additional voluntary option. defining the core benfits should include patient co-pays, deductibles, health savings accounts, coinsurance, and other design alternatives so that individuals can managemtheir own lifetime of benefits & costs. Choices are the keys to success." 28117 07/26/06 PA Agree "individuals should not be purchasing catastrophic health coverage....only fine tuning their specific family coverages, dental, eyecare,etc" Agree Disagree the federal gov't should fund and regulate....they can not replace the efficiencies of private industry through bureacracy and wasteful spending Agree Agree keeping in mind our country can not do everything for everyone...there is only so much we can do Agree legislation and business incentives to expand the current HSA model is a great way to start "this needs to be a non-partisan, non-political group with no hidden agendas" 28119 07/26/06 WI Disagree What we need is localized control in each state as health care costs and needs differ from state to state. No national program has ever been cost effective. The less beauracracy the better. More dollars diredted to the health care expenses. Disagree See above. Disagree Disagree Agree Agree 28121 07/26/06 CA Agree Building on Health Savings accounts introduce a program somewhat life food stamps where low income individuals and families can purchase health insurance and fund HSAs with government provided vouchers. Disagree "I feel that this would eventually lead to large central healthcare facilities and even less coverage for rural areas. Creating a new bureaucracy will worsen, not help the problem." Disagree "Again, government control will lead to less efficiency, not more. Look at how things are in all areas where government execises control. Example, I recently was discussing smog testing with a local mechanic. He was told that he was not failing enough vehicles, and his failure rate was below what was expected. Even though the automobiles he was testing were well-maintained due to being driven by his customers he was ""encouraged"" to fail more of them. Government standards lead to foolishness like this." Agree "In this case, yes there needs to be someone who can point out that people have to die sometime and using all avenues of life extension may not be the kindest decision." Disagree "YOu cannot mandate cost of healthcare. Only the markets can control that. The only way government can provide affordable health care is by restricting access to health care. I believe that most Americans, facing such a system, will become angry and feel that they were sold a bill of goods." Disagree The proper way to finance is with health insurance provided by many companies. Governments role should be in enforcing fairness in market conduct. Low income should recieve some form of subsidy to purchase health insurance. One thing about having many companies providing is that if a mistake is made by a company it will on harm some of the people. If a mistake is made in a government program it will harm all of the people. People should be allowed to decide for themselves what is of value to them and what they are willing to do without. "I have seen universal health care plans in action. Please do not bring such an immoral, unfeeling and heartless system to the United States." 28122 07/26/06 NC Agree "I believe that private rather than public programs should be created. Employers are often burdened with the cost, but our govenment is created to encourage free enterprise rather than government control. Private companies can be overseen by the government, not controled by it." Agree Agree Work on the prevention of fraud and we can save millions. Agree Most americans want to be at home at the end of their lives and more provisions and help can be given through LTC policies that enable the family to keep the family member at home. Above the line deductions for premiums for LTC and family leave financial support would encourage the family members to do as the elderly wishes. Agree Thsoe who are able to work should not be penalized financially in order to provide this care. Agree * Our country is over run with our youth and young addults addicted to some sort of drug or prescriptions. Perhaps we can give family support so a family can have a healthy parent in the home rather than having that parent need to work out of the home. More emphasis should be on giving addicted persons the time and facilities in order to create a new life without the dependency on their addiction. Health insurnace pays too little and for too short a period of time for the addict to change their lives. Preventative care is very important and should be encouraged and paid for by helath insurance. 28123 07/26/06 NV Agree this should be done with private programs Disagree Agree great idea Agree in my community this is being done already. The families I know that have had to face this problem have been very satisfied with end of life situations Agree Great idea but how do we do this. I dont think amerians are ready for national health especially baby boomers. Agree "Hosiptals charge high prices for bed pans, kleenex, towels, etc. Why cant the patient bring these items with them. It will save a lot of money for all. Raising taxes for national health care will not work. The government is having problems ruuning what they have now. " 28124 07/26/06 WI Agree Agree Agree Agree Agree must require 100% participation Agree 28125 07/26/06 NC Agree "* I am an insurance agent for BCBS of NC and I agree that something more needs to be done to help the uninsured and small business owners to offer affordable coverage. Revamping the HSA was a step in the right direction, but more needs to be done and it needs to be offered in such a way that everybody can understand it. Too often people fail to act out of confusion or frustration or too many choices. ""What's the right choice?"" As an insurance agent it is my job to explain a persons options to them and make recommendations if possible. Often I do not have that chance. In my opinion, something is better than nothing when it comes to health insurance. One very important guideline of the program needs to insure the the wealthy and insurable ""CANNOT"" take advantage of ""free"" health insurance thru loop holes or hiding assests such as what is happening with the medicaid system. Our Government has a very large problem to deal with in the not to distant future on Medicaid qualifications alone. " Agree I agree as long as more is done to prevent abuse of the system. I see and hear about too many situations of abuse. Agree I agree as long as more is done to prevent abuse of the system. I see and hear about too many situations of abuse. Agree After losing several family members to cancer and strokes I have seen the importance of these programs. Much of the funding comes from donations from loved ones after a person has passed on. There should be more funding options available. Agree Amen! Agree The United States could learn much from other Nations that have taken a leap to a Universal Healthcare system and have been sucessful or for some reason failed. Lessons can be learned from both. Rx and Dental services are a welcomed service to be added. These are two undervalued service areas. Only that I think thier should be involvement from Private insurance companies to ensure efficiency and an adequate distribution system to serve the public as well as a checks and balance system to prevent scams and abuse. Our Governments already has enough to deal with concerning budget. 28127 07/26/06 AR Agree "Basic health care should be available to all. Surgical and medical conditions that are very costly, but that impact the quantity (duration) of life and the quality of life should be available when medically indicated." Disagree I would rather see this on a state by state government basis. I worry that federal guidelines would make it more difficult to establish a health center meeting all the requirements. This is the case of the federal government offering to provide malpractice coverage insurance coverage through HIPPA. It is so convoluted and restrictive that it is just out of the reach of the small clinic. Agree "Very good ideas, but almost a contradiction of terms: ""federal government"" and ""fraud and waste reduction"". It seems too often that government programs foster fraud and waste rather than reduce them. For example, the problems with civilian contracts in Iraq and the problems with FEMA in ""helping"" Katrina victims." Agree I think the concept is laudable - but the funding source? Agree "We must be willing to shoulder the tremendous tax burden that this provision would encompass. I would like to hear some cost estimates and some cost constraints built into such a program. Many government health systems have proven that this is a huge, no, ** HUGE ** undertaking." Agree I strongly doubt that efficiency in health care service can be a reality. Excesses in Medicare are astronomical - I was actually advised by a home health care nurse (who worked for a medical supplier) that I should get new CPAP equipment just because enough time had elapsed that Medicare would approve it - not because I really needed the equipment replaced. "WOW !! A very lofty-sounding set of ideal, best case conditions. Good luck getting this to fly." "I appreciate the work this group is doing. There is a definite gap between available health care and the patients without insurance or finances. I worry about the known excesses and beaurocracy associated with government programs, but that may be the only avenue open to us. The tremendous cost of these programs will make it hard to sell. Yes, everyone agrees that health care available to all is a good idea. How many have agreed that they are willing to pay for it?" 28129 07/26/06 CA Agree "I agree only if the national health care plan were only a public one, preferably through a single payer, ie Medicare. I in no way, shape or form trust that a private entity could administer such a plan in a fair and compassionate way. " Agree "Again, concerned with the concept of allowing private commercial interests to administer or co-ordinate any health care delivery system. The lessons learned and fallout from HMO nightmares still abound... " Agree Agree "Palliative and end-of-life care are essential health care priorities, especially as this country's life-expectency increases. Also, please place an emphasis on pain management specifically, as this over-looked health issue is something that often negatively impacts life-quality. " Agree Agree "The conversion from a private to public health care system will save billions in administration costs. Yes, we all need to contribute to the system-- as we are now through various taxes. The 40-50 million un-insured in this country, their health care is already being paid for by various tax-payer supported programs. A universal health care plan will cost no more than what we are already paying for as society today for health care in it's current private/public manifestation. " "* Please, let's put an emphasis on preventing and managing disease and disorders from an evidence-based medical approach-- not a business approach that rewards rationing and cost-containment. And let's establish a mind-set that we are all owners in this new universal health care delivery system. We are all responsible for its funding, it's management and it's effectiveness. That being said, we all need to be responsible for our life-style choices that may negatively impact the effeciency and utilization of the plan (ie, cigarette smoking)-- and find ways to reward positive health choices. " 28130 07/26/06 OH Agree This sounds good. A safety net that puts a cap on health care expenses. Who will set the cap? Will it be needs based or the same cap for all? Agree "Again this sounds good but, is this going to become another massive department of the federal government that burns public dollars and creates a bigger problem than we had to begin with? Will this really create a better health care system? I doubt it." Agree "Again this sounds like a good idea but, this is not a function of the federal government. " Agree "It all comes down to money, who is going to foot the bill for this utopian health care system?" Agree "Has the role of government expanded to the point that it controls what we think? Not yet, but we are on the road to total socialism if we continue to allow more and more of our everyday decisions to be made by ""the government"". Too many people have the attitude that they have no responsibility for their own lives, if problems occur there is always someone else to blame. When will this stop? Big Brother is watching..." No response 28132 07/26/06 MN Disagree "health insurance already does this, but you have to own it before you need it. this falls under the area of individual responsibility. states have or should have health insurance available for low income earners at a modest cost = not free and there should be co-pays based on their ability to pay so the systems are not abused. " Disagree "the federal government should not be in the health care business. health programs need to be driven down to the states or counties so they are more manageable. we have way too many examples of federal programs that dont work now, we dont need another one. " Disagree "these programs already exist. lets make them work, not start new one's that don't work. one area that makes some sense in this recommendation is standardizing medical information to cut down on the paperwork. " Disagree "health insurance already does this. medicare goes over the top now for hospice care, they can't do enough for those in need." Disagree it's called health insurance and is available now for everyone in America. Disagree let the health insurance companies sell their products and financing will not be a problem. many of health insurance companies make a handsome profit so they are doing something right. you left out eye care! "* the root problem of our health system today is unhealthy people. get the people to eat right, exercise and health care costs will decrease as we live healthier lives, punish them if they don't. as a recognizable (i'm 56 and spent my lifetime living healthy and excercising) health consious person i resent haveing to pay for other peoples poor choices. get rid of cigaretts, don't fine the manufacturer for making a product that will kill millions of people, put them out of business. make physical education class required for all kids each day so they develop good exercise habits at an early age and keep reinforcing them. " 28133 07/26/06 NJ Disagree under a national program costs will sky rocket even more so than currently; the buracracy and the the expansion of coverage to people who don't contribute either money or labor will result in excessive tax increases without any controls Disagree "I disagree with any controls at the federal level; there are too many examples of mismanagement (medicare, social secutity, medicare d). however I would be in favor of bullet 4 above." Disagree why try and do everything all at once? Why not try to improve slowly to achieve proven results rather than disrupt the entire system all at once. Start by turning Medicare D over to medicare rather than to PBM's with no incentive to control costs. Medicare would create much more negotiating leverage than many individual organizations. Agree "I think I can agree with this if you are saying too much $ is spent unneccessarily for end of life illness, and there should be sensible solutions from the public and private sectors to reduce the suffering and expense." Agree "you are talking about a national single payor system that doesn't work well in other countries. I have family in Canada and their plan is in great disrepair as well.The private sector is much better equipped currently to provide health care . Admittedly there is room for much improvement.Again, there are opportunities for both sectors to work together to improve our system but to have the goverment take control is a reciepe for disaster." Agree "everyone must pay so a value added tax or national sales tax would seem most fair, but it won't work if there are not changes to the system and controls on fraud and malpractice claims and excessive admin costs." 28134 07/26/06 PA Disagree No response Disagree Agree Agree Agree 28135 07/26/06 NY Agree I believe that the program should be private with public only for those that are truly low income and not those that move assets to qualify for public care Disagree This seems once again to do nothing more but paying for oversight when dollars can be used for care Agree Agree Disagree "Once you put in ""regardless of financial resources"" there will be those that take advantage by not providing themselves with available insurance and then taking advantage of an open system of care. Purchase of health insurance should be required for all except those that truly are unable to afford it. Requiring healthy people to contribute will provide the dollars needed to care for all" Disagree The money should come from insurance premiums paid by all through a requirement that everyone purchase a policy of insurance to protect as much of their assets they deem appropriate - after that their assets should be used to pay any further bills. This of course would not apply to the truly low income population. A wiver of premium could be incorporated in these plan while a person was undergoing major care. How many more groups are we going to pay to study these issues? 28136 07/26/06 CA Agree THIS HITS THE MIDDLE CLASS AND ELDERLY Agree POSSIBLE THIS WILL KEEP OUR EMERGENCY ROOMS MANAGABLE FOR TRUE EMERGENCIES AND NOT OVERBURDENED Agree FIX THE FRAUD AND KEEP DOCTORS AND HOSPITALS HONEST AND MAYBE THE SYSTEM CAN WORK Agree WE SHOULDN'T KEEP AN INCURIBLE ELDERLY PERSON ON LIFE SUPPORT WHEN ALL HOPE OF A CURE IS GONE AND WHEN THE QUALITY OF LIFE IS NO LONGER PRESENT Agree BY ALL MEANS - WE ARE AN INDUSTRIAL LEADER IN THE WORLD! KEEP THE INSURANCE LOBBIES OUT OF IT! Agree "YES, THIS IS A MONUMENTAL PROJECT AND REQUIARES TIME TO WORK" FRAUD AND THE HIGH COSTS OF MALPRACTICE INSURANCE IS KILLING THE SYSTEM. IT TAKES TO LONG FOR A PROVIDER TO GET PAID IN THE CURRENT SYSTEM AND DEDICATED PROVIDERS BECOME DISCOURAGED TO PRACTICE. 28137 07/26/06 LA Agree "I agree. As a health insurance agent that has worked in the employee benefit market since 1978, I can tell you that employers are willing to offer catastrophic coverage. However the employees are demanding first dollar coverage with low copays. The general public needs to be educated and informed to encourage a transition to this type of approach to health care financing. " Agree This should provide the means for low income individuals to seek primary care at a minimal cost. Agree Agree Agree "I agree but lets make sure it does not become an entitlemnt program. Those working and those unable to work as result of disability, should benefit first before those just living of the welfare system but have the ability to support themselves." Agree The businesses should not be taxed additionally if they participate to a certain level in providing the catastrophic coverage to their employees. Only those that refuse to participate should incur a tax. The responsible businesses that provide coverage now will continue to provide additional gap coverage to their employees in the form of fringe benefiits. 28138 07/26/06 CA Agree "No one should have to worry about taking hteir children to the doctor, because they do not have the money. Senior Citizens should not go without food, so they can purchase their perscriptions." Agree Agree As long as patients do not have to jump through hoops in order to see the appropriate provider for their needs. Agree Agree Agree 28139 07/26/06 IN Agree Agree Agree Agree Agree This is an absolute! Agree "A feasable, acceptable model already exists--simply look at the model utilized by most industrilaized nations: Canada, Germany, etc. If we eliminate the current insurance company model, with its huge executive pay-outs, extraordinary shareholder profits, etc.--and create a new system using the Medicare model for efficient beauracracy and lower overhead, the plan could work." It is unconsciounable that a country with the wealth and resources of the USA has 50 million people NOT covered by health insurance. Lawmakers who fail to act soon on this pressing issue should be summarily voted out of office. 28141 07/26/06 OR Agree Americans does NOT include illegal immigrants. Reasonable basic healthcare is required...optional and electives should not be supported carte blanche. Agree Once again...illegal immigrants not coverred...legal certainly should be for at least minimal requirements. I am PARTICULARLY concerned about underserved rural populations. Agree Agree Agree Once again.....NOT illegal immigrants. Care to be provided for citizens and legal alien residents. Agree 28142 07/26/06 FL Agree "* Being on a low income, I have to struggle each month to just pay the copays on the meds I have to take to live. I have to choose, like a lot of other Americans whether to get my meds or buy food. In this the greatest country in the world it is a blot on our integrity that we have people who have worked and payed taxes who are unable to afford the basics of healthcare and the fear that in any one month they could be homeless due to healthcare costs. We should be the leader in the fight right here at home to take care of Americans before anyone else." Agree "By working together to improve healthcare assistance and the infrastructure that is needed to make it work, we should be able to provide quality care to those who most need it. Fearing that we will be destitute has keep many people from seeking the healthcare they need and countless deaths have occurred. A family of 4 without healthcare could lose the head of household because of the necessity to work to survive and letting little problems fester into deadly problems." Agree * Fraud and waste in the administration is the largest cost we have for healthcare in this country. Example: I was billed through Medicare for a prosthetic arm by a company in Miami. If I hadn't checked the paperwork it would have been charged to my Medicare account and I know sometime down the road would have caused me more problems. I reported this error and it was corrected but how many people just throw their reports in a drawer and don't know what is being charged to their accounts. Hospital bills for in patient care can show many charges for items which are never received. Correcting these problems and double checking charges for such minor things such as bandaids or aspirin could lower the cost by millions of dollars. Agree "I have no family to take care of me and I want to know when I can't take care of myself, what are my options and when will they come into effect." Agree This should be of the highest priority..... Agree Healthcare should not be based on how much cash you have. It should be based on the needs of the patient. "I would also like to see eyecare included in these programs. I am diabetic and although the Medicare system does cover the exam, I can not afford to pay for the eyeglasses I need after the exam. Even going to a training facitlity it would cost me $350.00 just for my lens. I face going blind for lack of funds to purchase new glasses." "I feel if we were taking care of ""Americans"" for health services instead of all others who come onto our shores we might be able to get an affordable, efficient system set up." 28145 07/26/06 VA No response No response No response No response Agree Agree 28147 07/26/06 NV Disagree "Establish guidelines that empower the Employer-Based system that is working for 80% of Americans to work for 100% of Employers. Noone wants mandates, however, there should be a choice between paying into a fund for those that don't offer a base level of catastrophic or obtaining a base level of coverage for al ee's. Subsidy's should be available and could be generated with creative thought." Disagree "All of these things should be done by the state, county, and city. " Disagree Agree Agree This should be accomplished at the state and community level Disagree This should be done at the state level 28149 07/26/06 FL Agree Disagree "who is going to fund this... the hard working but underpaid midclass worker? if taxes are increased to cover thise, you might as well put them into the group" Agree Agree Agree Agree 28151 07/26/06 FL Agree Agree Agree Agree Agree Agree 28152 07/26/06 MO Agree "I am the Medical Director of a Federally Qualified Health Center (FQHC)and I have experienced this system of care for many years. It is my belief, that this is one of the major steps toward providing health care for all." Agree Agree Agree Agree Agree 28153 07/26/06 CA Disagree "* We already have a system in place that should be bettered and have a plan to make it easier to help those that do not qualify for health care. Making it a whole plan would not work in this democratic country. People who work and already pay taxes to provide towards these programs, and more than likely have a health plan, will only end up paying more taxes to cover the mess that the government got us into with a total health care package. There would still be discrimination for the poor as to what services they can recieve. THE PROBLEM IS THE PROGRAM WE HAVE NOW!!! Make that more efficient and better serve the people!!!!" Agree Working on the programs and expanding what we have I feel is the immediate answer. Get the house cleaned and then maybe the American people at some point might want to consider a total health plan. Not the way it is now. Agree Agree Agree Disagree So those that work will be paying for everyone. Don't agree Too many variables. Everyone is an individual and the package deal should be open. Perhaps evidence-based science and expert consensus doesn't help a certain individual? This an huge undertaking and should be only presented with the utmost TRUTH AND CAUTION as to what a plan (any plan) means to ALL AMERICANS. Working and non-working. 28154 07/26/06 GA Agree Agree Agree Agree Agree Agree 28155 07/26/06 NV Disagree "I agree with the goal, but not the method. A national program could leave us overspent and worse than we presently are. " Disagree "Again, the solution, i.e. involvement of the federal government to the extent called for to my mind is a formula for a disaster. The Federal role should be relegated to creating strong incentives for privates and states to remedy the problem. " Disagree Agree Agree Agree 28156 07/26/06 AR Disagree "* I, as usual, agree and disagree. I agree all should have good health care. However, I disagree that we should get everything free. It's already bad enough that most states are broke from Medicaid costs. To put it plain.... we can't afford everything for everybody. No, I'm not rich.. but poor. Yes, I'd love to have everything paid, but I know my kids and their kids will have to pay for it. Another thing, look at Canada, England etc. plans..... very, very bad. Anything the government has anything to do with will have graft and waste... Medicare... FEMA. etc. are examples.. Just a thought...." Disagree Same as above... Disagree Same as above.. Disagree Same as above.. Disagree Same as above.. Disagree The US is broke now.... Same as above.. We can't afford to pay for full care for everyone.... 28157 07/26/06 IA Disagree "Health care costs are influenced by individual situations, many of which are influenced by personal, individual lifestyle choices resulting in medical needs--obesity, smoking, sedentary life, alcohol, malnutrition. There are existing private, state and federal programs that provide financing for the medical needs of all people. No new programs are necessary as described in this recommendation. What IS needed is more education and personal accountability." Disagree A disproportionate amount of money is directed to those areas that don't assume more accountability for their financial impact on the needs of all. Disparate market factors unduly influence the proportionate payments to providers in those markets--meaning high-cost urban markets get a higher ratio of per-person disbursements than lower-cost markets. A prime example is the Medicare reimbursement payment factor given to health care providers in Iowa. Disagree "I would not point to the VA, Medicare or Medicaid as programs of which to model new programs--they are very inefficient and cumbersome systems fraught with layers of expensive bureaucracy." Disagree "I agree with the premise and importance of palliative and hospice care very much. There are existing private and public programs that meet these needs much more efficiently. Programs already depend on government support, which is inadequate, and are forced to find alternate sources of funding. Another layer of government is not going to help." Agree This is status quo. Disagree "* I agree that financing will need to be creative, but feel the present system will work. Two major factors in the upward-spiraling health care costs are benefit plans that don't reveal the true cost services (copays for doctors and Rx) and lifestyle choices that lead to the most expensive chronic conditions. I believe the point of service utilization of providers would change radically if people knew the real cost to their insurance plan for doctor visits, ER visits and drug costs. Consumer Directed Health Care creates the right mix of catastrophic coverage with this service-for-a-price awareness that leads to a more enlightened consumer that will make wiser choices on how they live and the place and frequency with which they seek medical services." "This is already available through medical providers, insurance companies, insurance brokers, employer groups, legislative processes, websites and mainstream media." "* Medical malpractice is a major issue affecting providers. Capping judgments is not the answer because some very high expenses and fines are warranted with egregious conduct. Perhaps a layering of review by a board of peers would help, or a combination of civil and criminal review that incorporates judicial finding of degrees of fault that would lead to further possible charges/litigation. The process DOES need to be streamlined because a bonafide victim is severly pinched during the agonizingly slow procedural posturing. A court martial doesn't have this issue. What could be replicated from that process to this application?" 28158 07/26/06 CA Disagree "Currently everyone has access to health care, hospitals do not turn anyone away, private system should stay in place, with all people required to pay in some way, one of the major reasons premiums are as high is due to cost shifting." Disagree "I believe in the concept but do not believe the government should be involved, when the government is involved things are not done as well as the private system handles" Disagree Agree Agree Agree "Current system of people able to pay premiums should stay in place, for individuals of poverty, sin taxes and other surcharges." 28159 07/26/06 NY Agree Disagree Disagree Disagree Agree Disagree 28160 07/26/06 NV Agree Agree Disagree Disagree Agree Agree 28161 07/26/06 OR Agree "Look at the model provided by the Oregon Health Plan, as originally enacted in the State but never fully implemented." Agree Agree Agree Agree "Again, review the mechanisms enacted in the original Oregon Health Plan for a model that accomplishes your policy recommendations." Agree "As a senior health care financial executive for over twenty years, I have been intimately involved with the costs of the current system and the methods of compensation. It is probably overly optimistic to believe that 'improvements' to the current public and private payer systems will begin to resolve the problems. It may be time to look at a single payer system that takes significant cost out of marketing products and administering competing and duplicative systems." "Again, the Oregon Health Plan is still the best model approved to date that deals with the establishment of clinically effective core benefits." 28162 07/26/06 NC Agree "I strongly agree with the need to have finanical protection against health care costs. Americans should NOT have to go bankrupt due to a health care crisis!!! I am a single parent; if I get ill and can't work, my health benefits cease and I can't pay my health care bills, much less my mortgage." Agree Access is more than the ability to been seen in a clinic/MD office; it also involves transportation-an issue even in urban areas. Agree Agree Agree "I strongly agree with this value statement, but until Congress and the AMA and the Insurance industry all agree that Quality Healthcare is a RIGHT of all Americans, in the same manner as public educaton, this policy will not move forward." Agree A model whereby all tax-paying Americans have access to a basic level of health promotion/disease care with the ability to purchase add'l private health insurance is one option. See the American Nurses Association Plan!!! See the American Nurses Association Plan!!!! 28164 07/26/06 CO Agree It's necessary - let's do it! Agree Makes good sense to me. Agree Let's use everything we know works. Agree It's a terribly sensitive time and issue and should be handled in the most sensitive manner possible. Agree It's about time to guarantee access to those who need it. Agree It's a complicated process but doable. This seems a no-brainer to me - why would anyone oppose it? Keep up the dialogue and all we've started and let's see it through to its fruition! 28165 07/26/06 FL Agree Agree Agree Agree Agree Agree 28166 07/26/06 FL Agree Agree Agree Agree Disagree "I don't feel it should be a law like our automobile insurance. I feel this way because there are several reasons why people don't have insurance, including my family. Unemployment is part of the problem. High medical coverage is another. If it were a law, that would not change our reason for not having it now. We are unable to financially afford it - period." Disagree "* I don't think it is right for people to say that people with ""bad health habits"" like smoking should pay higher insurance rates. I worked with people who did not smoke, but they went to ""happy hour"" and drank alot. Would their habits be included for higher rates - probably not. I think smokers are being discriminated against. Everyone has a bad habit. Whether it be eating sweets, etc. Why are you only punishing people who admit they have a bad habit? What about those who have one and are hiding it from the public. If you do add taxes based on bad habits, who is going to monitor this? How are we going to include the bad health habits behind closed doors or the ones being committed by people who are not upfront and honest about their bad health habits? Why should they be excluded from paying higher rates? I guarantee you, if they don't smoke, they probably drink. And I know smokers who do drink as well, but they admit to it. I'm talking about the drinkers who don't admit to it. There would be no ""fairness" I think Americans need to decide what benefits they need and what they don't need. Our legislature is already backed up from people suing other people over the stupidest things that I can't even see us going there to make it a law. "* I think the laws of workers comp also need to be changed. My husband was injured more than once on the job. He was supposed to have life time medical benefits through workers comp. He has yet to be treated for compression fractures on his back that cause him daily unbearable pain. Back when we had excellent health coverage through my employer, I was told by his physician that it was against the law to use private health insurance and they could get penalized for it - so he was never treated for it. I was told we needed workers comp approval if he was to get treatment. We tried to get approval but were denied even an office visit. As tax paying Americans, I feel the system is failing in more ways than one. If you have private insurance, you should be able to get treatment regardless of if it happened at work. What difference does it make? We are the ones paying for it anyway." 28167 07/26/06 CO No response No response No response No response No response No response I want homebirth nationally legal and recognized as a safe alternative to the immense expense and over use of interventive hospital birth. Let's look at the countries where midwives deliver the majority of babies - better medical outcomes and at a much lower price. Why is this not a priority?!!!!!!! 28168 07/26/06 IL Agree All Americans should have some form of health care. Agree Agree Agree Agree Agree 28169 07/26/06 VA Disagree I am concerned that as inefficient as the government seems to be on other matters that there would be real problems getting a national program up and running and getting everyone enrolled. If such a plan was to come about I feel strongly that the private sector should administer the program. It has been proven by other programs that the private sector can handle it more efficiently and with less cost. Agree Agree This sounds like a great idea. But I have my reservations that they can reduce fraud and waste considering how much of this goes on now in medicaid and medicare. With a even bigger system it is going to make it even more difficult to monitor fraud and waste and it will be on a much larger scale. Agree Disagree I think people will interpret this as an entitlement and health care should not be entitlement. Then we have the whole issue of who is eligible for financial assistance. I see no incentive to work hard and help yourself and not depend on the government to pay for your health care. Agree This whole system seems to be to help those who have no health care now. What about the millions of Americans that have been paying for health insurance and medical cost for years with money from their own pockets. I can't see where this is going to help them in any way. 28170 07/26/06 IA Agree "Even if the deductible for everyone (family) is $10,000 and the public must decide if they want to buy insurance downward to have smaller deductibles, co-insurance, and co-pays to ""insure"" against these smaller claims. Bottom line is that if I have a catastrophic illness/accident I'm only responsible for $10,000 max. Most of us can dig ourselves out of a $10,000 hole but more than that may significantly change my life." Agree Agree Agree Agree Agree 28172 07/26/06 CA Disagree "* Our Health System is strained to the limit, and Metropolitan areas are seeing a shrinking of hospitals and servicing centers. The cause is strickly economic and is spinning out of control. As hospital costs increase, medical insurance premiums increans, and the number of uninsured increase. Medical insurance is simply the pooling of a large group of individuals resources for the future payment of medical claims. When that pool shrink in size, more money must be collect from the insured to keep it solvent through increased premiums. Thus, more people drop off the insured roll and premiums have to increase. Also, the report does not mention anything about the responsibility of individuals to protect themselves. Essentially, 100% of the burden to fix the system is being placed upon the government, employers, and insurance companies. Since when is it the responsibility of the government to medically treat all individuals especially those capable of taking care of themselves. Here in California, we hav" Disagree Hard to believe the Federal Government could be a leader in anything Agree Agree Agree Disagree Is this freedom of choice? 28173 07/26/06 CO Agree "I believe we need a basic public program that covers basic health care needs and is funded by taxpayers and available at no cost to all Americans. I would also consider an option to pay for additional, extra coverage through private insurers or providers. " Agree Disagree "* I disagree, because I believe we need to replace these existing programs with a nation-wide public health care network. I.e. I believe we need public hospitals and health care providers, funded and maintained by the government, rather than e.g. medicare-directed subsidies of private providers. The current practice of setting payback amounts by medicare, etc. simply ensures that (a) private entities refuse to accept medicare patients, and/or (b) the cost of services for non-medicare patients increases to ensure the overall profit goal is reached." Agree Agree "I agree with the principle that all Americans should have access to basic health care. However, rather than providing affordable health care, I believe basic health care should be provided to all at no direct cost." Agree "If money that is currently wasted on individual and group insurance plans and the overhead/profiteering associated with these costs were instead diverted to funding a public universal health care network, I believe the overall cost to taxpayers would be less than the current system." "I appreciate the solicitation of input from citizens, and in fact believe this is the ideal means to address these issues. I would like to maintain transparency and the solicitation of input throughout the design and implementation of programs developed to address these recommendations." 28174 07/26/06 IL Disagree Do NOT include everyone in America. Do include all U.S. citizens. Disagree Should be paid for and regulated at the state level. States differ greatly on the value placed on health and safety. Disagree The Federal programs cited do not represent best practices. Disagree "Death and dying is not, and should not, be controlled by government regulation." Disagree "Regulated by individual states, for citizens of that state, and for U.S. citizens only." Agree No new taxes. Cuts in government spending must be first. "Recommendations are fine, but the decisions should be made at the state level. The Federal government should not dictate to the states." 28175 07/26/06 CA Agree It is long overdue for the US to create a single payer health care system that is financed like our Medicare system. There should be no person who does not have full access to health care. Agree Agree The continuing and rising costs of health care are caused as a result of the lack of costing contraol and quality standards. this need to be corrected. Agree Agree See above Agree See above All Americans should have equal access to health care. 28176 07/26/06 AZ Agree We need a private system that has built in incentives for the consumer to make their own decisions based on their individual needs. Get rid of third party payors and use a consumer based approach like HSA's that allow each individual to purchase coverage for their situation and economic position. Disagree "This is exactly what we do not need, another government agency clogging up the system. The only way to fix the problem is through individual responsibility and education. If you keep trying to help everybody they will continue to be dependent on government and become more complacent." Disagree "Show me one example of how the government has ever improved quality and efficiency? Controlling costs, are you kidding? Have you seen our deficit situation lately? Bad idea. " Disagree "Make these services available through the private insurance policies. Everyone of these recommendations refers to funding, where is all of this ""funding"" coming from. Or are we not supposed to ask these questions?" Disagree "* I am a broker that sells individual and group health policies and I can tell you that 80% of the people that contact me that are uninsured have chosen that for themselves because they don't want to take the responsibility to protect themselves not because they can't afford it. We need to provide tax incentives for people to purchase their own insurance and the majority of them will do it. The proof is in the statistics generated since the HSA was introduced. These are plans that most can afford and purchase if educated on how they work. Why don't you provide my business with some of this ""funding"" so that I can expand our ability to get the word out on consumer driven healthcare? I can assure you this will have better results than if we continue to throw money at a broken system (i.e. our public school system)." Disagree "* Everything I am reading will make the situation more complicated than it already is. It's real simple, provide a safety net for those that cannot provide for themselves (not won't provide for themselves, can't provide for themselves) and then expand the use of consumer directed plans that can be individually owned so they are portable and cannot be taken away. Problem solved. The marketplace will solve the other problems such as; benefits that people want, fair compensation for healthcare providers and access to services. " See all my other comments. This approach is unsustainable (see Canada) and unnecessary. 28177 07/26/06 CA Agree I believe that all American citizens should have affordable health care. Agree "As there is already a federal agency that addresses healthcare issues, there is no need to create another layer of bureaucracy. Medicare could be the initial model." Agree "Revoking the licenses of those practicioners that do not meet standards should be a permanent application of the 'punishment.' Electronic record keeping is in place, utilized what exists and expand from there. Keep the program support in the USA- DO NOT send these jobs overseas. " Agree "No government agency, federal or state, should interfere with the private right to choose to terminate one'ds own life or the life of one thst has appointed a healthcare trustee." Agree "A super or sur-tax could be imposed on those companies that elect to ship their manufacturing, services (or support centers) overseas; American businesses, manufacturing and products and service support should remain in the USA." Agree Nationalize non-Native American gambling and use the resources after operations costs to fund healthcare for all American citizens... Impose sur-tax on all profits that exceed an increase of 10% per year; impose a sur-tax on all excessive CEO salaries and retirement 'packages' ($1 million or more per year). NO ONE from the health insurance industry should be allowed to be a member of this oversight group- medical providers and private citizens should make up the membership. 28178 07/26/06 MS Disagree "Health care is a priviledge, not a right. I resent having to pay for those who choose to live in an inappropriate manner. Americans today want to shield themselves from their own lack of responsibility and have others pay for their mistakes." Disagree It is just another layer of inefficient government. Agree Disagree More government bureaucracy. Disagree It will raise our taxes to intolerable levels. Disagree "* This is typical liberal bull shit. When you say that most Americans are willing to make the additional financial investments to guarantee access to healthcare, belies the truth. Most Americans don't have a clue as to how much it will cost them, so they cannot possibly make an informed decision. Even if they knew, they wouldn't understand the ramifications of what they were being informed. The only way that healthcare can be financed for all Americans is with enormous increases in cost. The only other option is to ration healthcare and most Americans would be repulsed with that idea." Just another inefficient government mechanism designed to further burden the system. "* The biggest problem with healthcare in America is that the system has been deliberately destroyed by the Democratic Party and the American Left. Most of those advocating universal access are either seriously misinformed, incredibally naive, or damnable liars. The simple fact of the matter is that we are victims of our own excesses, we want to bear no personal responsibility. As one who is in a position to know both sides of the issue, I have seen enough to become sickened by the whole situation. The fact of the matter is that there is no way to guarantee universal health care access without bankrupting the country. We have the finest healthcare in the world. On a scale of 1 to 10, with 10 being the best, we are a 10 currently. The rest of the world does well to maintain a 3. Having healthcare capabilities this good does not come without a cost. You either bankrupt the country or ration care. Every other socialized system has come to the same result. Usually they do two things: ration care and s" 28180 07/26/06 WA Agree The cost of healthcare prevents many people from getting the care that they need. Consequently people get their care too late to prevent serious consequences. Agree These programs are underfunded and need more resources to accomplish their mission. Agree Agree Agree Agree Medicare reimbursement should be at an equal level to our insurance. Presently it is not cost effective for private providers to serve this population. Consequesntly many medicare patients get less care than those who have private insurance. This is backwards. Our seniors should be recieving the best care available. 28181 07/26/06 NV Agree the devil is in the details. Agree Disagree "Unless you are going to mandate this to all payers, it makes no impact on the majority of privately insured Americans. Why can't this recommendation also target private insurers? " Agree Disagree "This paves the way for a Massachusetts type of financing scheme wherby Americans will be required to have insurance and remove the burden off of others. For example, the Mass law requires employers to provide benefits to their employees, or pay $300 per employee per year to the state for coverage. Do the math, if you are a large employer, would you rather pay for health insurance for your employee (avg. 200-300 per month) or pay a single fee to the government and no longer cover the employee? " Disagree "This sound a lot like incrementalism in achieving universal access taking great care not to mention any overhauls needed in the existing payment schemes. If this is a recommendation towards a goal for all Americans, then the way it is stated indicates maintenence of the status quo." "These types of recommendations need to try to come up with some form of goal date. I don't know why access to the information about the ""high cost"" services aren't already available to decision makers through CMS and the Governmnet Accounting Office. Simply using Medicare data should be able to identify where the high costs of health care are located. The ratio of cost is not likely to differ across health services when examined by insurance payer type. This recommendation only delays the overall goal. " "On the surface, the recommendations sound good. But are they a lot of meat without the teeth? Any time I read about creating study committees to further examine the problems I become cynical about the process. Health care has been studied to death. Tax credits are offered to employers and individuals with little impact on reducing uninsured (last count, 45 million and rising, or approximately 15% of all Americans. The recommendations also seem to take great care as to not address specifics. " 28182 07/26/06 CA Agree We need to have this in America Agree Agree Agree Agree Agree "We need to move foward on these issues, Americans need access to health care which is affordable" 28183 07/26/06 TN Disagree "* I am opposed to to the recommendation because I am against the goverment making decisions for people which takes away the ""freedom"" which allows the individual the choice. I believe that everone should have access to health care which would be possible with some minor revisions to state laws. The state could require that there be no individual underwriting for groups of two lives and above. By doing this all insurance companies would be on a level field and would only get there share of the higher risk employees. This would also provide more competition and lower costs for the small employer. This would reduce the uninsurable population that COBRA and medicaid could handle." Disagree "I do not agree with the federal government involvement other than grants, interest free loans, and other incentives. Otherwise once federal funding ends the program wil end." Disagree Before the FG started telling anyone else about fraud and waste I would suggest that the FG look within. We need a smaller FG not Larger FG. Disagree I want less not more government Disagree Yes I believe that everyone should have access to health care but it should be the choice of the individual. Disagree No more Government funding!!!!!!!!!! Create the legal framework and establish the incentives and let the private sector do it! "I do not think that there is such an animal as bi-partisan, independent or fair when someone other than myself is making a decision for myself. The FG has all it can do taking care of the programs it is responsible for now. They should be increasing benefits for the VA instead of reducing them!" "Ther are steps that can be taken to provide better access to healthcare. However, putting the FG in charge of healthcare is like putting my children in charge of my checking account." 28184 07/26/06 MT Agree Agree "Everyone should be included in the package, even when your working seems like you can never get ahead of yours bill." Agree Disagree Disagree Agree 28185 07/26/06 MI Disagree We need basic coverage for ALL Americans which includes preventitive health care services. Agree There is a tremendous amount of WASTE in Health Care because services are not integrated and coordinated. Doing things in a timely coordinated manner could save sufficient funds to pay for the coverage we need for all Americans. Agree Integrated care and electronic medical records would go a long way toward improving care and reducing cost. Also Evidence Based services need to be expected. The Washtenaw Community Health Organization is proving this to be true. Agree There is waste again because patients and families and not given good information and their decisions are not followed. Too many health care professionals want to do more to extend life. Financially it is in their best interest to do so. Agree YES Agree "There is large waste in the administration of health care. Billing for example. I now get a bill from the provider, Medicare, and my insurance co. How much costs does this add to one visit. US has one of the highest Admin Cost in the world. We can do better!" "Coverage must inlcude mental health, substance abuse, and dental. Failure to cover these services will only add to over all costs." 28186 07/26/06 CO Agree Agree Agree Agree Agree Agree 28187 07/26/06 ND Disagree What would be the incentive for a person to purchase health insurance if coverage is guaranteed. I like programs sponsered by the states that guarantee coverage to people that are declined for health coverage on there own. Disagree "I believe that Cities, Counties and States are allready doing plenty to help vulnerable people with healthcare. I work in Minnesota and North Dakota primarily and they have special programs for people who fall through the cracks and also comprehensive health plans for otherwise uninsurable people. I wouldn't object to expanding medicaid to a larger population and have it on a sliding scale based on income. " Agree "I mostly agree with these recomendation, however I believe our health care quality is already very good it could be much more efficient. I truely believe that Tort reform could do alot to improve the efficiency and lower costs." Agree I did notice loccally that when medicare began paying for hospice care the number of employees increased dramaticly Disagree High quality health care is very expensive and does require some sacrafice financially to afford it. It doesn't seem fair that someone who has adjusted there lifestyle to afford health insurance and are trying to live a healthy lifestyle should get the same care as someone who has nerver paid for a premium and lives a unhealthy lifestyle. It seems there should be some type of reward for people who are paying high premiums and living healthy or why even try? Agree "Again I agree there should be more efficiencies and fairness. If I told my client who is paying $1,200 per month for there share of there group health insurance plan that the government is deleloping a plan that will help uninsureds and add quality and fairness to the health care system, but it will cost him an additional $200 per month in taxes, I doubt there would be much support. Sin tax and tort reform would be good financing sources." 28189 07/26/06 TN Agree Agree Agree Agree Agree Agree 28190 07/26/06 UT Agree "We need a public system to provide a minimum, humane plan as part of a multi tier system. Those who can afford it should be able to purchase more insurance. A private solution is not an answer as the private insurance companies are part of the problem. there shouldn't be any more denial of coverage due to preexisting conditions. The public system needs to have real power and shielding from corporate influences." Agree "advisory group should be composed of a broad range of members-including regular citizens, doctors and nurses It should have a regular rotation too" Agree Agree Agree Agree "everyone has to be in the pool for fairness-to keep the costs as low as possible, the young and healthy-they will be using the system sometime-so like social security they need to pay into it withdraw the tax exemption from payroll benefits, personal assets should be considered, there could be varying levels of co-pays for different care" 28191 07/26/06 NH Agree Agree it should cover everyone Agree Agree Agree Agree Make healthcare the same for everyone and that includes elected officials as well. The current 'money talks' system is unfair and biased 28193 07/26/06 CT Disagree I have seen socialized medicine in action in Austria and Canada and I do NOT WANT to see it in the USA! Disagree I repeat! I have seen socialized medicine in action in Austria and Canada and I do NOT WANT to see it in the USA! It would lower the quality of care we receive and be a dis-incentive to potential young up and coming doctors. Disagree "TriCare, Medicaid, Medicare and Community Health Centers and especially the VA often have poor reputations re: the quality of care one receives. It is not good business to get the Government involved in our health care. We need less regulation for this nation to prosper as it is fully capable of doing, not more regulation!" Disagree "We already have available ""do not resuscitate"" provisions in place. We need less laws and regulations, get us Tort Reform and then we will be making progress. As it is doctors are afraid to help someone injured on the side of the road for fear of law suits. You are barking up the wrong tree. " Disagree "Many healthy people do not want to bother with healthcare until they get ill and then they want ""affordable"" coverage when they did not bother to put money into the insurance pool. You are way off track in your thinking." Disagree "We should consider personal responsibility and use the ""shared responsibility"" programs already in place. It is called health insurance for individuals, small groups and large groups!" You are so out of touch with reality. Please do not do this to our country. You have the best of intentions I am sure but you do not really understand how the system works and what the consequences of your choices will do to this nation. Mercy! "PERSONAL RESPONSIBILITY, PERSONAL CHOICES, FREEDOM TO SAY NO THANKS, I WILL CHANCE IT AND THEN BEAR THE BURDEN OF MY DECISION." 28194 07/26/06 KS Agree Effort should be made to keep this process in the private sector Agree Agree Agree Agree We nned to work toward this goal. It is an ambitious goal. Agree A portion of the financing will need to come from efficiencies produced through improvements in the process 28195 07/26/06 IL Agree We are not free if in order to cover health care costs we can't afford to live.Being impoverished by health care costs is not abiding byn our constitution. Agree There are many talented health care providers who are willing to serve uninsured and low income people. Expanding federal health care programs will establish coverage for all Americans. Agree Investing in the health of a population will make the population more productive in the long run. Agree Respect for each American includes available health care during our most vulernable time. Agree I agree with the above message. Agree "The system should include incentives to maintain health.Americans who take care of themselves maintain proper weight, exercise and don't smoke should have incentives like lower taxes.This might motivate people to "" practice preventative medicine""." "Health is a wholistic approach to wellness. There is evidence to support the ""core"" health services are neccessary for maintaining health." 28199 07/26/06 NJ Agree Agree Agree No response Agree Agree 28200 07/26/06 NY Disagree "Where as everyone would agree that no one should be ""impoverished by health care costs"", ignoring the real issues will continue the escalting premiums and ever increasing employee cost sharing. Until we as a people curb our thirst for longevity and expectation of a perfect medical delivery system any change will be like trying to catch a rocket with cathers mit." Disagree "Hello, networks do not provide ""quality healthcare"" never did never will. They provide cheap healthcare, cheap price and cheap service, generally." Agree Good intermediate step Agree Anything that can be done to help the good people who provide a most difficult service would be good Disagree "Again, we need to lok at the problem and stop repairing an ailing system" Disagree Boo "* Network based healthcare system segregate the medical profession, the new and less popular providers join every network as well do the very large provider groups. The remaining population and the very best providers stay out. To get the best care for all people we need to go back to the Fee for Service approach where all providers are on a level playing field and competition controls price, just as it does in almost every other business sector of our economy. To make this work however the bases of our expectations as people has to change first. We need serious caps on healthcare litigation at the same time not expecting doctors to be perfect. We also need to stop expecting medicine and science to keep us alive for ever. The projected course we are on is to eventually become partially or totally mechanical beings." 28201 07/26/06 NM Agree "It is sad that many people file for bankruptcy because of their medical bills. It is important that by ""Americans"" we mean people who live in America, not just ""citizens.""" Agree "This advisory group needs to include ""consumers,"" not just individuals affiliated with an organization. These ""consumers"" should include those who use the publicly funded health care system and those have been uninsured in the past." Agree "Focusing on prevention is important. Also, this education should also include behavioral health issues. " Agree Agree "Again, Americans should include those that are not citizens." Agree "* Some of this fairness should include decreased profit in the health care industry. Providers shouldn't be forced to stop providing needed services because of profit (such as behavioral health.) Also, the health care industry should not make decisions on what research they will do or specialties they will focus on based on profit. I am not comfortable giving more money to a system that involves such waste in administration. I would be willing to pay more if the health care companies were MUCH more efficient in billing and other administrative costs. " The dental part of this is very important. Dental health is greatly undercovered by insurance but extremely important to total health. 28202 07/26/06 TX Agree "I think that it should be a combination of both public and private funds. We should have a National Pool that pays claims over $250,000, and the private sector should provide insurance for all working adults." Agree "Again we need all working adults to be covered by the private sector with a stop loss set at $250,000 when the government steps in and starts paying the bills. All workers should have coverage through their employers." Disagree This will not work Agree Agree Agree Financing should be provided to those that have taken care of themselves. If they are drug users of obese they should have to pay more for there care. 28203 07/26/06 MS Agree Agree Agree Agree Agree Agree 28204 07/26/06 CA Agree "It does not go far enough. We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." Disagree "We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." Agree "We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." Agree Agree "We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." Agree "We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." "We need a system that provides quality care for all Americans. This can be accomplished by a Single Payer System paid for by MediCare and other already existing governmental programs, with some contribution by those employers who already have health care benefits, and to assess large corporation who have not provide it on a fair and equitable basis." Single Payer System!!!!!!!!!!!!!!!!!!!!!!!! 28205 07/26/06 PA Agree "With reservations. We must find a way to monitor true low income need and encourage more responsible insurance usage, ie emergency room over use, more dialogue with providers for alternative care, a more responsive FDA policy regarding medications and alternatives, etc." Agree Again with reservations. Health care providers need to have a voice in all these activities as they are the ones on the front line and understand the ramifications of proposed changes. Agree Good ideas Agree More proactive involvement with care providers in other countries to look at how they are dealing with these issues Agree "Again with reservations. I have seen many people with the resources consciously choose to go without purchase of insurance coverage, contributing to the adverse selection inherent in providing care for those most in immediate need." Agree Attention needs to be paid to the insurers themselves and the use of their profits for expanded health care vs. community involvement along non-healthcare lines. With proper implementation and attention to truly catastrophic needs vs. funding ofmaintenance of good health beyond education initiatives. 28206 07/26/06 CA Agree I believe it should read Americans and those documented workers who are living and working here legally. I also believe the funds used for programs that provide medical to people who are not in this country legally can be redirected to help pay for those that are here legally. Agree Agree The drug companies have to be reigned in. They may not charge as much for their product if they weren't spending so much promoting it on television. Agree "I strongly agree with this recommendation, especially about having choices honored." Agree I don't care if you are the President of the United States or a homeless person...we all deserve the SAME high-quality care. No one human being deserves more than any other. Agree "Again, I think many program dollars can be redirected to help finance this lofty goal. Use funds from programs that currently make it attractive for people to come here illegally." "Does vision fall within physical? If not, then like dental, it should also be addressed." Thank you for taking on this huge task. I only want to add that it is my personal belief that costs have increased like they have over the last decade because (like with energy companies) those greedy folks at the top know people will pay through the nose...we may hate it and we may complain...but we will always pay. 28207 07/26/06 NY Agree "* It's time that both citizens and the federal government acknowledge that we already have national health insurance -- albeit in multiple forms: Medicare, Medicaid, Tri-Care, FEHB, etc. The best of these programs should be developed into a single, low admininstrative cost plan with a standarized scale of co-pays, premiums, and/or deductibles. And the plan should also cover long-term/chronic care. Let's drive out the unnecessary cost -- private insurance company bureaucracies and profits -- and pay for quality health care, including developing new models of care and new treatments." No response "If there is universal access to health care coverage, there is no need for this initiative. And if there isn't universal access, the fact is that ALL Americans need and deserve integrated, patient-centered, case-managed networks of health care regardless of income status. Frankly, in many areas, the only advantage that wealthier persons have is that they can afford to waste more money on fragnented care. " Agree "* I get worried whenever cost and quality are discussed in the same sentence because the emphasis is usually on the former, not the latter. Re consumer-usable information -- this is somewhat of a misdirected pipe dream because when a person is most in need (for example, when a spouse is injured in a car accident or has a heart attack), there is no time to search for the best trauma hospital or cardiac surgeon. And when there isn't a specific health need, there is no sense seeking education. Consequently, the focus should be on ensuring equal access to a quality health system for ALL Americans whenever or whatever the need." Agree We have to turn the current model of form following finance on its head and reimburse services of value. Agree Don't forget home- and community-based and long-term care. Agree "Get rid of the wasteful, multiple, and duplicative private health insurance bureaucracies to free up funds to provide services. Pay for health care delivery, not denials." "* We don't need to keep studying and cogitating on this -- there is already sufficient evidence of what works. Therefore, the core set of services should include those preventive, primary, acute, and continuing care services that have proved their value in terms of lives saved, institutionalization averted, quality and/or length of life improved, etc. Why do the bullets under the recommendation that ""the set of core health services will go across the continuum of care throughout the lifespan"" focus only on acute and primary care?????" "This was a tremendous project and process. Kudos to the forward-thinkers who proposed, developed, and implemented it. Now let's roll. " 28208 07/26/06 WV Agree "what is the definition of ""very high""? How would it be regionalized? a % of the poverty line?" Agree "I'm ok with the points, but how much will this cost, and who is expected to fund it? Business? Taxpayers?" Disagree "the government expanding their programs, i.e. Medicare and Medicaid will only add to the waste, fraud and incompetence." Disagree "in our area hospice is BOOMING and they are doing their own expanding and marketing and communicating, to Nursing Homes, senior centers and churches. what funding?" Disagree "I only disagree in that IT IS ALREADY THERE!!!!!! The health care system, at least in WV, is taking care of anyone and everyone that will darken the door. there are so many programs and policies available that people wont choose any, because they want to have ""it all""" Agree "who were the ""most people"" willing to ""invest""? Were they taxpaters, or takers? Were they Gov't employees, or Business owners?" "depends on what you call ""core""" 28210 07/26/06 TX Disagree "Medicare and Medicaid do not work why implement a national program, the thing to do is restrict insurance carriers proift. this is ignored by congress and the general public, the average profit by health carriers is 42%" Disagree you have the contracts in place with medicare. Agree AS long as insurance brokers are continually involved. Agree Agree "As long as brokers are involved, we are cheap labor. There is product to serve the poor right now in the system. the issue is controlling the carriers profit. Federal does not get that issue. We have controlled cost for the OCC the last three (3)years because we understand profit margins, risk management and experience modifiers that insurance carriers use to determine premium." Agree "the tools to manage health care are in place. The solution is within understanding the entire system. 1 hour on a phone with me will help you understand the tools are in place, controlling the system is the issue. Interested?" "I would like to be involved on this committee to define benefits for Americans not currently insured. 37 years of employee benefit administration, design, implementation, etc. gives me a voice in finding an amicable solution" 28211 07/26/06 KS Disagree "* Each individual has the right to be responsible for themselves and their family's. No intity should be allowed to determine the type, amount, location, degree, of health care provided. Self determination, means self responsibility. If your intent is to provide a Federal charitable health plan, providing for those individuals that are unable or unwilling to provide a program for themselves, then present it as such, and ask the citizins of this country if they are willing to pay for that plan. It should be voted on by those that it will effect. Currently, it appears that those in office are not informed as to what we the people really believe needs to take place. " Disagree "* The focus of your recommendation is the identification of and development of plans to correct a precived problem with our health care system. False premise, equal false conculsions. Therefore total waste of assets. The current system evolved from ecconomics, federal and state legislation. You don't have to do a survey to understand what you have already done. If you truely do not know what you have done in the past, no amount of surveying will be of any benefit. Doctors and other medical personel, as well as equipment, and management personel, go where the money is. Make it profitable for those individual to go where you want them, and you have solved your precived problem. The cost will be born by those recieving the bennefit. " Disagree "You will have to show me this one. The only thing that goverment can expand and accelerate is it's use of resources. Thereby making them no longer available to anyone. Humane nature is to take advantage where ever possible. When you put a hungry man at the gate of the chicken coup as a guard, you will see your chicken population decrease in direct propotion to your guards appietite. " Agree "This information should not only be made available to the public, but you will also need to inform the public where this information can be found. Make a centeral repository for this information, such as a library. " Agree This sounds like a tax increase. Although I personally would like this to happen I think only God could make it work. Agree "You can eat an elephant, but only one bite at a time. Over a really long time." "This might provide usefull information on what is needed. If additional information is needed. But as to how the desparity is to be overcome, in all probability will not come from this type of gathering." 28212 07/26/06 OR Agree "Since the change of the bankrupcy laws, this is a logical step to protect most Americans from destitution." Disagree "Our state, Oregon, is prepared to do all of this. Our counties provide the safety net. Rather than duplicating our work, give us the money." Agree All important Disagree "This is duplicative of existing Oregon programs, passed twice by the voters, to enhance end-of-life care." Agree "Yes! We should make this ""quality of life"" issue central to our plans." No response The medicare system has low overhead so we should work a program to extend medicare to all. 28213 07/26/06 CT Agree Disagree I would agree with this recommendation as long as the Federally Qualified Health Center concept retains its hallmark regulation that all FQHCs be governed by a Board that is more than 50% users of the services. Agree Agree Agree Agree 28214 07/26/06 SD Agree "This will be fine as long as we don't have those who make themselves poor in order to get ""free"" health care and those of us that pay the tab have to pay for them also, more than our fair share." Disagree The govt has been involved in BIA health care and it has not done a decent job of taking care of this group of people and yet has put a lot of resources into the program. I am concerned about pass history. Agree It is back to funding again and past history has been to put funding from these programs when the going gets tought. A good idea. Agree Agree The problem is that people make life choices that are not in their best interest and we pay the price for them. Agree Partners in the process should be not be there for monetary benefit. This a tough one as we live in an era of entitlement requardless of our life style and contribution to society. 28215 07/26/06 CT Agree Agree Agree Agree Agree Agree 28216 07/26/06 OR Disagree Government should not place itself in the position of promising to provide coverage. The better alternative is incentives and disincentives to those who do not. Disagree "Free enterprize needs nurished, not additional government. Mandated governmental intrusion dismantles free enterprise solutions." Agree "Increased transperancy of cost and quality allows for consumer competition. I am NOT in favor of regulatory attempts at efficiency, a concept contradictory unto itself." Disagree "Free Enterprise dictates end result of type of coverage provided, not regulation. I do agree that government should support and facilitate healthier living, such as remove junk food from schools, and mandate physical activity and education on healty lifestyles." Disagree "First problem is with ""affordable"". Who shall define this? How can ""affordable"" be defined to meet various different populations needs? If public policy is decided to guarentee all American's have ""affordable"" coverage, we're back with the responsibility to provide such. WE CAN'T AFFORD TO, NOR CAN GOVERNMENT EFFICIENTLY PROVIDE THIS!!!" Agree "Financing should NOT come from general fund, nor taxation. A reduction in the cost of health-care by implimenting competition, by privatizing Federal Programs, by intsalling incentives for having insurance, and disinsentives for not can voluntarily fund those needing assistance and will fuel competition, not stifle it." I agree that a definition defining what health plans must provide in order to satisfy a minimum core benefit is needed. "Stop thinking regulation, mandates, taxation. Start thinking incentives, disincentives, ""Pay or play"" models, inhancements to the free enterprise system, transparencies to cost and quality issues with providers, tort reform and such. Governmental programs are highly inefficient and destroy free enterprise, the most efficient model. Free enterprise allows choice and encourages creativity. Regulation stifles creativity and limits choice." 28217 07/26/06 CA Agree "in a country as rich as ours, no one should be without health care" Disagree i have no confidence in the current administration of the federal government's ability to provide this vehicle on health insurance. This type of health care program should be made available to all Americans if administered with the people in mind. Agree "i could agree with this under any other presidential administration than the one we currently have. NO HSAs, that is a disgraceful suggestion." Agree These services should be part of any new health care/medical programs being developed and not be funded separately Agree well stated Agree "Refer to the Lewin Report for an appropriate funding mechanism. This study was done in California to support the health care initiative that makes the most sense written by Senator Kuehl. this report provides for a h/w contribution from the employer and employee at each paycheck. with the amount of money we currently spend, this plan will provide quality care at an affordable cost." "If such a group could be found, this would be acceptable" 28218 07/26/06 ID Disagree "All Americans can buy Health Care right now. By stopping the large law suits and working together on insurance we could lower the costs. We should not have a socialized medicine nation. It is time to stop the drain on tax payers dollars and start taking care of ourselves. It they choose not to protect themselves, then let the churches help them." Disagree "the more you allow the Government to take over, the worse plans are going to be. Stop this nonsence and let the private sector work and stop giving out our tax dollars and let the Churches take over." Disagree "Again, leave Tricare for the Military. They earned it. Keep Medicare for people over age 65 , they earned it. Use Medicaid for the truly poor and allow the churches to work with the ones who need to learn how to work and take care of themselves. Education would be a great advantage if people were taught on how to live and pay their own bills." Agree Disagree We have affordable health care now and people choose to have the government pay all the bills. People should have a choice and live with their decisions. Disagree "on Financing , this should be left to each state and to work with the insurance companies. It should not be a welfare situation. " This sounds like Socializm and I vote for a free America with a good free system. Let private industry sell health insurance and the government stay out of the business. All the government has done is create a needy society. Go live in China if you want socialized medicine. 28219 07/26/06 FL Disagree Agree Agree Agree Disagree Agree I believe our current infrastructure can be revised to support financing for all citizens healthcare with out substantially changing existing funding. Cost controls and more efficient delivery can improve the healthcare system. Many citizens choose not to buy healthcare insurance coverage in leu of other purchases. These citizens should not be subsidized.I find this particularly choice prevalent with young adult males. 28220 07/26/06 CA Agree "This country should be ashamed in the fact that it is the richest and best country in the world but we neglect our own citzens when it come to health care for all. We as a country are ready to send money to forgien nations at a drop of a hat weither they respect our believes are not but will let our own citzens fend for them selfs when it comes to health care along with other issues. Thank you for your time," Agree Agree Agree Agree Agree 28221 07/26/06 IA Agree "* Opposing the statement is like opposing motherhood and apple pie! The devil is in the details. At what point does the national program assume liability? 10,000,000? 5,000,000? 1,000,000? 500,000? Depending on the ""transfer of liability"" level, this becomes a sweet way for employers and insurers to shift their liability to the govt. And at what earned income level (taking into account individual assets and investment income?????)can citizens begin to harvest assistance with the cost of premiums? Will there be a ""needs"" based criteria? Will the qualification be indexed to inflation? Lot's of questions - their answers will dramatically change the voting results." Agree Sounds good so long as the federal govt does NOT transfer madates to the state/local provider without assuming financial responsibility for those mandates! Agree "The danger here is that the ""system"", if it works, could easily be expanded to provide national health care - a one provider, one payor system that can limit access when the tax payers decide the costs are more than they want to pay." Agree No comment. Agree No comment Agree I hold little hope of seeing a system installed unless someone can learn from the diaster visited upon the nation's elderly this year with the prescription drug program. A private/public partnership can work if sufficient resources are invested in creating a plan that is easy to understand and that appears equitable. No comment 28222 07/26/06 MA Agree private sector solution with public sector support - perhaps a reinsurance mechanism for unusually high risks and/or high medical costs Agree "the delivery of healthcare is a local issue and developing a strategy/means of delivering it at the community level is a great idea. We always hear, ""healthcare is not affordable""...it's not an affordability issue as much as it is a convenient access issue" Agree "Again, private solutions with public support. There needs to be greater transparency of COST and QUALITY and it can start with CMS. CMS is a huge data warehouse that can be mined for meaningful information on COST and QUALITY..." Agree Agree "* Agreed - with one caveat...I'm not in favor of a single payor system and/or the government running our entire healthcare system. I agree that everyone needs access to affordable healthcare - but to me it's an access issue more than an affordability issue. It is also incumbent upon our government to reduce the differences between our states and the mandates they make law. In Massachusetts, 16% of every premium dollar is applied toward state mandates. Developing/allowing a ""mandate light"" benefit plan with consistency from state to state would help...as would building more community health centers for people to get that routine level of care. Consistent routine care should cut down on major medical care and reduce healthcare costs." Agree "Private solutions with public support - standards of care and transparency of cost and lastly access to convenient, affordable care on a community level would be a big step in the right direction" COMPLETELY AGREE - SEE MY COMMENTS ABOVE 28223 07/26/06 CA Agree "The overall administration of a national program should be the role of government in order to prevent what is currently happening with the cost of health care. We have many ""privileges"" living in this country and one of those ""privileges"" should be affordable health care. We educate our children through a public system paid for with tax dollars and deny no one an education; I believe we should also have a health care system paid for with tax dollars and administered through a public single-payer system." Agree Agree Agree Agree I strongly agree that all Americans should participate in a public single-payer system which is financed through income tax and payroll taxes. Agree "As indicated above, I believe a public single-payer system should be financed through individual income tax and payroll taxes. For those Americans in low income tax brackets, they should receive additional assistance in paying for health care." "I believe having an independent, broad group with all stakeholders involved (patients, providers, etc.) provides the best scenario for developing core benefits and high-cost protection. " "I applaud the steps taken and efforts of this group to tackle this issue which has now become a crisis in our great nation. Not only do I believe we can fix the problems with health care in this country, I believe, working together, we will end up with a system that is affordable, that provides superior health care, and that we can be proud of." 28224 07/26/06 WA Agree Agree Agree Agree Agree Agree 28225 07/26/06 CA Agree It is unconscionable to have Americans choosing between eating and medical care. The fact that people are cutting dosages of expensive medications from what is prescribed by their Doctor simply because of cost while Big Pharma reaps record profits denigrates us all. Disagree This is a band-aid approach to a problem that needs to be solved by a system wide approach. An approach such as this is subject to the fluctuations of government funding and will likely result in another unfunded mandate that places the burden on local infrastructure. Disagree "* While I agree that this adresses significant problems in the delivery of health care in America it simply creates another program with more red tape. Public education suffers from over-accountability and under-funding (look at Special Education programs) and a program like this will only transfer that experience to the medical community. A better approach would be to standardize the paperwork and computer programs used in the medical industry, standardize the patient care protocols, and combine all existing programs into one program for all Americans." Agree This approach makes sense but only if it is part of a larger reform of the way medical care is financed and provided. Agree We already provide access to health care to everyone living in America the problem is that we do it in the least cost effective manner. Combine all existing programs into one and fund quality essential care for all. Agree "If we combine all the existing ways we finance health care and eliminate or control the profit margins of the Pharmacutical, Medical Insurance, and Medical Provider segments of the medical industry the burden on individuals should be greatly reduced and can be made appropriate to individual financial capabilities." Care needs to be take in this approach to allow 'new' approaches in medical care and prevent treatment options from stagnating. While I would agree that most cosmetic procedures should not be covered there are exceptions and there would be exceptions to every parameter we could set that should be allowed with the goal of advancement in medical treatment and the needs of the individual. Combine all existing funding sources for medical care into a single payer plan that provides universal coverage for everyone living in this country. 28226 07/26/06 CA Agree I would not be infavor of a plan that would raise taxes to accomplish this. Agree I would not be infavor of a plan that would raise taxes to accomplish this. Agree I would not be infavor of a plan that would raise taxes to accomplish this. Agree I would not be infavor of a plan that would raise taxes to accomplish this. Agree I would not be infavor of a plan that would raise taxes to accomplish this. Agree I am not in favor of a Universal Apprach that is run by the government. I strongly beleive that the private sector to work in concert with the government is the best solution 28229 07/26/06 MI No response "Look at medicare, welfare, social security, and other government programs. What makes anyone think the government will be able to handle medical care for everyone in the country? The prescription plan was next to impossible for the average - even above average - person to figure out. The paperwork would be a nightmare." No response No response No response No response No response 28231 07/26/06 CA Agree Citizewns should be able to choose between private and public health plans. No response don't we already have this established through MediCare and MediCal? Agree Isn't this redundant? I believe this are all already in place. No response "Let's face it. If we want it OUR WAY""IN THE ENVIRONMENT THEY CHOOSE"" we also need to be willing to pay for it." No response No response 28232 07/26/06 CA Disagree "Coverage for all Aericans is a pipe dream. The cost will break our government and cause taxes to go through the roof. The current system takes care of those who cannot afford coverage. The rest of us pay through our high insurane rates. Just imagine if those of us who pay through the nose for medical coverage, did not have to pay for the uninsured. Our premiums might become somewhat resonable." Disagree "I do not believe our government has the solution to the healthcare debate. Most americans have lost total tust in our government. They allow total mis managment at the post office and use the IRS as tool to get at politcal enemies. The IRS is a mess. The foreign policy of the current government has alienated many of our previous allies. So tell me how the government can fix anything, let alone Healthcare." Disagree "I veamently disagree with this one! Reduction of Fraud and waste...give me break. Our government cannot tackle this problem in so many other areas like in the Military alone. Fraud and waste is one of the many downfalls of our government. How could I ever have the confidence in a government who cannot even manage it's own ship, why trust them with my healthcare? I don't think so!!!!" Disagree I am sorry. These ideas are illusions. Get the government out of micromanagement of my life. I have never seen anyone turned away from a hospice because there was no room at the inn. Disagree "* If the government could clean up the fraud and waste in government and healthcare, everything would be less expensive. Think about it..how much of every healthcare dollar goes toward known fraud and waste? I'll bet it is an astonomical number. The truth is the government has not been willing to get rid of coruption, waste and fraud. It runs rampant with no real solutions in sight, ever. So how can I trust a government to govern my healthcare when they cannot do anything right except pour money into wasteful, often fraud laced solutions." Disagree "* Fairness and efficiency...now that is really some statement. How can a government who does not have or demonstarate an ability to live within its means through the taxes we now pay. Sure, they want to tax us more to throw more money into the heathcare debate. I am not a a crazy person. I have worked hard to make a living and to help other people by gaining their trust and helping solve their problems with solutions they pay for. People/customers trust me far more than they do the U.S. Government. Why? It is because I deliver what I say, when I say at the price they have agreed to pay for it. The Government has so many people on the public dole they will never go out and find an honest job and work hard at it because afterall the government will give them money to live and food stamps to eat. You must convince he voters that the government can do anything fairly and honestly before the public will ever trust then=m with the heathcare issues." "I don't think this will work because there are too many dishonest, out for themselves people in our government that have casued the public to lose trust in them and their medioric soluitions to any problem that seldom work out successfully. I'm telling you that the government is not the answer especially the politicians who are not trustworthy. You can fool some of us some of the time, but not most of us all the time. We are not stupid and do not trust our government to do anything, period." "In summary I believe the government and particulaly the legislative branch of government has never had the solutions that will work. Look at HMO's for instance..congress created HMO's years ago. For the most part they have failed due to attacks by the same congress who invented them. Why, because it was and is politically expedient to curse HMO's. Our loss and I guess their political gain" 28233 07/26/06 AZ Agree Who will underwrite the cost? Agree Again where are the finances to support this? Agree Cost control is vital to any program. Agree "Ideally, if the immediate family, if available can support this effort it should be the family's financial responsibility to the extent available, to provide funding. Public financial support should then be provided." Agree This is a very idealistic solution which I wonder how it would be implemented. Agree I only wish that I could provide some solution to financing this project. I recall a previous White House administration that has some grandiose plans but it went be the way side due to financing. "Basic eating habits, exercise and other elements that contribute to good health must be emphasized to promote better health so that an individual would be more prone to require less medical attention." "I am in agreement with all the recommendations. However, itwould seem to me that the total cost would be prohibitive. In any type of program the first, and most important aspect should be to emphasis nutrition and improved health habits with an emphasis on obesity which undermines the health problems that are all too prevalent." 28235 07/26/06 CA Disagree "Those who can pay, and everyone should have some amount of responsiblilty." Agree Agree Disagree Agree I only agree in concept. Disagree "I don't know what is ment by leaving the current system. It seems that there are at least two systems, public and private. If this is talking about leaving the private system then I am not for the recommendation." Core benefits should only be for the major type expenses and dental is surely not. I have experienced the way our government runs the V. A. system as well and the new part D of medicare and it is very limiting on services and confusing for users. I am very skeptical on a more government run sustem. * I understand better than most the problems with our systems and the need for correction. However moving to a government/tax basis system would not be in the best interst of all or even most americans. It seems the government spends way too much time and money on trying to fix the broken people of the country and way too little encouraging health and wellness both mental and physical. If we continue with the sickness that we encourage by life style choices and with baby boomer aging population it will not matter what system we have chosen it will bankrupt the country and we will have lost our position internationally. I think we are trying to externally fix an internal problem. 28236 07/26/06 MI Agree "I believe health care should be available for everyone, and if cost is necessary, it should be reasonable within everyone's ability to pay. people should not have to become impoverished to pay medical bills." Agree I believe a plan to serve all will be most welcome by all. Agree I like the idea of improving quality and efficiency while controlling cost for everyone. Agree This is a very vulnerable time for patients and their families; it is also claimed to be the highest cost of health care. It seems that there should be a way to make this time more understandable and acceptable to help make decisions to benefit the patient and the family. Agree Just what I said above. Agree "Perhaps a system of payment in kind, [the old barter way] could be implemented; that no one should feel unable to compensate for health care received. Perhaps the health care systems need to get out of the business market and back into the compassionate humanitarian arena." "Maybe it would work if it can be simplified, so all wil inderstand how it works, and get the benefits of healing." 28237 07/26/06 IL Agree "We spend tons of money on questionable outcomes. Does a 85 year old with health problems need the new hip? Do we spend a million dollars on a 1 1/2 pound baby with poor outcome? Just because we can, should we? " Agree Limit hospital services in a given area. Our city has 2 hospitals. Have one hospital could provide services for pregnancy and delivery and the other hospital provide end of life services. Get rid of the duplicate services and save the taxpayers some money. Agree Every day someone want to go after a poor person on Medicaid. Let's really work on the big fraud in the providers. That is where the greatest fraud occurs and they have the lobbyist and poor people have none. It is sad. Agree "We should guarantee a level of care to everybody, but if you want the extras, the patient needs to pay for it. " Agree "Minimum level of coverage with a high deductible for all americans. Expectations of the public has changed, they expect everything and don't want to pay for any of it. If you are over age 85 and need heart surgery that may add 3 years to your life, you can, but you will pay 50% of the cost. Demand will go down." Agree "I would like to see a uniform tax added to social security that all workers pay. If a person is at poverty level, 1%, those make over $500,000 would pay 8%. If the employer is providing the benefits, their share would equal current contributions. " It takes all parties to agree to the changes and the public will accept it. We can't continue at this rate. Our problem is we use all of those educated experts and not one single person with common or street sense. Keep it simple. No more donut holes!!!! 28238 07/26/06 ND Disagree "We already have medicaid for low income individuals and families. Far too many are disposing of assets in order to qualify for medicaid. At some point in time, everyone's life will draw to a close. Just because certain heroic procedures can be done, the real question is, What are the social, emotional, and societial benefits, risks, and costs (financial is only one of the costs) invloved? Just because it can be done does not mean it should be done." Disagree Let American Capitolism do what it does best. Disagree "This looks too much like Canada where you have to wait months to get anything done. Without a competitive environment, you end up with less care at a higher cost." Agree This is already in place and no change is needed. Agree "Furthermore, the core set of health care services should be for wellness and preventative only. No ""fix it"" care should be included." Disagree "Health Insurance is often looked to as a funding source for all medical procedure costs. The system would be much better if insurance were viewed as disaster risk management and individuals were responsible for paying their own small, regular bills." Wellness and preventitive: OK. Beyond that: NO! 28239 07/26/06 CA Disagree "Medical care should not be an entitlement. It's a comodity like any other service. Further, the Federal government should be the last resort to serve as a health care provider (Cf. US Postal Service v. UPS and FedEx)." Disagree "See above. Keep the Feds out. If there is a demand for such service, let private industry supply it." Disagree "Price fixing, even by the Federal government, will be counter-productive. Most of the current fraud in the health care infrastructure is due to large-scale government plans (e.g., MediCal, Soc. Sec.)." Disagree "Families, in conjunction with churches/synagogues and private programs such as Hospice, already do this well. Government would not be ""culturally sensitive"" to the majority who are persons of faith (Cf. sex education and abortion services already in place)." Disagree "There's no such thing as a free lunch. Politicians can buy votes by promising such benefits, but if provided they will certainly result in increased taxes, impacting the working family the most." Disagree "Financing should be private, or the product of negotiating with employers. ""Fairness"" invariably means transferring moneys from working people to those who cannot work (certainly exist) and will not work (even more certainly exist, in greater numbers)." I strongly oppose the entire concept. 28242 07/26/06 MD Disagree I am very afraid of the ultimate cost of this approach and the limited choices each citizen would have in chosing their health care provider and coverage. Disagree This would offer limited choices to allow us to chose our OWN doctor and medical care. Agree Anything to control the cost of health care for the Government is welcome Disagree "I think this should be an individual choice. I personally would not want anyone to pay millions of dollars worth of support services on my behalf, if I only have a few days or months to live. I would support making the individual feel comfortable." Disagree "Everyone thinks they should be provided the best possible care, but who will pay for it. I am not willing to pay higher taxes that I already pay. I choose to have a high deductible plan and pay for a portion of my health care cost. To give a free ride to all Americans is unrealistic." Agree Small business and individuals are already being taxed unfairly. There is no seamless or smooth transition..just more taxes "I agree with a core benefit, BUT who will pay for it?" 28243 07/26/06 CA Agree This is long overdue. The lack of health coverage for all Americans is a National shame and must be remedied. Agree I want these services for low income populations but fear that we will never see this under the present Administration. I now believe that Federal support for these services will have to wait until our National leadership changes. Agree "See my comments above. These services will have to be formulated and staffing and oversight provided by individual states. Perhaps the Federal government can be pressured to provide the funding, or at least some part of the funding." Agree Programs such as these are already in place in California. They need to be expanded and made available to all who wish to utilize them. Agree YES!!! Agree Financing is a thorny issue. Middle class Americans are already being taxed to the max. How about a tax on the wealthy and super-wealthy who seem never to pay their fair tax share? "Can we please have skilled, experienced and competent professionals administering health care programs? The FEMA fiasco is my worst case scenario of what inevitably occurs when inexperienced, incompetent people are in charge of government programs." "I have dreamed of health care for all Americans for all of my adult life. Is it possible that this may yet happen in my lifetime? But, of course, we have to get the rascals out of Washington first!" 28244 07/26/06 CA Disagree "This concept can only involve government as a ""solution"". I have little or no respect for the programs the government ""runs"" now so I can not possibly agree to more programs that won't work and better than the failed programs government runs now. The very problems we are faced with now are because the Federal government sets rates and policies through Medicare and therefore negatively affects the market by forcing unnecessary costs on the proviate sector." Disagree "The very fact it takes four long paragraphs to describe, n very arcane terms, ""the fix"" tells me this is a bureaucrat's dream come true. Just more layers of wastefull folks producing no healthcare." Disagree "The wonderful platitudes outlined as the solutions to apply to the problem are just a continuation of the problems created by the current ""system"" of government ""solutions"". All of the waste fraud and abuse that exists, and it certainly does exist, was casued by the very people that propose the ""new"" solutions outlined above. Government can not kill waste fraud and abuse. It is simply incapable." Disagree "These platitudes reflect our unwillingness to speak out..........we spend a great deal of money at the end of life seeking ""magic bullets"" to keep people alive. People would make different decisions if they had to pay the bill for (wasted and ineffective)services provided at the end of life." Disagree "The primary statement speaks to ""affordable health care"" with no definition. One persons affordable plan is anothers ""exhorbitant"" plan. We should allow each person tomake their own decisions. Isn't this a ""free country""? Certainly this decision should be made by each citizen and not a planned decision by someone in Washington DC." Disagree "* This is just the same old swan song of government as the solution. The government brought us most of the problems we have today and this entire excercise offers no solutions to some of the current problems IE: Physician malpractice costs, authorized duplication of services, waste fraud and abuse in the Medicare system (estimated by some at 20 to 40% of the total cost, and others. When government will not face these matters why do we think they can and will face the new problems they will create with the new proposals." This entire exercize has excluded many qualified experts from the private sector that could and would serve as participants on the solution team. These solutions offered clearly are just another attemt to back the same old pig in the garage and paint it a differnt color to try to diguise that it is still a pig. This whole exercise is just an exercise to work toward defeating our supeior medical system and replacing it with a European or Canadian style socilaist model. 28245 07/26/06 AZ Agree "We need to look at other countries and pattern something after their form of government healthcare. I have worked with the countries of Bermuda and the Cayman Islands and they have a standard healthcare coverage for everyone, but employers usually offer an extended version of that, which is very much like our private healthcare. It works well and insures that everyone is taken care of for basic medical needs." Disagree "Sounds like too much red tape to me. Once you start establishing committees, etc. it seems that too much money is spent on the administration and not where it needs to be." Agree Educating the public is critical. Maybe promote a volunteer type of unit that would conduct or assist in seminars in regards to taking control of your healthcare. I would volunteer to do this as I work in the insurance industry and was a claims processor for 11 years before moving into the technical side of the business. One thing I have noticed is that people do not understand their rights and do not take control of their own health care. Agree Agree "See my comments about Bermuda in question #1. They use the ""payroll"" tax to cover the basic coverage, but even people that do not work are still covered." Agree "You definitely will need general public people to be on this committee so you can get a fair, balanced perspective. I would research other countries too and see what they are doing and how it is working." "I think that wellness and alternative care are becoming more important in our lives these days. If we can catch diseases early, healthcare costs are decreased. I think more people would go get physicals and routine services if there was a 100% benefit to do so." 28246 07/26/06 CO Agree No response Agree Agree Agree Agree 28247 07/26/06 MA Agree "As a School Nurse, I interviewed working parents whose incomes were not large enough to afford health insurance for their families. Consequently, routine eye exams, dental care and physical exams were not done. Prevention of routine health problems did not occur. Consequently, health care was sought when health problems impaired a family members function. Late diagnoses led to greater expense and sometimes poorer medical results." Agree "I strongly recommend expanding health services in the public schools. It is a central location which is accessible to both children and their parents. Medical and nursing personnel are in place in school-based clinics. In the event of an emergency (national or local), knowledgeable professionals are available to provide necessary services." Agree A national vaccination record for all children and adults would allow health care providers to recommend immunizaton updates whenever necessary. Technology to support the program must be a priority. Funding (both private and governmental) for professional health careers is essential for obtaining this recommendation. Agree Long Term Care insurance should become a standard requirement of health insurance programs. Individual options for care would be planned in advance and allow ease of access when care is needed. Agree Members of my family live in Canada and Germany. where every citizen has national health insurance. Anecdotal evidence of their health care systems make the US system sound punitive and medieval. Thank you for your efforts to improve health care delivery. Agree A formula should be derived allowing working individuals to invest a fair amount of their income in a national health insurance plan. Unemployed individuals with independent incomes should be similarly enrolled. The formula must be broad enough to provide sufficient monies to cover individuals without an income. "Please include routine vision exams, and corrective lenses where needed. Plans should allow some flexibility in the time between routine visits based on symptoms presented." 28249 07/26/06 OR Agree There should be no reason an american worker should fear losing all he has worked for because of an illness after they retire. Agree i feel that working people should be the dominate feature in any advisory board to make sure that the subjects most important to them are dealt with Agree Agree Agree "people shouldn't have to chose between eating or a roof over their heads to have health coverage, it is way out of line" Agree there should be a fund that people can draw from for catastrophic illness separate from what they use. their health insurance should be for preventative care and maintenance drugs and procedures 28250 07/26/06 CO Agree I completely agree with this recommendation. I believe the federal government should establish universal health insurance or at the very least consolidate all government health programs and simplify patients' entry into the system by having a single eligibility criteria. Achieving cost efficiencies and maximazing economies of scale should be first priority. Agree I agree with this recommendation. We have an a significant issue and addressing quality health care in rural areas. This recommendation seems to go well with my comments up above. Agree Agree Also consider allowing self-deliverance or assisted suicide as another alternative for people that are ready to take this step. Agree "Health care costs continue to be out of control, state governments will soon go bankrupt as more baby boomers will exponentially need more health care services. Universal health insurance can take care of this issue. " Agree We need a paradign shift where preventive health care is emphasized and proper funding of public health is achieved in order to be most cost effective with the limited resources we have. It is imperative to have this dialogue and perhaps consider consolidation of government healh programs. "I agree with the recommendation. However, there should be a way where consumers that can afford a higher benefit package are able to purchase the ""bells and whistles"". Preventive health care should be the focus on a core benefit package." 28251 07/27/06 KS Disagree "We do not need another medicare/medicaid program. The one we have now is about to bankrupt us and does not teach the public, providers ,or anyone else how to conserve costs and get excellent care at the same time." Disagree If you need great heath care you need to be willing to seek it in an area where it is cost efficent. Paying too much to establish a provider in an area where there cannot be an efficient use of it is cost shifting the wrong commodity. Disagree I think we need to rethink the box. Education and controll on provider cost practices are key here. This is free enterprize here and I hate to limit the providers too much so we need an incentive program that gives the providers what they need not what they want so all of the public can be served in an equitable fashion that stays consistant and also has the ability to change as the need may arise to conserve costs and improve service for the dollar spent. Disagree * Nature has a way of weaning out the weak and allowing the strong to survive. If we concentrate on the health care of the average health individual and their education that they need to live longer and more fruitful lives then the weaker individuals will catch on as well and do their part to conserve their health to be able to have a better quality of life. Government does not need to prolong weak individuals when they were not willing to start working on it themselves at an earlier date to maximise their quality of life style. Agree "I agree with the premise that we should all be a part of this solution. The problem is many are not willing to pay the price by doing their part in the education, participation in buying health insurance and planning family wellness strategies." Agree "The theory sounds great, but I disagree when you imply that most people were willing to make additional financial investments to service their total health care needs. If that were the case then everyone would be doing their part and buying health insurance to cover their expenses and controll the providers that tend to overcharge the people that do participate in financing the system to pay for those who are just looking for haandouts without any responsibilities to go along with the services." "* We definitely need a plan (education early on is the key). If the individual is aware that their total health is dependant on how they take care of their physical, mental, and dental health then parameters will be established and good practices will come out of it. Of course not everyone will buy into it. They should reap what oats they sew but also have a way to buy back into a sound system after they realise the error of their ways. After several generations it will become easier and easier as an accounting is formalized and followed what is fair for everyone." Just use common sense about how we run our health system. There is nothing majic about formalizing a system. We need to have everyone participate (even the least capable) so the system will not be abused and everyone will look at it like it is their system and needs to be protected from those who would abuse it. This includes everyone. If everyone takes an equal ownership and works at it then the system will automatically be corrected and revised as need be by the very people that use it. 28252 07/27/06 WA Agree Agree Agree Agree Agree No response 28253 07/27/06 TN Agree " Another great idea, but I don't want to pay for it." Agree "this sounds great, but I don't want to be paying for it!" Agree "The Federal Government is me, which means that I am paying for these things. I do not want to pay for anything." Disagree "End of life issues are best left to Christian church /care givers. And you can't have that if the Government is paying for it, so no." Disagree I do not want to pay for anyone else's health care by way of my taxes. Disagree Absolutely no financing by any taxpayers in any manner. Ever. "Again, this is just another way of having the taxpayer pay for others care. No." 28254 07/27/06 CA Disagree to much like Canada health plan and costs the tax payers millions and the federal government can not afford it! Disagree The system works now and just needs the federal government to remove the large drug companies and the FDA that is killing the American people and making us sicker. Doctors need to be trained in nutrution! Disagree "YOu are not looking at the prevention side of the health care for all. You are not looking at the food industry and what they put in the food, soda drinks, etc. are very bad for all of American's!" Agree Disagree Disagree Can not be done without raising taxes to 70% for all to pay. Individuals and corporations. More focus on dental is the real gate keeper to ones health. Read all the studies and proof that backs all this up! PreventCare of American will be the anwser to all's health care. 28255 07/27/06 CA Agree Agree Agree Agree Agree Agree 28257 07/27/06 CA Disagree Disagree Agree Agree Disagree Disagree 28258 07/27/06 KS Agree "As a physician, I have seen the detrimental effects of health care delayed or neglected due to the lack of affordable health insurance. There is no reason this nation cannot provide a national health insurance plan which would put everyone in the same risk pool, thereby making insurance affordable and health care more accessible." Agree "However, I have spent twenty years practicing primary care medicine, and have worked or volunteered at ""safety net"" clinics. While these clinics are intended to provide care to the indigent population, they operate ""on a shoestring,"" often delivering care by whatever provider is available and dispensing samples if they are in stock. This results in second-class medical care, worsening our two-tier system (have/not)." Agree "Ultimately, we need to achieve a one-tier system, similar to Medicare (Medicare-for-All) which would provide at least basic health care and preventative services. Critics will say that adopting the Canadian system will result in long delays for elective procedures (perhaps not a bad idea), but I'm sure that Americans will demand prompt care for non-elective services (and probably much more!)." Agree "The Federal Government should not interfere with a patient's right to die with dignity. In reality, there is a very fine line between providing analgesia for a terminally ill patient and assisting in the termination of life. Ending a patient's life through the administration of adequate analgesia provides comfort and dignity to the patient, relief from suffering by the family, and the fulfillment of a moral obligation by the provider." Agree "The AMA recently passed a resolution stating that all Americans should be required to have health insurance. Based on the Massachusetts legislation, this plan would require everyone above 500% of the poverty to pay for this, while those below 500% would receive tax incentives to pay for insurance. Unfortunately, this does not address the huge overhead associated with the health insurance industry." Agree "I would favor a single payor system which would be similar to Medicare, providing necessary health care services to all Americans, regardless of age. I believe that truly elective procedures should not be fully financed. Adherence to evidence based medicine would be linked to physician compensation, which should be adequate enough to ensure a continued supply of providers. Eliminating private health insurance companies would greatly increase efficiency and reduce the huge overhead in the industry." 28259 07/27/06 CO Agree "* The simplest and most cost effective way to make affordable health care accessible to everyone in our country, from birth to death, is to establish a single payer universal health insurance plan with everyone in one risk pool and standardized comprehensive benefits for all, including prevention, acute care, chronic care. Countries with single payer universal health care spend half as much per capita as we do and also have better outcomes. Public funding of private and/or public health care would be affordable and equitable. All other developed nations fund universal health care, and most of these are single payer plans because this type of universal health care is simple, equitable and affordable. Each country funds and administers universal health care a little differently, but there are many excellent models to study. The best ideas from each country could be combined in designing a single payer universal health plan for our country. By making early intervention and prevention available to all, we could " Disagree "* Incremental changes, continued fragmentation and multipayer chaos will not solve the health care crisis in our country. The huge waste of administrative costs in a multipayer system is 20% to 30% compared to 2% administrative cost for a single payer system, enough savings to cover everyone and even have a surplus. All entitlement programs should be eliminated and everyone treated equally with equal access and equal benefits, including choice of health care provider and hospital. Expanding or modifying existing programs simply will not solve the problems, nor be affordable, but only add to the complexity, cost and waste. Health care in the U.S. is so badly broken, costly and unfair that comprehensive reform, such as single payer universal health care, is the imperative solution. Most developed nations have about fifty years of excellent experience with universal health care. We can gain wisdom by studying models of other countries that are working well, costing about half as much per capita and experiencing" Disagree "* Yes, we need to improve quality and efficiency of health care while controlling costs, but this can best be achieved by comprehensive health care reform, replacing our entire complex multipayer health care system with a simple, unified single payer universal health plan that includes everyone in a single insurance plan from birth to death, with comprehensive standardized benefits and standardized reimbursement of providers for services delivered. A universal electronic medical record which is secure but accessible to all physicians, hospitals, pharmacies, the ""health authority"" and CDC would greatly enhance quality of care and eliminate fraud, as well as give us accurate data on incidence of diseases, treatments and outcomes." Agree "Yes, palliative care should be available to all patients as an option. Education of health care professionals in palliative care, as well as public education, is needed. Community or public funding is needed." Agree "* The best way to achieve access to affordable health care for everyone is to establish single payer universal health care publicly funded. If everyone is included in one risk pool, it becomes very affordable and simple to administer. Comprehensive benefits should include prevention (immunization, prenatal care, delivery, post partem care, family planning, screening), acute care (out-patient and in-patient), surgery, emergency care and transport, chronic care, prescriptions, medical devices, physical therapy, mental health, dental, vision and hearing, long term and palliative care." Agree "* Australia's comprehensive universal health care is paid for by an income tax of 1.5% for all who are employed. In addition high wage earners (single with income over $50,000/yr or couple with income over $100,000/yr) pay an additional 1% in income tax. Public funding of universal health care can be achieved in a variety of ways. At present more than half of the health care dollars spent in our country are coming from income taxes. See Congress bill HR 676 for proposal by Conyers, Kucinich and others. The out of pocket costs and premiums currently paid will likely be reduced per capita when we implement a universal plan. " "I would add long term, palliative care and autopsies." "I hope your report will include the vision and courage exemplified by the majority participating in Denver and other cities who believe single payer universal health care is the affordable, equitable and best solution to the health care crisis in our country. " 28260 07/27/06 FL Agree Agree Agree Agree Agree Agree There is unbelievable waste secondary to practice of defensive medicine. My guess as a physician is that at least 1/3 of hospital admissions are not necessary and billions of dollars are wasted on unnecessary tests. Hospitals and providers currently profit from this and it will not change until payers stop paying for it as a fee for service. 28261 07/27/06 UT Agree "the highdeductible plan is not going to work for this, as most medical care of any consequence exceeds the deductible by several orders of magnitude, making the issue of the deductible a non sequitur to the cost of the insurance policy (and to the cost of health care globally.)" Disagree this sounds like government speak for another do-nothing commission or office that is paralyzed by infighting by all the interest groups. Disagree "again, another high-minded phrase obscuring what is essentially an aggrandizement and entrechment of existing power groups in the medical-governmental-industrial complex." Disagree simply financing inhome long term care by medicare is enough; the verbiage of this recommendation once again betrays fuzzy thinking and lack of clarity about goals Agree "the ""common message"" shold be the only recommendation of this effort. the leadership required to make it happen will have to take energy from the statement and proceed from there, and it will not be a committee effort--it will be an individual leader" Agree "this should be replaced by ""americans are willing to pay for fair access to health care for all, whether through taxes or through enrollment payments. however, americans want to see that they are getting a fair return for their payment and do not want to see profiteering from insurers or medical providers. the danger of profiteering is highest when accountability mechanisms are lacking.""" "once again, too much ""committee-speak."" the last two subparagraphs are all that is necessary to express the idea" "in general, these recommendations are simply rehashing what was already known and proposed. the only new information and receommendation is that americans are willing to sacrifice financially for a better and fairer system, but are not willing to be fleeced as they have been in the past." 28262 07/27/06 NH Agree "I strongly believe that a single-payer system is the only way to achieve equitable, accessible health care for all." Agree Agree Agree Agree "Health care should not be something available only to select individuals. Access to universal, affordable health care is the hallmark of a responsible society." Agree Health care financing CANNOT be tied only to employment. There must be alternate/supplemental mechanisms to create group coverage. "With all of the above initiatives, but especially with this one, use the expertise of the country's nurses -- particularly those who now practice in public health settings. They have a wealth of knowledge, experience, and ideas." This should be the number one national priority. 28263 07/27/06 IL Agree "But I am not in favor of socialized medicine; low income have Medicaid which they abuse; wellness and preventive care should be a priority; stop free care to illegal aliens; get rid of the abuses in current system; re-allocate dollars from administrative, beauacratic, CEOs spending to lower premiums and to patient care" Agree "Educational programs at times people can attend, literacy problem inherent issue here, exception is illegal aliens" Agree "many evidence based/best practice programs have already proven to be ineffective i.e. hypertension in the elderly; education at varying times; education on eating habits to lower obesity - stop food stamps for junk food. Drug costs are outrageous - why use new improved when old drug works just fine. Fraud and abuse is being looked at from the bottom up, it needs to be looked at from the top down." Agree use dollars for home health care when more cost effective than hospitalization; dollars are wasted every month on durable medical equipment used by elderly when the monthly payments over years exceed the cost of the equipment Agree illegals are draining and abusing system in various parts of the U.S.; Medicaid patients abuse the system; CEOs of insurance companies are also abusing system Agree "Financing thru more tax dollars is socialization not a good thing; beauracratic spending, CEO salaries and administrative cost must be lowered to trade off the cost of quality care and preventive/wellness; The waste in the current systems must be stopped first. Public aid to people who do not need it must stop. The abuse of the current system must cease." "Start in pre-school with education; put together programs that are educational, informative and entertaining" "There are sources of help for people currently but the red tape and lack of knowledge on the availability of the programs is part of the problem. When CEOs for insurance companies make multi-million dollar salaries their is a significant problem. Fraud and abuse is being looked at from the bottom up, it needs to be looked at from the top down." 28265 07/27/06 RI Disagree "The national program should be public but protected from the whims of elected officials. Being privatized will lead to a variety of problems as demonstrated by situations as states have privatized formerly public programs, for example provision of group homes for the mentally handicapped. Whether operated as a non-profit or as a for profit there have been a lack of responsiveness to the needs of the patients." Agree "However, we are ALL one pink slip away from being a member of a vulnerable population. I support a system of universal health care." Agree Agree Agree Disagree By reducing the number of people who have to handle any one health care transaction the costs will be greatly reduced. Financial coverage of the cost should come from taxes generated thruogh the financial strategies listed above. Companies should not be given the option to opt out. "* May physical ramifications come from lack of addressing spirirual health ( very different from religious beliefs). Registered nnurses are required to address health issues of the body mind and spirit. JACHO now requires that spiritual issues be addressed. Any health insurance needs to include this. A ""health insurance"" MUST onclude health promotion and disease prevention in order to reduce the occurance of illness. Research reveals that a large percentage of the acute and chronic diseases experienced by people in this country are a result of preventable activities. We can reduce health care costs and improve quality of life by assisting people to improve their own health status and reduce their risk of costly medical care and untimely death." 28266 07/27/06 FL Agree Agree Everyone both rich or poor excellent health care. Agree Agree Agree Agree 28267 07/27/06 IL Agree "I agree in principle with the above recommendation, but question at what cost and how it would be funded. In addition there needs to be individual responsiblity involved. Even today there are many people who choose not to acquire health insurance even though it is available and affordable based on their circumstances." Agree "The sentiment of this recommendation is good. However, I question funding and implementation. Federal and State mandates are already part of the increasing cost of health coverage for all Americans, including cost shifting with respect to Medicare and Medicaid." Disagree The current federal programs are part of the problem. Expanding them will lead to further inefficiencies and cost shifting to the private sector. Disagree "Again it is hard to argue with the statements in this recommendation,but at what cost? ""Accessing the kind of care they want"". Everyone wants the best care available, but at what cost?" Agree Again I would stress the importance of personal responsibilty. Is the above in the public best interest. Yes. But again at what cost? How is to be funded? Payroll taxes for a federal plan unless the taxpayer can show qualifying employer sponsored or individual coverage in force? Agree "Sounds like a good and noble statement. However, I am skeptical of any government initiated programs based on past performance." Assurances must be in place to make sure such a group is not stacked with people with a particular agenda in mind. "Federal cost shifting, state mandates, and a legal system which seems to know no bounds regarding liability limits are all significant parts of the problem which are not necessarilty addressed by the above recommendations. " 28269 07/27/06 NE Agree "Change the tax code to make health insurance affordable. Give every American a reasonable refundable health insurance tax credit. This will result in savings to Medicaid, remove the tremendous inequity between individual health care and health insurance income tax subsidies and provide affordability for core health insruance plans." Agree "By making health insurance affordable through a tax credit, some of the areas under concern will have resolved by bringing health care capital to those currently under-served areas." Disagree "Unfortunately, government control often equates to price shifting, increasing private sector consumer costs." Agree Agree A refundable health insurance tax credit could make private health insurance universally affordable. Agree Changing from a system of employee income exemption on health insurance premiums to refundable tax credits can be a cost transfer rather than a new cost. Defining a core benefit is good but remember not to mandate a core benefit. Look to the individual health insurance pricing disaster in New Jersey where specific plans were mandated. Mandating benefits limits innovation. We need a viable competitive marketplace that can rely on innovative health insurance product design to react to competitive developments. The core plan developed could be used to certify that any given plan achieves core plan standards. Consider adding a health care finance/insurance member to the Citizens' Health Care Working Group. 28270 07/27/06 VA Agree "This step is the most important, but also the most difficult because of the costs associated. Will the funding come from existing tax revenues or will taxes need to be raised? Also in view of the current immigration crisis, how do we define Americans?" Agree Agree Agree Agree see #1 Agree see #1 28274 07/27/06 TX Agree needs some patient accountability Agree "Please emphasize bullet #3(expansion of FQHC type programs).Most family medicine residency training programs provide the majority of care for the uninsured and underinsured of their commuities,but,because of their additional focus of education,they have not been embraced by the existing FQHC's...which are very productivity and not continuity driven)" Agree "Noble thought,but NONE of the entities on this list have a reputation or demonstrated interest in any of these activities.CHC's focus on # of patients seen,Medicaid and Tricare deemphasize primary care by their devaluation of its services,and VA has never worked well with community physicians re continuity." Agree Agree Agree "* Our current health care system is fatally flawed because we do not have a viable and strong primary care infrastructure(which the rest of the western world has).There are great research results which demonstrate that quality goes up and costs go down when there is a strong primary care physician base.When people can go directly to high cost subspecialists(many who have no external accountability and whose # of procedures done are limited only by amount of insurance) without agreement from their personal primary care physician, there are often inappropriate and unnecessary procedures and costs.I am not asking for a gatekeeper model(that failed ,thank goodness!)but a coordinated and integrated gate way model" This is great if we honestly look at evidence based results and not high tech bells and whistles.Americans are in love with technology and will want the magic test or magic pill..Many expert panels push the procedures of their own specialty.Some mental health treatments(eg alcohol treatment programs) have been remarkable failures despite huge costs: these need to be evaluated dispassionately for effectiveness. "I really want to emphasize the need to readdress the FLAW of the basic US healthcare system.We need to value our primary care and help it develop the infrastructure(IT,patient focused care,quality assessment and improvement,and coordination and integration of all aspects of care)by reimbursing at a rate that will allow these physicians to cover the costs of that necessary infrastructure change and hold both the physicians and their patients accountable for quality,effectiveness, and efficiency." 28275 07/27/06 IL Agree Agree Agree Agree Agree Agree 28276 07/27/06 OH Disagree We already have this Disagree Keep government out of healthcare decisions Disagree keep government out!!!! Disagree Disagree Disagree 28277 07/27/06 VA Agree Disagree Too complicated - it would take a major agency to handle such a task. Needed functions should be coordinated with CMS as health management has begun with Medicare. No need to duplicate work. Agree Makes more sense than prior point. Disagree "Again, no need to re-invent services. Work and support local organizations already doing this." Agree We have the highest standard of living of any country - yet many suffer and cannot afford basic health care. Agree "no question - it will cost a lot of money. I would favor employee/employer and value-added (or sales) taxes over income or ""sin"" taxes." "I favor catastrophic coverage only (at least $10,000 deductible). Allow for private insurance to supplement and assistance for low income." 28280 07/27/06 IL Agree "While I agree with this, I don't think a National Health Plan such as they have in Canada is the answer. I belive it needs to be kept in the private sector and that everyone needs to pay a premium tied to their income." Disagree I believe this will end up being another government boondoggle. I seldom have seen the government in the last 40 years be able to set up anything without negative consequences. Hurricane Katrina is an example. Over $1 billion dollars lost in fraudulent payments. Agree "Item 3 in this statement is the most important. However, this is going to take a large sum of money. Where is that money going to come from?" Agree I agree with this up to the last statement. It concerns me about funding. Too many people depend on the government to give them services. We need to learn self-responsibility about educating ourselves. Agree "Everyone deserves health care, but as I stated before, I believe everyone has to pay some portion. " Agree I believe that the government should not be expected to finance the insurance. I don't believe in a socialist government. 28281 07/27/06 MN Disagree No health care program should be funded by public tax dollars. Disagree Again there is to much federal control and therefore more taxes. Agree This is an area for federal regulation. Agree Agree Agree If by universal coverage we maean a NATIONAL health care system I do not agree. Safety net yes. Shared and equal NO. Communism does not work. Even there the result was differences. "I do not think you will be able to establish an independent, non-partisan, private-public group" Private responsibility with a basic Safety net would be the most cost effective. 28283 07/27/06 CA Agree Agree Agree Agree Agree Agree Cultural competency That health care will be delivered in a culturally competent manner should be included as a core principle in the delivery of health care. 28284 07/27/06 WI Disagree I want freedom of choice. Disagree The federal government needs to stay out of the health care business. Disagree "Again, the federal government needs to stay out of health care." Agree Agree Disagree 28285 07/27/06 TX Agree "Affordable insurance models, such as 3-Share plans, have been successfully piloted in many areas. They serve as good models for how such coverage might be constructed. Developing such a program should be a national priority." Agree A wise and necessary approach. FQHC's are a good basis from which to build. In Texas there are presently too few FQHC's--we need more FQHCs and more expanded networks. Agree "A good place to start--waste, barriers to enrollment, and inefficiencies plague the Medicaid system in Texas. We can do a lot better. Providers must be adequately reiumbursed for services, and in a timely manner. Without a strong provider base, these public programs are not functioning well." Agree Agree "Otherwise, the costs to us all are truly unaffordable, and we will simply preside over a collapsing medical system." Agree 28287 07/27/06 CA Agree "We need a national healthcare system like medicare that covers every single American. Profit driven corporations have failed to keep costs down, disenfranchising millions of working class and poor. " Disagree "This is just nibbling around the edges and doesn't provide a long term, reliable system where everyone has coverage. Nationwide we need a single payer system that is funded by all workers and covers everyone in our nation with a comprehensive plan." Disagree This can be achieved without combining all these programs. One system that covers everyone is the answer. Agree "I agree with the goal, single payer comprehensive coverage is the streamlined answer that will solve these problems. Window dressing this serious issue is dangerous." Disagree "If everyone paid their fair share, a small % of their salary, and business paid a small portion, we can fund the healthcare system that covers everyone." Disagree "The Lewin group has reported tha t asinglr payer system that covers everyone comprehensively could be financed with a 3.4% payroll tax on an employee while the employer would pick up 8%. Story over, everyone has dental, vision, chiropractic, and medical and prescription coverage." See my comments above 28288 07/27/06 MO Disagree I do not want Federal Healthcare in any shape or form. Agree Agree Agree No response "As stated previously, I am TOTALLY against Federal Health Care. If a system can be implemented where private enterprise - not the government controling all the contracts, then I would be open to that foremat. The agent HAS to stay in the system. We do not need socialized medicine""." Agree "I feel healthcare IS available. If it means expanding clinics for low income Americans - then I would agree. Making all of us pay into a system so that everyone has the same coverage, run by the Government, Absolutely NOT." As long as private insurance enterprise is still in the ballgame. One size fits all is NOT an American concept. "Competition is the American Way. Basic health benefits could be offered by the Government for low income, disabled etc. just as long as Americans can pick their own carriers." 28289 07/27/06 OK Disagree "* no one today goes without health care. the problem is who pays for it. we need to establish a program for those who do not have group coverage available. the burden today is being paid for by the employers of this country. cost shifting is an burden to small employers particularly. there is ovewhelming evidence that a single payer system, such as canada has been a disaster. they also have the overwhelming problem of increasing costs, inadequate coverage, people dying waiting for CARE. WE ARE USED TO A LEVEL OF CARE THAT A GOV'T RUN SYSTEM IS INCAPABLE OF PROVIDING. EVEN THE CANADIANS ARE HAVING TO ALLOW INDIVIDUAL COVERAGE TO MEET POEPLES NEEDS. " Disagree "I DO BELIEVE THE FEDERAL GOVERNMENT IS CAPABLE OF RUNNING A NATIONAL HEALTH CARE SYSTEM. IF MEDICARE IS AN EXAMPLE WE WOULD BE IN SERIOUS TROUBLE. WE MUST DEVELOP A SYSTEM THAT IS RUN BY THE PRIVATE SECTOR, AND SUPPORTED BY AMERICAN BUSINESS. " Disagree "THE GOVERNMENT RUN PROGRAMS ARE AND HAVE BEEN A DISASTER. MEDICAID, MEDICARE AND ETC, HAVE SO MUCH WASTE AND DUPLICATION IN THEM THAT THIS TYPE OF SYSTEM WOULD ON SERVE TO INCREASE COST CONSIDERABLY AND PROVIDE CARE THAT IS WORSE THAN TODAY. " Agree "ONE OF THE BIGGEST PROBLEMS WE HAVE TODAY IS THAT OVER 50% OF HEALTH CARE COSTS ARE PAID OUT IN THE LAST 30 DAYS OF LIVE. TOO MANY DOLLARS ARE SPENT TRYING TO HELP A SITUATION THAT ONLY A MIRACLE WILL HELP. HOSPICE HAS BEEN A GREAT IDEA, THAT IF SUPPORTED PROPERLY, WILL ALLOW SOMEONE TO MEET THEIR MAKER IN A DIGNIFIED MANNER. " Agree I BELIEVE THIS SHOULD BE A GOAL FOR ALL CITIZENS. HOWEVER THIS MUST BE A PROGRAM RUN BY THE PRIVATE SECTOR. WE CAN NOT AFFORD TO HAVE THE GOVERNMENT SQUANDERING ASSETS FOR SUCH A NEEDY PROGRAM. WE MUST HAVE S SYSTEM THAT AMERICAN BUSINESS CAN AFFORD AND SUPPORT. Disagree * THERE ARE MANY PEOPLE TODAY WHO CHOSE NOT TO PAY FOR COVERAGE WHEN OFFERED TO THEM ON A VERY ECONOMICAL BASIS. WE NEED TO ADDRESS THE TRUE PROBLEM - RISING COSTS. WE SEEM TO TRY TO FIND MORE MONEY TO THROW AT A SYSTEM THAT IS VERY WASTEFUL ALREADY. WE EITHER HAVE TO ACCEPT A LOWER QUALITY OF COVERAGE OR TRY TO MAKE OUR DOLLARS WORK MORE EFFECTIVELY. WE MUST GET THE LAWYERS OUT OF THE SYSTEM. AT LEAST 25% OF EVERY DOLLAR SPENT IS EITHER ON DEFENSIVE MEDICINE OR MAL PRACTICE INSURANCE. JUST SLOWING DOWN THE TRIAL LAWYERS WOULD PROVIDE A LOT OF DOLLARS FOR CARE. "WE ALREADY HAVE A CORE OF BENEFITS, PROVIDED BY AMERICAN BUSINESS THRU PREMIUMS. WE NEED TO REQUIRE PEOPLE TO TAKE BETTER CARE OF THEMSELVES, THRU DIET, EXERCISE AND ETC. WITHOUT TRYING TO CHANGE PEOPLES HABITS, WE ARE ONLY THROWING GOOD MONEY AFTER BAD IN PROIVIDING HEALTH CARE. WE COULD SUBSTANTIALLY REDUCE THE NUMBER OF HEART ATTACKS, DIABETICS AND CANCER CARE THRU EDUCATION NOT MEDICINE. " I BELIEVE WE HAVE THE BEST SYSTEM OF HEALTH CARE IN THE WORLD TODAY. WE HAVE A LOT OF EXCESS THAT COULD BE TRIMMED DOWN. NO ONE GOES WITHOUT CARE TODAY. WE HAVE A LOT OF POEPLE WHO DO NOT HAVE A HEALTHCARE PLAN - BUT THEY STILL GET ALL THE CARE THEY SEEK. 28290 07/27/06 TN Agree "I strongly agree as I am uninsurable, 53 yrs old and scared to death of what the future holds." Agree Agree "There is so much waste in the system, esp the VA. I am currently having to care for a Father and a brother thru the VA. They get really great care. But it seems to be they don't appreciate the care they get. I think people should have to pay for minor doctor visits and perscriptions and then insurance kick in. Take more of responsibility for your own health." Agree I think alot of this aging process should start being taught in elementaty school and continue. Most of us have no idea what is going to happen until it smacks you in the face. Agree "Yes, yes, yes!" Agree "* I don't know why a certain percentage of the lottery sales couldn't be given to health care. Education scholarships are given. So a person gets educated, making a good living and is then stricken with a horrible disease. If a person wants an education he will find a way. If a person gets ill, medical costs are so huge there is no way to pay. Take the money to care for the uninsurable and find new cures. Medical costs are by far the scariest to deal with and you don't even begin to realize that until you become 50+ or develop an illness." I just pray that I will be able to take care of myself as I get older and my disease progresses. Some days I just want to die. 28293 07/27/06 TX Disagree "This is already in place, people choose buying a new car etc, over buying a health insurance policy. " Disagree more government bureaucracy Agree Disagree Disagree "The concept is good, but how do you do it? The current system basically does this, except for those that choose not to buy insurance coverage." Disagree "Again a good concept, but how do you do it?" A good concept but how do you do it. Has government ever been able to do anythilng better than private industry? 28294 07/27/06 CA Agree I support government run universal health insurance for everyone. Disagree I support government run universal health insurance where any individual could go to any primary health care provider. Disagree I support government run universal health insurance where any individual could go to any primary health care provider. Disagree I support government run universal health insurance where any individual could go to any primary health care provider. Disagree I support government run universal health insurance where any individual could go to any primary health care provider. Disagree I support government run universal health insurance where any individual could go to any primary health care provider. I support government run universal health insurance where any individual could go to any primary health care provider. "Government run health insurance similar to, but better funded than, the Canadian model addresses all of the above concerns in a fare, affordable way. " 28295 07/27/06 CA Agree " I agree in principle, however, throughout all this discussion one fails to address two key issues. Costs are driven up by two significant groups of people. 1. Young adults who choose to not purchase health care for themselves. 2. Illegals even if it is available will not contribute to health coverage. They know that they can get it free. If they participated, we would see a decrease in the premiums paid by those of us who take care of ourselves." Disagree "IT sounds good on paper but the government has continued to expand health care benefits while reducing their finanical contribution. To much of government dollars are wasted in administration. In addition, virtually every government program begins to grow itself." Disagree "We are gradually encouraging people to not take responsiblity for themselves. While I agree that the poor and elderly need assistance, I do not believe that most Americans need assistance. They make choices that they want the government to assume. " Agree Agree Disagree This will grow like most government programs to consume a high % of our GDP We do have a problem in health care. Government at many levels have forced providers to constantly add additional benefits to their coverages which forces premiums up. Government has also increased the cost just by layers of administration with no benefit for the dollars. 28296 07/27/06 CA Agree Agree Agree Agree Agree There are other countries that take care of there own. why shouldnt ours do the same . Born and raised hear at still struggling to keep the ins i do have which isnt much and doesnt cover everything. I still have to go through another program t have health ins for my children. Oh yes and forget Dental ins. There just isnt enough money to pay for it. We barley get by now and its getting harder with gas prices going up everyday. Agree 28298 07/27/06 TN Agree I totally agree. Being a Realtor for twenty nine years and the cost of health insurance is extremely high. I haven't had any type of health insurance for over two years and in good health. No one ever knows what each day will bring and someone's health will be affected. Agree I agree with all of the above. Agree No response No response Agree This health care situation is very important to uninsured people that need health insurance. 28299 07/27/06 MO Disagree "Healthcare is not a guaranteed right, it is an individual choice. It is not the taxpayers responsibility to insure those who make the choice not to have health coverage. We already have programs in place for those who CAN'T get heatlh coverage due to health of finances. " Agree This sounds good as long as the governement does not attempt to run the system. Let the private sector have the control. Agree "It is fine to use the exisiting programs to better health insurance. But do not lay the responsiblity of paying for everyone's health insurance just because they refuse to pay for it. Help the ones that need help, don't add to the problem." Agree "Help those who need help, this sound like a good idea. But the cost of the Hospice Care should not be federally funded unless under the exisiting programs susch as Medicare. The rest should be covered under the private health system." Disagree "* It is a dangerous idea to have a governement run healthcare system. It would take the choice out of our healthcare. The government would be in control of the doctor we see, the treatment, and everything involved. The doctors and the individuals would no longer have a say in their treatment. Bad idea! People that NEED financial assisitance already have programs in place, use those. Do not create additional ways to burden the taxpayers who do the right thing by providing their own health insurance. It is not fair to the honest taxpayers to pay for those who are to lazy to provide their own. We are a democratic society, not a socialist society. Government run healthcare is socialism at it's finest!" Disagree "People who want to work hard and provide their own healthcare will do jsut that. It is a priority to them. Those who are too lazy to work for it are not the honest people's problems. It is not a prioritiy to them, so it is not my fault. " "Again, do not create additional programs or rules. People are in charge of their own destiny. The majority if the uninsured are that way by choice, it it not the responsibility of honest hardworking taxpayers to cover them. I work hard for my healthcare, they can do the same. Those who cannot do so ALREADY have programs in place for them. " "Keep America as democratic society. Do not make us into a socialistic society by having government run healthcare. Let the free market and the PEOPLE determine healthcare. Government run healtcare for ""all"" is a major mistake, If I wanted to be a socialist, I would have moved to Canada or France. I want my America to be a democratic Society! " 28300 07/27/06 CA Agree Agree Agree Agree Agree Agree There should be parity for mental health care equal to physical and dental health care. 28301 07/27/06 WY Disagree "We have these systems in place, they are called health insurance and medicaid. This recommendation does not address the core problem of high health care cost, i.e. low reimbursement rates from Medicare and Medicaid, non-paying patients, and exorbitant charges from medical providers and facilities for their services." Agree Agree Agree Disagree "* For those who need the financial assistance, the medicaid system is already in place. Health care, like many things in life, is a decision which individuals have. Unfortunately, far to many make the decision to go without care or insurance and when it is needed and becomes a financial burden, all others pay through higher health care costs. this is due to non-paying patients which ultimately evolves into higher insurance premiums as the insured and private pay patients carry the burden for them. With all the systems we have in place, few people are totally without access to some form of care." Agree "* I strongly agree that ALL Americans need to share in the cost of health care. One of the primary reasons for high health care costs is the unfunded costs of providing care to Medicare and Medicaid patients. Non-paying patients also make up a fair percentage of the unfunded costs. These factors drive the increased costs which are ultimately picked up by the private pay, generally insured, patients. Ultimately, reasonable costs need to be established. How much should a doctor make? What is a reasonable return for investment in research and capital facilities? Many of these issues need to be addressed before we start throwing more money at the problem." "Throughout the recommendations, reference is made to Americans. No mentioni is made to the millions of dollars which is spent and paid for by insured patients and taxpayers for the services provided to illegal imigrants who have essentially equal access to all facilities." 28303 07/27/06 MT Agree Should not be govornment run Agree Disagree Agree Agree Agree 28304 07/27/06 CA No response No response No response No response No response No response This is a valid email. Why won't you accept it? 28305 07/27/06 CA Disagree "Coverage for all ""citizens""must have some limitations to it, this should not just be a blank check. There are some health issue that a person must take some ownership for!" Agree Agree Agree Agree Agree "In the long run I believe you will need to take the ""profit"" out the part of the current system of agents & etc who sell the plans. The plans should be a standard set of options that we as an individual would select based on desired benefits & what I will/can afford to pay for on a monthly basis. If my expenses exceed my plan I will pay the difference, it was my choice." 28306 07/27/06 CO Agree "* This national program must NOT be run privately, or else we will only be in the same situation we are in now: private companies that are far more concerned with bottom lines than they are with actual healthcare. We need a universal, single-payer, private-provider healthcare system (like medicare but much, much better; or something similar to that of every other civilized country in the world); a system that is government run but still relies on private-providers (e.g. physicians, physical therapists, nurses, etc.) to make important decisions about their patients' health care needs, and to provide the best possible care at prices negotiated between those working in the healthcare fields and those within the government-run health care program/system." Agree "* Please keep in mind, however, that America's middle-class is suffering as well. They are more and more often being denied reasonable health insurance coverage, forcing them to either pay exorbitant premiums for less and less care, or to simply go without healthcare insurance for their families entirely. The middle-class is also increasingly just one stroke of bad luck away from bankruptcy themselves. A universal, single-payer, private provider health care system would give EVERYONE EQUAL consideration regarding health care (again, just like every other civilized country in the world). It seems to be the only sensible safety net for all of us." Agree "I am convinced, however, that the only way the federal government will be able to achieve this, without repeatedly spending everybodies' arms and legs off, would be to implement a universal, single-payer, private-provider health care system once and for all." Agree "Hospice is a wonderful program, and I feel that it should be expanded to reach more people/families during times of health crises." Agree Agree "I think that all Americans should pay a fair and equal amount in taxes to make a universal health care system possible, perhaps with exceptions for the very poor." "* I really do hope that a universal, single-payer, private-provider health care system can be established sooner than later. Americans are losing faith in their government, especially when they can see that such universal systems can and do work for the citizens of all other industrialized countries in the world. Our current system is crippling Americans in so many ways, including making us less competitive in the world market. As it stands now, with insurance companies wasting, denying, and making excuses while lining their bottomless pockets, it can only get worse for average citizens. If we're going to fix it, let's do it right this time. AND PLEASE, LEAVE THE INSURANCE COMPANIES' LOBBYISTS OUT OF IT, FOR ONCE, FOR THE SAKE OF AMERICANS' HEALTH, WHICH IS FALLING BEHIND FAST." 28307 07/27/06 TX Agree Agree Item 3 should include use of nurse/practitioners and also video doctor visits. Agree Agree "This is especially important with the aging ""baby boomer"" population." Agree "The only problem is that we will then get into ""who is an American"" and ""what about immigrants""" Agree "A sin tax should also include foods leading to obesity, such as regular soda, high-fat snacks, fast food, etc." 28310 07/27/06 MA Agree "However, elective surgery and new age treatments must be excluded. " Disagree "Health care should not be income dependent. The same care must be accessible to all persons. It is absurd to only dedicate governmental funding to the low class, when it should be spread equally. " Agree Agree Agree What about limits on Law suits? Malpractice and insurance processing are major costs in our system today. No response 28311 07/27/06 LA Disagree "Health insurance is not a guaranteed ""right"". In an ideal world it would be nice, but there are too many folks UNWILLING to work and partiicpate in paying their share of the bill! I am 58 and have been employed since age 16 contributing to others care while many that I have known over the years choose to do nothing and collect government benefits. This would be yet ANOTHER GOVERNMENT BENEFIT PROGRAM paid for by those of us who WORK! " Disagree "As I stated, this is just MORE GOVERNMENT PROGRAMS it seems. I am for less government programs creating more incentive to work. The exception should be for our elderly or invalid. Those folks we should take care of completely." Agree "In our schools, we should be teaching HEALTH, NUTRUTION, HOMEMAKING & NURSING SKILLS AND FIRST AID. We should also require physical exercise....all of which focus on health promotion. We have shied away from so many programs because of some brilliant theory somehwere and becasue we are afraid of lawsuits. It is time to take a realistic view at today's results and results in eduction 20 - 30 years ago. The children were far better educated and much healthier! " Disagree This sounds like ANOTHER government program to be funded by taxes. I believe the God gave us families to take care of us with the assistance of qualified medical care. The government should not have to assume that responsibility!!!! Agree "They have access now, but in my state, instead of using the hospitals provided, they go into the ""for-pay hospitals"" and demand care. The hospitals give it, they do not pay, and the paying client's bill goes up by 30% to cover their cost. Many of these people are ABLE TO WORK, but choose not to. I STRONGLY OBJECT to this and any other increased governemnt programs. We need to make the ones we have WORK and eliminate the corruption and inefficiencies of these. " Disagree "Guess who will pay for this utopia????? Every worker, and those who CHOOSE not to work will get anothre free ride thereby encouraging their progeny to do the same (which has happened in the last generation with the welfare program). This is a Democrat's dream plan; ""make them depenedent upon the government, and we will get their vote by promising to give them more and scaring them into beleiving our opponent will take away their wonderful, valuable health care""!" "If you have read my comments, you know that I strongly object to government sponsored health care. I believe in work-fare, not welfare for all who are able to work. I believe in taking care of our elderly totally; all other should be required to work to receive benefits." 28312 07/27/06 CA Disagree "* You have not defined ""Americans"". Does that include non-citizen groups? America is the land of opportunity and we are all free to provide for our own medical and insurance needs. Those of use who are less fortunate are being provided for through public assistance. If I can afford for a higher level of medical care because I have worked and saved to provide for my family's care, then that is my right. Where does it say in the ""Constitution"" that we as a people must provide all people equal care? It says the we are free to work and provide for our selves." Disagree "* Government can not fix all things and ask us a taxpayers to foot the bill for everyone. They tried to fix the telephone industry and failed. They tried to fix the airline industry and have failed. They have borrowed and stolen funds from Social Security to the point of inevitable failure. The Government and the Insurance Companies Lobbists and special interest groups that manipulate the laws and Federal spending are trying to destroy the current medical care system. Because of Medicare, State Welfare and our current position on immigration, the medical care system in the America is in a state of collapes. We should fix the issues that have caused the current collapes of our medical system not the system itself. We do need more taxes to provide for those who cannot provide for themselves. We are sending tax $ on other countries health needs, when are we going to spent some of our tax $ on our county's health needs without increasing the working American's tax burden." Disagree "Bigger Governmet has not solved America's problems, it has ony created more. How is BIG GOVERMNT going to regular any industry when it can not regulate itself or it's ability to control its spending. This will be just like the Big Dig, the ceiling will fall in on all of us. " Disagree "* This is our personal choice. If we can afford to provide Hospice care for our family, then that is our right. Now Big Government wants to control how and when we will all die. Get out of our lives. Let us make our own decisions. For those who are not capiable, let their families made that decision and can not afford it, then that is not America's problem. America's problem is that our goverment wants to turn this Democracy in to a Socialist State and all of those have failed. Read the history books, they will tell you that a Free Society is a Strong Society. By trying to manipulate all thigs through legislation, we are slowing destroying the Great Nation. God Bless America and save us from ourselves." Disagree "* Again, you have not defined ""Americans"". Does that include non-citizen groups? America is the land of opportunity and we are all free to provide for our own medical and insurance needs. Those of use who are less fortunate are being provided for through public assistance. If I can afford for a higher level of medical care because I have worked and saved to provide for my family's care, then that is my right. Where does it say in the ""Constitution"" that we as a people must provide all people equal care? It says the we are free to work and provide for our selves." Disagree "* When we settled this county, we did not have medical care for all. We worked together as communities to develop a privately funded system of hospitals and care facilities that attracted medical caregivers. Privately owned insurance companies came later. They provide an insurance products that would insure subscribers against a catastrophic occurance. As they became more profitable, they expanded their product lines to cover medical care. We have forgotten that it is an individual's personal right to choose for themselves and ability to pay for these insurance produces that makes them avaiable. It is not American's responsibility for us to pay for eveyone's medical, car, homeowners or any other from of insurance. Where is it going to end?" "All Americans need to be free to choose for themselves. Socialist and Communist chose what is best for all and in the end if we allow Big Goverment to take our freedoms away from us, we to will become slaves to Big Goverment." "* Stay out of our lives. We are capable of making our own personal choices. If we break any laws then, we can expect government to intervene. If we can't afford insurance then we can't afford to go to the medical care provider unless we really need to. The corrent welfare, Medicare and immigaration policies have allowed those that can't pay to misuse and overload the current medical care system. Fix the cause, not the system. It worked fine until Big Goverment allow it to be overloaded and misued by those who are not paying their way. If I have a cold, I go to bed not to the emergency room. If American citizen's can't pay for their legimate medical care needs, then Big Government should use some of our current tax $ to pay for their care and subtract it from the $ we are sending to other counties. American citizen should come first. American can not be all things to all people. America needs to start saying NO! " 28314 07/27/06 WI Agree Agree Agree Agree Agree Agree 28315 07/27/06 AZ Agree I agree with the concept but there should be some sort of Catastrophic health policy that would be made available to everyone at a resonable cost not goverment entitlement. kind a like flood insurance Agree Agree Agree Agree Only as long as this doesn't turn into a goverment hand out everyone should have accessto quality health care but should commit some of there finacial asset to the cost based on income Agree 28316 07/27/06 CA Agree We also need to keep our standard of health care high and not let our standards fall down as has happened in other countries. Agree An example of success in this area are the parish nurse programs established by many churches. Agree This will be difficult since our health care system is over-stretched already. Agree Hospice is already doing a wonderful service and hopefully it could be expanded. Agree It will be difficult to provide while retaining the high standards we have for medical practice. Agree It will be difficult to find financial sources. This is a huge undertaking. My biggest concern is that we not lower medical standards as has happened in other countries. 28317 07/27/06 CA Agree " I agree 100%, I feel that we need to implement some kind of regulation on medical costs. Why hasn't the government done anything about this? I think that all working individuals should be given some type of medical plan at their work place, it should be mandatory, all Americans should have health coverage there is no reasonable excuse for this." Agree "I think this is a good strategy that if implemented, we will be going in the wright direcction." Agree I think this will be very benefitial to everyone. Agree I am glad that we are addresing this particular need and feel it is a great recommendation. Agree I think this is long over do. Agree " I think that as long as the correct reaserch is done and the implementation is based on fairness for all, it will work." I think that it will be benefitial for all. I just hope that this recomendations will be taken in to concideration and we can get our health care crisis resolved. 28318 07/27/06 AL Agree "More than half of all bankruptcies occur because of medical bills. Even if someone has health insurance (usually at a high premium!) then if that person gets sick, he or she may loose their job- and consequently looses their health insurance. " Agree I support a public health safety net. We need a health population in order to be productive! Agree Agree Agree Agree I'd be happy to contribute what I am currently (although less would be better) paying for health insurance towards a comprehensive universal health insurance plan. More Midwives! 28320 07/27/06 NV Agree The system needs to be private. Tax based systems only leed to rationing. Disagree "This removes the private sector and creates a huge government problem, that will not hold down the cost of care. All it will do is to raise taxes" Disagree "This amounts to government run health care. Higher Taxes, and long lines. This country does not want to head down this path." Agree People with out a means of support for the cost of care need to be helped. Most people have coverage to cover the cost of this care. Most insurance plans pay 100% of this. Disagree All americans have access to health care. Especially with reforms that have been passed. The problem is a lot of people don't want to pay to buy coverage. When they get sick then they want help. You have to play in the goods times and bad. Disagree The private sector works fine. If You turn this into a tax based system you can't go out a shop your income taxes when they go up. If your health insurance rates go up you can shop for new coverage. People don't stop to think about this. This is nothing but a big government run health plan and these things do not save money. They turn into a big machine that you cannot stop or slow down "The entire problem centers around cost. If the cost of care is not controlled insurance costs cannot be held in line. A government run system will not solve the problem. In order to drive a car you must have auto insurance. Every one should be required to have healt insurance, or have them pay into a tax based fund so the public is not strapped with the cost. People must take responsibility for their acts. Suggesting that an entire government system be set up is insane. " 28322 07/27/06 WA Agree "* Health care for everyone, we are way behind in providing health care for all Americans, see other world leaders but value into their families, by giving vouchers to babys and mothers that will help in early childcare, ie our children , infant mortality is pathetically high there is no ethical reason for this occurance. We, the people need to care for each other. Health care has gotten out of control with expense due to our poor preventative health measures. Peopl with no insurance must seek care in the emergency room with is the most costly access to health care. I am a nurse who worries about my maturing at 54 years I ask: who will care for me if I am ill, will I have to declare banckruptcy if I no longer able to pay my bills? Will I become homeless? Not only do I see Americans loosing their retirement benfits because of loopholes, ie United Airlines, Enron etc. How can I count on a retirement plan? I see patients now that are ""Illegal"" but getting health care, but my adult citizen children have no h" Agree "* Mental health care, why are the mental health isses addressed by the police and jails? Police and jails are full of the mentally ill? is this a humane country? can we reinstitute state hospitals? this would provide for a more humane society and a safer society. Our local news paper , The Columbian, last month presented offeners, murders committed by psycotic atlarge "" living within the community"" How shocking! Family members are aware that their loved ones are ill but could not get help for them, until, they committed a crime and went to jail. This is a population that falls thru the cracks in our society. Mentally ill people often times will stray towards self medication or abuse alcohol, become involved with illegal drugs and become victimized by drug pushers. Drug offenders should not go to jail, but to recovery, and more effort must be placed on getting rid of the meth labs. This is a toxic waste, destroying our national parks and ecosystems." Agree "* I worked for the VA and I am proud to say we were very vigilent on budget since the budget was tied to the Presidents anual budgt, we had to await for moneys and services until Congress signed the bill. The V.A did not have enough money to serve the veterans. If we have a national health system, the congress should consider giving up their benifits, to match the benifits of the veteran, not to have privledges that exceed a veteran especially when no one in the Congress has family in Iraq, etc Congress should not have special privileges, we need to do away with preferential and ellitism." Agree "* At present, the er is catch all for end of life issues, resulting in poorly planned discharges . Frequently people are sent home to the care of an elder spouse with no assistance or home care therapies. I know this as I was an advice nurse to the Veterans or as known: telephone nurse. I was able to assist as best as I could, but the elder was afraid to use his minimal resources, they often time would not call paramedics for help for they were terrified of the $1,000 ambulence bill along with the $1,000 bill for 4 hrs in ER." Agree "I have been a nurse for 35 years, and I advocate for national health system. I goes with our right for freedom, happiness. Wellness is freedom. Now we have ""Ill Health ""care We need to fight against poverty, hunger, homelessness, ignorance, poor job training, better schools, a better USA" Agree "* Emergent funding campaign: approach it as a "" Katrina"", tsunami or other crisis, if we are to prevent PanFlu we need to start now! Invest in America campaign. This week I have spoken to 12 Pharmaceutical Reps, trying to sponser a lunch, dinner for my providers. This has to stop! What a waste of money and my time. This money could go towards medication program. I would like to reign in the powerful special interests, the pharmaceutical companies. Stop war, stop Pres Bush for from sending military and moneys to every warring country. IT has not worked in the past. If countries want to fight we still can use non violence measures." "I am a Parish Nurse, defined to include spiritual care. Health, the abscence of illness, includes mind, body and spirit. I would willing to be involved assist in any commities." "* Thank you for the opportunity of this survey I currently work for a non profit federally funded health center founded by spanish community of Seattle wa in 1978. I am proud of their vision and accomplishments. I just started working with them one month ago, after my postion with the V.A.along with 60 other nurses and health care asssitants, our telephone care unit was closed due to the V.A cost control, not due to a ""NEEDS ASSESSMENT"" I chose to decline V.A re-assignment for I feel the VA has lost their vision and mission for the Veterans. I am proud to serve the underclass citizens to access health care. I will learn spanish and russian language and cultures, to enrich my life and hopefully, I will make a difference in my community. ps please edit for spelling and punctuations, thank you. Valerie Huggins Martin Rn" 28324 07/27/06 WA Disagree "I do agree that ALL Americans should be covered by some type of health insurance. We DO NOT need a mandatory coverage that covers everything under the sun - there must be limitations - a ""basic"" plan that takes care of catastrophies. It is NOT government's job to provide this, individuals should be financially responsible for themselves. " Disagree Get government out of this business. We DO NOT need moree bureaucracy - do NOT need another government agency. Congress and states should enact laws requiring coverage of some type - but should NOT supply the coverage - nor pay for it. Disagree Again - not another government agency. let the marketplace take care of it. Disagree "Good plan, but tax dollars should not pay for it." Agree Agree Individuals need to pay. We need to make health care a priority - ABOVE buying that new SUV or other toy. 28325 07/27/06 NV Agree I oppose Government run health care. Disagree I oppose government run health care Disagree I oppose government run health care No response No response No response 28326 07/27/06 OH Disagree "I don't think it is the governments or""My"" responsibility to provide health or child or home care to ""all"" people. I think my ""care"" is not your responsibility but mine. I have a few exceptions; people who cannot provide for themselves. The handicaped, aged as examples. But this is to be a help and not a right." Disagree see comments above Disagree see above Disagree see above Disagree "It should be public policy that all Americans work. Right? What are you people thinking? What do you think government is for? Is it to make a life for me and then make it comfortable and then help me die in comfort as well. These are all Great sentements but they are not the governments task to take up. America is about the free opportunity for these things. These things are not ""RIGHTS"" as discribed. " Disagree "A new Health care tax, well thats a great idea now that gas is over $3 a gallon. You people have got to be kidding. " "So you guys want to have the govenment pay for everyone's dental, mental, and physical, treatments. Does the ""American"" have any responsibility towards there well being? What about people who make poor choices and get hooked on illegal drugs. Is that our responsibility too. Come on we can do better than that." I hope somone reads this because I took time out of my life to write it. How many prople do you know that dont get care. I mean die on the hospital steps because they were turned away. NOT MANY IF ANY. 28329 07/27/06 AZ Agree Disagree "I agree with everything other than establishing the advising group on a national level. If not at a lower level, the trickle down effect takes too long and there will be changes because of the passage through so many hands." Agree How will fraud and waste be reduced (point 3)? Will there be a table as to the quality you can expect in specific health care centers (point 4)? Agree Agree "How would we ensure high-quality? In other national care systems, the wait for services is very long, are we aiming to control that before it happens? This means that there would have to be a considerable amount of national care centers, is this going to happen without compromising quality?" Agree "I don't want to pay more taxes for someone to have health care if they refuse to help themselves. I have to go without health care at times because of my financial situation, but it is not because I refuse to work or am of a criminal mindset, I don't want to pay for those people to have free health care. How are we going to avoid this?" I think that the core outline would have to be flexible or we would run into trouble fast. 28330 07/27/06 CA Agree "why: i believe high out of pocket should be available because as an insurance agent the cost isn't large or high or difficut to pay. regards coverage for all and low income, there needs coverage for basic needs and preventive. there must be some ""skin"" in the game.ig" Agree i guess i agree; i do not know if the goverment has done a good or should i say quality job of what they have done. Disagree i want private enterprise in administing some or alot of these programs. i do not trust the government to be efficient. period. Agree Agree "i believe the HSA is excellent start to give me the opportunity to own insurance at a cost a person can afford. here in california we have it real good. the individual rates are excellent, the ones who can't get coverage have COBRA and MRMIP's and the new government program,i can't think of its name." Agree insurance companies finance health insurance via premiums. the premiums are fine with me. i feel there should be a high deductible insurance plan that brings a lower premium for people who can't get medical insurance. i strongly believe each individual needs to be responsible for their bodies and mind and include an exercise program in their life. "preventive coverage should have some kind of mandadory rule for a person to use preventive measures to access additional high deductible coverage. when you give coverage that covers everything, people do not use it, it costs too much, and isn't necessary. the big picture i think is coverage on the higher charges, hospital and surgery, to not ruin a person/family financial life" HSA is a concept that i sell and people love it. people who do not buy HMO and pay the approprite higher premium. HSA is what the government has done to make more people get and own insurance at a cost and savings benefiting the individual. 28331 07/27/06 WV Disagree Healthcare resources are limited. There is no possible way to ensure coverage for all americans without stealing from one american to give to another. Any such program would thus be an initiation of force against our neighbours and morally/ethically the incorrect action. The only way to reduce healthcare costs is to reduce the regulations that cause it to be such a burden to enter into the healthcare field and make healtcare professionals basically a special class of citizen. Disagree "The federal government in the united states has not initiated any action that has brought to fruition the results that are desired. If the federal and state governments will get out of the way of the natural generosity of the peoples of this united states, we would be able to set up a charitable organization for people without insurance or the cost of insurance might be lower if the only way to basically get it wasn't from an employer." Disagree "* The federal government should stop federally funding healthcare alltogether except for those programs for federal employees and enlisted/veteran troops. We should stop requiring the current working generation to pay for the healthcare of the previous generation, especially since for the current generation all these systems will most likely be bankrupt if we do not remove the government from the equation. The only thing the federal/state governments should concern themselves with when it comes to healthcare is fraudulent claims by healthcare providers and mal-practice by providers as well. Allow the people to choose from whom they wish to receive their health care." Disagree We should fundamentally restructure the mentality that the only way to provide a national helthcare systems is to do so through community or government works. If I did not have to pay approx 5200 a year into the medical/social security system I would be able to more than provide for my own healthcare and those of my family through savings and preventive care. Disagree "If should be public policy that all americans be free to choose the level of healthcare that they desire to have without government interferance or mandates on how much insurance they should have and/or how much they should have to pay for it. Putting a cap on the cost of ""affordable"" health care and/or defining what is and what isn't affordable and the minimum amount of insurance that the people should have limits the ability of people to choose for themselves what it is that they need." Disagree Any financing for health care and improvements of health care should come from the consumers of health care products and the companies that provide those products. "As commented earlier, people should be able to decide with their insurance provider, what if any insurance they need." "* Socialist programs such as this are anathema to freedom. Freedom requires responsibility and one of those responsibilities is providing for your own health. If we still live in the land of the free, people should be able to decide their end of life and living health care needs themselves without regulation or interference from any outside body be it public or private. People may make wrong choices and there will be bad companies. However, if the government is in control of it, there will be no choice and no good ending. The socialist health care systems in Europe and Canada are failures in providing quality minimum health care to all. The only way to provide it is to remove the many regulatory barriers that are already keeping healthcare costs high." 28333 07/27/06 CA Disagree "All should have core coverage, but protection against very high medical costs will cause the cost of health care coverage to increase even more than it is now." Agree No additional bureaucracy. Agree Disagree No funding for high cost medical services. Agree "Again, high cost services should be excluded." Agree I will strongly oppose any financing that comes from value-added taxes or sales taxes. Exclude coverage of high cost medical services. 28334 07/27/06 TN Agree The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured including guaranteeing financial protection agains medical costs. Agree The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. The system should include a network of community clinics that coordinate information and activities. Agree "The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. A single-payer universal health care system should continuously strive to control costs, seek the best bargains and best practices, and improve oversight over fraud and waste." Agree "The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. This should include hospice and other ""end-of-life"" care." Agree "The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. The costs of medical debt, preventable illness, poor prenatal care, unchecked medical and pharmaceutical prices, threat of communicable disease and epidemic, and lost work to illness are infintely greater than the cost of a universal health care system." Agree "The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. Care should be based on need, not on ability to pay. That's fair. Investing in utilizing and improving technology and other cost saving and service improving abilities are of course desirable." The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. An institutionalized and supported means to maintain citizen input is desirable. The U.S. need a single-payer universal health care system. Savings from having a single-payer health care system can cover the cost of people who are un- or under-insured. 28335 07/27/06 na No response Disagree "If we all lived in a perfect world, this would be great. I don't think that the Federal Gov.should be in the health care business. They can't even take care of the Medicare and the seniors. I don't want them responsible for my health care. The medical profession and private insurance companies should work together for the optimum health coverage for all Americans and not be so greedy for the buck." Agree "The Federal Gov. should provide quality care, access to care and streamlined and efficient record keeping for the agencies that they are responsible and should the private sector for those people not on Gov. programs" No response What does this mean. It is such a general statement. I would need more specifics before I could answer this question Agree All Americans should have access to quality medical care no matter what there income level is. Let's speak to the insurance companies about this Agree This needs to be specifically outlined and not be solely financed on the Federal gov. back 28336 07/27/06 FL Agree Disagree Which doctors do you think you are going to enslave to provide this care? Disagree "Again, forcing all physicians who participate in Medicare/Medicaid to lay out capital investment to meet these needs without, I'm sure, increases in reimbursement." Agree Disagree "Getting close to a National Health Care Plan, are we? I hear the fleeing footsteps of America's best & brightest, away from medical education and toward some other, more lucrative career. One without a 10-15 year commitment before the first paycheck. " Agree 28337 07/27/06 CA Agree As a self employed father I find the cost of health care to be burdensom. As many very poor use government provided health care I find myself living with less disposable income then those making less than my family. What is right with that? No response No response No response No response No response 28338 07/27/06 CA Disagree We should stop paying for health care for illegal imagrants. That would solve 100% of our national health care problem. Disagree same as above. Disagree Private industry is the only solution. To creat a Federal program would be a disaster. Agree If some one wants to die let them die. Agree They can do this now with private insurance. Disagree I pay for my coverage and everyone else can pay their own way. Health care should not be free to anyone. same issues. 28340 07/27/06 AZ Agree I also feel that natural or holistic cures be covered by health insureance and a reduction in the reliance of drugs Agree "Yes, these must also ensure cultural competent delivery of services" Agree Agree Agree "Why, not the cost of not providing health care to all is too costly, especially if people use the emergency rooms as primary care." Agree "Whatever the outcome, there must be equity and cost effectiveness." "Yes, but also realize that health is very subjective and varies across cultures and contexts." 28341 07/27/06 IL Agree "Someone must however, make health care providers stop the exorbitant price increases which are only justified by their bottom line" Agree Agree Agree Agree Agree 28342 07/27/06 CA Disagree "Create a spend down rule like they have to medi-cal. It still goes back to resonsibility in Americans to take care of their needs and then if they do get to the point of giving most everything, reward them for their dilegence offering them help (after they've done all they can do)." Agree "Establishing a national public-private group to help advise the federal government on issues and how to handle health related problems and should be a task force of health care providers, health agents, and consumers, and government representatives. Should be a guidance not mandated conclusions. " Agree Why pay for new when you can improve on the existing systems. Educating consumers is a huge part of the solution but needs to be simple and user friendly. Educated consumers will be more aware of fraud as well and will be able to help identify it. Agree "The care for end-of-life support should definitely be a combination of public and private programs. I think it would benefit all areas of our health care and would definitely effect the health of the survivors by meeting these needs as well. Should be offered as part of the training to physicians. Or offer specialists who are available, i.e. hospice workers that do have special funding at least part from government. " Agree I believe there has to be contribution levels for all people in order for us to make affordable to all. We have to have accountability for what we give out in care and when people are part of the solution via financial participation or work related payment. Maybe set up a work program that credits a health account that would pay for care? Disagree there has to be accountability for financing the cost of healthcare. It has to include the recipient of the health care. I'm okay with the equal sacrafice in the terms of percentage vs dollar amount. Americans should still have a variety of plans and benefits available to them according to their need and desire and what they are willing to work for. Choices!!!!! 28343 07/27/06 CA Disagree Provide tax incentives for people to buy health insurance. Make the purchase of a basic policy mandatory. Disagree Health insurance should become as basic a life need as clothing or a car. Disagree "I'm all for eliminating fraud since it drains valuable resources. Make the population more literate and educate people on how to prevent diseases like diabetes, obesity. This requires more than federal programs." Agree Disagree Everyone needs to accept some responsibility for their health care and health care expenses. It should be as basic as providing clothing. Agree Good luck making this happen! a core package with a core price so EVERYONE pays! 28344 07/27/06 NV Agree But I am not willing (nor does anyone I know) to pay for it. Disagree too costly Agree "I like this one, but wonder if the ""solution"" ends up costing as much or more as the ""problem""." Agree "I think that way too much money is being spent on end-of-life services, such as surgeries, etc. " Agree The only problem: who will pay? Agree I feel that life changes such as diet & exercise need to take priority over prescription drugs and surgeries. 28346 07/27/06 VA Agree Agree Agree Agree Agree it is a human right. Agree 28347 07/27/06 TX Disagree "Coverage and protection should be an individual responsibility, not paid by somebody else or paid by the rich to support the poor. Nobody should have to pay for immigrant care." Disagree Statement sounds like it was drafted by a committee to support another tax-funded giveaway program. Agree Disagree All that verbage adds up to more taxpayer responsibility for programs that are already broke. Disagree "Health care certainly isn't a right, and we can't pay for the programs we have now. When the younger generation discovers what they've been obligated for, they will revolt." Disagree "Taxpayers cannot support what we have promised now. We must spend less, not more." Sounds like a lobby group to invade the taxpayers' pockets. 28348 07/27/06 OH Agree Agree Agree Agree Agree Agree 28350 07/27/06 CA Agree "There are far too many uninsured/underinsured citizens. The fact that they cannot pay, or must file bankruptcy to protect their hard-earned assets, passes the uncaptured cost along to the rest of us. Our country should universally cover all its citizens, if we are indeed created equally. " Agree "I agree if there is an HMO model, advocating wellness and preventative medicine, that can steer patients toward a healthier lifestyle. It must include vaccinations, general screenings, and education." Agree We have an incredible infrastructure of health care facilities. The advertising revenues of drug companies could more than pay for many of the uninsured---maybe ads for drugs should be banned at the consumer level. Agree "My mother died with hospice care, at home, surrounded by her family, in her own bed. I can only hope my own final days are the same; with well-trained nurses and aides, adequate pain meds and adjunct care, and in familiar surroundings." Agree "If you are unfortunate enough to contract a major illness or disease, you should have the same chance to survive as I did. It is immoral, in the richest country on the planet, that someone could suffer due to lack of access to the technology and research available only to a select few." Agree "There are too many giant corporations operating at the expense of the communities at large.Far too many CEO's make outrageous salaries, compared to the meager earnings and benefits of the employees who do all the work. Taxpayers and workers shouldn't have the onus of that bloated compensation---corporations need to be more responsible for the health and welfare of the citizens they employ, not less--as is the trend." "No citizen should have to decide whether to buy groceries, or pay for health care coverage. Do you get your lifesaving meds, or pay the light bill? These are the types of decisions people make every day in the U.S---and it is our national shame. " "All Americans should have equal access to health care services. We are all vulnerable to the ravages of disease and injury---we should all be able to survive them equally, without regard to assets or circumstances." 28351 07/27/06 TX Agree What about illegal aliens? Agree Agree Agree Agree Agree 28352 07/27/06 IL Agree Agree No response Agree Agree Agree 28355 07/27/06 CA Agree Agree Agree Agree Agree Agree 28356 07/28/06 WA Agree "We need a single-payer system with no opt-out, which provides a basic level of care to EVERYONE, regardless of age, employment status, or immigration status. Healthcare is a BASIC HUMAN RIGHT. Private insurance programs siphon off too much money which should go into direct service!" Agree Our Public Health System has disintegrated and must be rebuilt! Agree "It is very important that allopathic medicine (e.g., the American Medical Association) NOT be the only player in determining what care is provided. Allopathic medicine offers chemotherapy and surgery for cure, while more emphasis needs to put into prevention, wellness and environmental health. We also need funding for research in complementary care practices!" Agree Agree "...but this fails to state our emphatic belief that a SINGLE-PAYER, FEDERAL system is needed, and insurance companies with their multi-million-dollar-earning CEOs and other executives should no longer be able to siphon off dollars which should go into direct care provision." Agree "Health information systems often generate their data in terms of hospital days or prescription costs. We need to re-define health criteria in ways that consider other than chemotherapy and surgery as effective healing modalities. Emphasizing deep-level health education and public support for more healthful lifestyles will infuriate the corporations benefitted by the FDA and its food-manufacturing cronies, but it will pay off in reduced costs of damage-control medicine as today's children age." "I agree BUT--allopathic medical folks should not be the only drivers of these decisions. Complementary care systems have much to offer, and may be less costly in both the short- and long-term." "When I left the Seattle forum, I felt energized and hopeful. When I saw the 6 recommendations, they looked diluted and more of the same-old, same-old that has kept us from making progress. American medicine is the laughing stock of the modern world. Please let's make some REAL CHANGE toward promoting healthful lifestyles and treating illness holistically!" 28358 07/28/06 CA Agree "* While I agree that there has to be some way of ensuring health care coverage for everyone, I also believe that people will not appreciate it if they don't in some way work towards obtaining it. Sure, we have many poor and disadvantaged people who cannot afford to pay out of pocket for these expenses, or they would already. AFFORDABLE and comprehensive care is essential. But more importantly, we need to ensure the doctors and hospitals who provide the care can be more free to do so without the blatant abuse of mal-practice insurance. Doctors PRACTICE - meaning that they are human, and make mistakes. Working in a hospital, I know that there are checks and rechecks, and health care providers do their best to provide the patient with the services to help meet their healthcare needs. However, so many good doctors and excellent hospitals are bound by the high costs of malpractice insurance that it impedes their efficacy in providing optimal care. So, we also need to have an insurance that is affordable to " Agree "* Again, we have a great resolution here, however, we also need to make sure that we look out for those patients who are ""repeat visitors"". Many of these patients have problems that need to be handled through treatment, such as drug and alcohol abuse. An integrated health care system needs to have with it the ability to access records to these people so that they can indeed receive the care needed. Many of these patients go from hospital to hospital, psychiatrist to psychiatrist, psychologist to psychologist, and even treatment center to treatment center. If we as a nation return to a nation of individuals who are proactive in looking out for these persons - no matter what clinic diagnosis, whether it be schizophrenia, alcoholism, or any other myriad of diagnoses, having an integrated system available for health care providers (based upon a fingerprint identification system) will help get these people to the facilities which can best help them meet their needs. Big brother is not watching - big brother " Agree Argued in favor above. Agree "* With the growing number of seniors who are going to be requiring the needs of such care in the next few decades, we also need to allow for the right to die. Humanitarian efforts to assist patients who are in the throes of terminal illness NEED to have the option to end their lives. We NEED to allow the American people the right to die, and a comprehensive program that allows for a graceful, peaceful and dignified end to life. What we have now is ""keep the patient alive at all costs"". So many don't have advanced directives, wills, or even powers of attorney. While this is addressed when patients enter the hospital and are cognizant and aware of these options, there are also those that don't have the opportunity, and the aegis of responsibility falls upon family members who may or may not be able to meet the needs and desires of the patient, but act out of a sense of ""responsibility"" or ""guilt"" about not ""being there"" for the patient when healthy." Agree Argued above. Agree 28359 07/28/06 NH Agree Agree Agree Agree Agree Agree 28360 07/28/06 PA Disagree "* To save the taxpayers money I believe that after the age of 90 all citizens and any others accepted at hospitals should be willing to go to a hospice to die. This will save lots of money spent for impossible to cure problems, like old age. Illegals and anyone who has stayed beyond their visa limit should be denied healthcare and deported. Let their governments pay for the cost of the airline ticket. It should be deducted from any foreign aid payments to said nation. As for women's healthcare, all the options should be given to the women concerning reproductive health. That includes a statement that any child born and not cared for will result in a charge of child endangerment. Men and women should be required to be screened for known genetic diseases and an abortion should be required for any that are enormous costs to the individual and to society, like sickle cell disease, any disease of the lungs such as cystic fibrosis. Religious reasons for denying healthcare desired by an individual " Disagree "* I have been the recipient of such public private care under the Eisenhower administration. As a child I had only one cavity while covered by a step-parent's work provided benefits. When the company moved overseas and we were supported by unemployment coverage, the private dentist only was paid if he drilled teeth. Hence, suddenly, I had an entire mouth full of cavities though I did not really have any just a few months before. Doctors are not little gods who are honest at all times. One payor system for all screening and opt out privileges for care should be part of the system. If someone wants to pay a private care facility they should be permitted but still have to pay into the single payor government system. " Agree Remember that even Rumsfeld was forced to admit that good bureacrats are very useful. This was after seeing how Iraqi bureaucrats went home on Fridays without cutting the checks for Iraqi police. Agree To the extent that the end of life care doesn't decrease the rights of young and productive individuals then it is OK. We old people must realize that we need to climb on that ICE FLOW for the sake of the rest of humanity. Disagree "If a person refuses to stop smoking, drinking and using addictive drugs then they should not be able to obtain healthcare at the expense of taxpayors. They must be willing to undergo and maintain ""sobriety"" from all addictions." Disagree FDR taxed his own class at 97% when we were recovering from the depression and in WW 2. That the rich need to pay their share is beyond argument. Dividends and profit are earned by the muscle and health of the working poor and the middleclass who fool themselves into thinking that they are better off than the unemployed and unable to work. independent non-partisan private-public group This is just so much bullshit code for neocon handpicked rich people who have an agenda to obtain government contracts for any policy they suggest. The congress should make the decisions in an open way on C-Span covered sessions. "I do not want a rich man like Forbes foisting his 6 kids on the overpopulated world anymore than I want some fundamentalist Hindu, Islamic, Catholic or Protestant spewing out more than 2 replacement clones for the ""family"" cell chosen by a pair of people. Like China we need to limit the population so that the eco system doesn't collapse. It is time to couple health care with an understanding of why we need population control." 28361 07/28/06 TX Agree Agree Agree Agree Agree Disagree 28362 07/28/06 FL Disagree "* I agree with the broad concept that we should protect Americans from high health care costs but there is no viable vehicle outlined to perform this task. This is the worst type of empty chest thumping. Want to do something? Legislate that every working American must be offered an HSA type medical plan that both the employee and the employer will share the cost for. Once every working American is covered, you end a major portion of the cost shifting that now occurs. Not working? You are likely covered by Medicare or Medicaid." Disagree Isn't this called Medicaid? Disagree "Sorry, but this is more empty rethoric. We already have state of the art medical care if you can afford it. If everybody pays, everybody can afford it." Agree "Finally, something with merit." Agree "With this acknowledgement. None of my clients claim they can afford healthcare although many of them have vast amounts of assets. It is human nature to desire a benefit such as health care but to say the costs should be born by others. A good example is the Interstate system. It is in a state of disrepair that everyone can agree on, yet the majority of Americans favor tax cuts (which often do not go to the average American) rather than taxes that will afford better roads." Disagree "* In the end, there are only two viable financing options...A single payer system similar to Canada and many Euro countries, or mandated employer provided coverage with costs shared by both the employee and the employer. The first will impact everyone through higher taxes and less and less affordibility and value. The second will provide incentives for providing a better product, preserving the competitive edge needed with a capitilistic approach and the freedom for all Americans to search for the best companies. As a small employer who has had lengthy discussions with people in Canada and England, I would rather deal with the problem as an employer rather than as a tax payer. Single pay systems are 2 teired and provide basic coverage to everyone but quick and detailed service only to those who have aftermarket covergae. If our industry really wants to have an impact in this discussion, it is time for us to present a real solution rather than platitudes. The momentum for single pay is gaining force. " "We don't need a ""group"" to define what is needed. It is already here in the form of the HSA. If everyone is insured, the costs will stabilize. " 28363 07/28/06 IN Agree I beleive all citizens should have the opportunity to affordable healthcare but also must take personal accountability to maintain good health. There must be an incentive in lower costs for those who maintain healthy lifestyles. Agree "The new system must be, in my opinion, a public / private partnership. Neither can realize optimal results alone." Disagree * I don't believe the federal government has today maximized resources or reduced waste and fraud. It exists within the federally funded programs. I know a millionaire who seeks free care at the VA. Dollars are spent on insurance administration with insurance executives making multi-million dollar salaries while we continue to see an incrase in the uninsured and the working poor who cannot get access to care. A new system must totally overhaul funding and watchdogging. The dollars spent must be re-directed to delivery of quality services with measurable results and must be a combination of public / private entities involved to provide a check and balance. There is little to no trust in the current government system otherwise we would have seen change. Agree Agree "I agree to the extent we don't negate personal accountability. There cannot be a ""free ride"" system for those who neglect or injury there own health by engaging in a lifestyle which increases the risks of chronic diseases. ( Smoking, obesity, etc ) " Agree As a country we need to re-prioritize healthcare from where it currently is in our agenda. We must look at the other areas of spending and reduce waste before increasing taxes or asking employers to pick up more of the tab. All frivilous spending at the federal/state level needs to be addressed before the American public should be asked for more funding resources I appreciate the opportunity as a citizen to provide feedback and would encourage the use of this technology for giving feedback on other relevant issues 28364 07/28/06 CA Agree "I agree.. my daughter is stuck with high hospital costs because public health care dropped the ball, and an overworked social worked could have cared less about helping her, let alone returning her phone calls." Agree Agree "It is time to put the choice back into the hands of the treating physician. I am tired of being denied benefits under my health plan because someone behind a desk does not believe that the procedure or health care plan is needed. That should be at the hands of the doctors. If it is an extreme treatment plan, then it should be a forum of doctors that reviews the treatment plan, not an insurance or HMO flunky." Agree Agree "* I AGREE!!! I am tired of people bring needy people from other countries here for free health care services because a "" caring group of Physicians and health care professionals"" and those that live here are not granted the same ""loving, caring, giving"" help. Why someone who lives here in these great United States suffer without help when it is all around them, but out of reach because of the cost? Don't get me wrong, Doctors with out borders, and other organizations that help impoverished areas to health care options that not available to them is a wonderful humanitarian effort, but where is the humanity when dealing with our own citizens? I do not know that ""universal health care"" is the perfect answer, but I do know that all Americans should have access to great health care. " Agree "* I fail to understand how this country went from a country that most companies offered health care insurance to a country where NO company wants to offer health benefits. Why has no one defined the reason WHY health care became unaffordable for everyone. I understand why employers shy away from good health care benefits for their employees, the cost has sky rocketed.. and by allowing a corporate Giant like Wal-mart to dictate corporate policy... no one wants to pay health care for their employees. Wal-mart sits back and brags about the fact that they have third world countries fighting between each other for the right to sew their $5 shirts for the least cost to walmart... and how they drive the profits of major US corporations like Proctor and Gamble thru their procurement practices... can you imagine the health care package that they could demand for their employees? If they truly drive the economy as they believe they do ( yes, they were just kicked off the throne by EXxon) They would be the drivin" "as stated above, I do not believe that a person behind a desk at an insurance company, or an HMO who has no medical training can deny benefits to needy patients. I believe that a medical review can only be done by trained medical professional. " "* With the corporate greed that is running rampant in this country, the deaparity between the haves and the have nots is growing wider every day. How is it that the politicians only listen to the corporate giants that finance their election campaigns? How is it that the CEO of my company sits on the Homeland Security Council? He does not even care about the employees in his company, he only cares about delivering to his share holders.... so how could he possibly care about the rest of America?He doesn't he is a personal friend of the President. Again with the Waltons...they sit behind their plain unmarked doors in the kingdom of Bentonville like they are still that plain unassuming Sam Walton who opened a little dime store in a small town in Arkansas... it is a sham.... Sam may have lived in the little house that his family grew up in, and did not flaunt his wealth, but the new generation of Waltons lives above their employees reach also, and they too care nothing for the well being of their employees... the" 28365 07/28/06 VA Agree "* We must, as a nation, realize that a healthcare safety net is a necessity. One way or another we will end up paying for uncompensated care through cost sharing or higher fees passed down the line. Isn't it better that these hidden costs also reflect the current drive for transparency? Let citizen's know what they are paying now in taxes and what they may end up paying in insurance or user fees. Let them compare and decide. If catastrophic caps are built into the military health system's (TRICARE's) various programs, shouldn't we acknowledge the importance of such annual (or possibly lifetime) caps for all Americans? I don't think it unreasonable to limit out of pocket costs to a percentage of income--not to exceed five percent--if it guaranteed real access to care and limited financial exposure and capped annual copayments/cost shares." Agree "* I don't think more bureacracy is the answer. Expenditures at the federal level should place implementation responsiblity and accountability at the state or even a more local level. Regardless, at every level a PERSON who is actually in charge must be held accountable. Maybe we need a national health czar. Seems no less important than national security to me. I must say I wonder how the federal government can justify this kind of approach while dismantling Medicaid and failing to provide real oversight when it grants states waivers? Are we replacing one system with another simply as a distraction? Quite frankly I don't think most Americans trust the federal government to do the right thing and sees Congress inability to work in a bipartisan manner as ""representative"" of the problems inherent in the federal bureaucracy. " Agree "This may have the most weight in the marketplace. Money/funding/reimbursement seem to have the most power to accelerate change. Market forces can work if they are not subject to manipulation, in which case the system loses all legitimacy and credibility. " Agree Health literacy and increased patient-provider communication are buidling blocks for beeter care and cost containment through choice. Agree I don't think this is a new idea but maybe we really can learn from history!!! Agree I suggest you consider including dome kind of national long-term care insurance in this mix. Perhaps it would help increase the longevity of Medicare and Medicaid if integrated into this financing strategies mix. "(Access to)Health education, chronic diesease care and management, special needs populations and preventive care should also be part of the defined set of core benefits if the intent is to be all-inclusive. " 28366 07/28/06 IL Agree We should be ashamed that we pay for viagra and don't let children get their immunizations. Agree Agree Please don't just create another level of bureacracy to spend money on administration and committees. Agree Agree Agree 28367 07/28/06 MA Agree Agree Agree "* A significant component of this plan should involve integrted information to provide sharing of health information among providers to assure continuity of care and avoid unnecessary duplication of services. Information technology designed for health information sharing should be a requirement of all health providers who serve/bill under any federally funded program. The expense for this technology though needs to be considered, and shared by both the government and indivudual providers who choose to bill under these federal plans." Agree Agree Agree 28368 07/28/06 CT Disagree A private system is better. Disagree Leave the system the way it is Agree "Now you have it. Tweek the system. find fraud, and penalize the violators. Do like Connecticut does. Cover the poor and poor children. let ther country follow Ct." Agree Ageing and illness connot be avoided. Ok to help them. Disagree No way. that just means more taxes Disagree No new taxes... No new government plans. Just look at the VA. Keep our current system. Look at Connecticuts plan. 28369 07/28/06 KS Agree I would add financial protection for middle income individuals and families. Thank you. Agree Agree Agree Agree Agree 28370 07/28/06 PA Disagree "* These comments come from an insurance agent who has been selling major medical, disability, medicare supplement and long term care insurance for about 14 years. Speaking of impoverishment, you are speaking of health care costs. Your study completely ignored the major cause of the rising costs and that cause is 'law suits'. Stop the attorneys form suing for every little thing and you will see a dramatic reduction in drug costs, malpractice insurance, doctor fees etc. Apparently your group is hell bent on a national health plan. National health plans have not worked in England, Canada and either Italy or Spain. Why do we not learn from other's experiences? A sales lady from Canada stopped in my office about four years ago and relayed her experienc with Canadian doctors after an auto accident. She needed an operation on both shoulders. It took her four years to find a doctor that would treat her. In the mean time she was disabled. Is this the health care we want in America? I do not think so!. I read Geor" Disagree "Federal government programs are subject to the whims of the politiciaons therefore they can not work. Look at social security, the medicare and VA programs. We do not need more federal cutting to fund those programs. I am a retired veteran. The promises made to us in 1954 have been constantly eroded. No thanks, I do not need more government." Disagree Don't mess with my Medicare and TRICARE. The private sector can do a much more effective job. The best strategy is to eliminate the attorneys from the law suit environment and force the drug companies to be reasonable in their pricing. Agree "* I partially agree with this statement. My mother was terminally ill and would not recover. She had given the doctor her written instructions that she did not want life sustaining support. However, the doctor was implementing all kinds of procedures to prolong her life. After a very heated argument, the doctor agreed to remove the life support tubes. In my humble opinion, the doctor was doing this to avoid a law suit. What a shame! We an do better in this country. Let's addres the real cause of the high costs of medical care at their roots!" Disagree "My experience in desigining health plans for clients convinces me that there is no such thing as 'core health care services' that will fit all americans. Our society is far too complex for this. The fourteen of you on this panel do not have the expertise to design such a plan. Therefore, your recommendations are out of touch with reality. " Agree Your financin strategies are subject to politcal whim. There is nothing fair or reliable about your suggestions. The private sector can do a much better job. More taxes on employers is out of the question. I was an employer! Taxes can kill a business very quickly. Have we not learned yet? This is a qualified agreement. The demographics in Pennsylvania are such that many counties have different health plans from the same company. Developing a core health plan is a tall task. Do not implement a national health plan. Look at the results in England and Canada. 28371 07/28/06 NY Agree "Such a program would not be necessary if we had national, single-payer health insurance with no co-pays. If national, single-payer health insurance is not available, then this program should be public rather than private to reduce costs. " Agree "Again, a special program of this type would not be needed if we had national, single-payer health insurance. A program of the type described here is like a band-aid, to fix the problems generated by the absence of a co-ordinated national single-payer health insurance program." Agree "Much of this proposal is simply good medical practice. Some other aspects of the proposal would be rendered unnecessary by national, single-payer health insurance." Agree "Whether or not we have national health insurance, palliative and hospice care should be integrated into the total package." Agree "The simplest and most cost-effective way to solve this problem would be by provision of national, single-payer health insurance with no co-pays. Absence of co-pays is necessary so as not to discourage poor people from taking advantage of health services." Agree "The most important consideration regarding financing is the reduction of costs. The current system contains two avoidable costs: profit to insurers and the paper-work costs required by the presence of multiple insurers. These unnecessary costs should be eliminated by transition to national single-payer health insurance. Physicians for a National Health Program (PNHP) has developed an excellent plan for this transition, and PNHP also has recommendations for financing (http://www.pnhp.org/)." See http://www.pnhp.org/ for further details. "There's a reason why Americans pay twice as much per capita for health care as other developed countries, yet fail to insure a significant fraction of our population. America is the only developed country that I'm aware of that doesn't have a national health insurance program." 28373 07/28/06 ND Agree All Americans should also be required to participate in the cost of such a program. The taxpayers should not foot the whole bill. Deductibles and copays should apply. Disagree Federal programs per-se are not cost effective. The programs should be administered by private insurance companies. Disagree The proof of inefficiency in federal programs is the fact of waste in the current programs. As they get bigger waste will increase. Disagree We as a people need to accept the fact that death will occur. We have too many feel-good programs financed by taxpayer money now. Don't coddle let people grow up Disagree People in this country have a tendency to let someone else foot the bill if they can. All Americans have equal opportunity to get health care in our present system. We have tried to take the responsibility for your own welfare away from everybody thus growing the welfare state. Disagree "There are hundreds of affordable health care plans available now. People will have to individually set their priorities. New boats, cell phones, new cars, and all of our electronic toys should not take priority over taking care of yourself." "The plan sounds good on paper however, in practice it will become a good-old-boys club for political appointees. We cannot have foxes guarding the chickens." 28374 07/28/06 CA Agree Agree Agree Agree Agree Agree 28375 07/28/06 MT Agree "* Just offering a plan will not address the ""high cost"". There needs to be concessions from everyone (caps on litigation, incentive for Dr. and Hospitals to not make so many mistakes, low first dollar coverage and caps on out of pocket expenses, limits on expensive drastic livesaving measures and experiemental, some way to pay for the program that isn't all on the backs of middle income families as now the poor get help and the rich don't pay much, Medicare & Medicaid cost shift must be adjusted,limits on drug company advertising and profits, etc)." Agree Agree Agree People should be able to refuse treatment that prolongs life without quality. Agree "Again it needs to be a fair share, where the middle income people are not the only ones paying. Maybe we should tax the CEO bonus and stock options." Agree "Healthy life style should be emphasized and rewarded. Smoking, etc.need to be discouraged and maybe penalized. " 28376 07/28/06 KY Agree Agree Agree Agree Agree Agree 28377 07/28/06 MI Agree "It should be a public program, with all FOIA protections, whisteblower, etc. That said, this is an incredibly low mark to set. It's unworthy of the time being spent. Health care is a right, and business and government bear the responsibility of making it available as individuals do not have the means to make it happen." Agree "Where you live and your income should not affect your ability to receive quality health are. Additionally, community networks need to be linked with GLBT centers to bring our GLBT citizens into the broader community more fully." Agree Agree "All well and good, but not one cent should go to religous organizations and services. If religious groups want to get involved with health care, they need to fund it themselves as they always seek to limit health care (abortion, rape counseling, birth control, etc) because of their tenets. It's fine to believe what you want of course, but not to have it affect the kind/quality of health care delivered." Agree "Duh, on core health services. Financial assistiance should not be part of the picture as it shouldn't cost us a dime. Our taxes should go to funding this like Canada and various European countries do." Agree "* We have another instance of a group of people who all want ""A"" but in the committee process with private companies ends up with ""B"" or many little ""B's"" as they try to protect profits. Health care is NOT about profit. Health care is about people's lives. Funding this is simple. We take money currently allocated to the Dept. of Defense and transfer it to our new national health insurance plan. We spend an immoral percentage of our national wealth on the ability to deliver death. Next, the profits of the pharmaceutical industry could be taxed dollar for dollar over a certain percentage or cap. We don't need more rich shareholders and CEOs. We need money to keep our citizens healthy. The moral choice is clear." "Again, we don't have specifics that protect a woman's right to choose, nor do we have protections for birth control, sex education, and treatment of STDs and diseases such as AIDS. We must have those or we leave the door open to ""faith-based"" not evidence based science." "* I am frustrated that this process has not been able to sum up more succintly what we are trying to get to. While there are a number of bland generalizations, there hasn't been writing that describes the context for universal national health care and why it's being tackled right now. Try this: Citizens of the United States have the right to the pursuit of life, liberty and the pursuit of happiness. One aspect of these rights is the right to live, to be healthy in body. The economic realities of our capitalist society require government intervention to provide univeral health care for all citizens. Health care should not be for profit in dollars but in the well being of people." 28378 07/28/06 KY Disagree Disagree Agree Agree Disagree Disagree 28379 07/28/06 CA Agree Agree Agree Agree Agree Agree 28380 07/28/06 WA Disagree Health care is a right: all Americans should be guaranteed health care coverage through a national health insurance program. Disagree Health professions schools that recieve federal money should be expected to produce more practitioners who are dedicated to working in underserved areas. The federal government should provide incentives for providers to work in underserved areas. Disagree Much of the rising cost of American health care stems from rising administrative insurance costs. These should also be addressed. Agree Agree All Americans should have access to health care through a national insurance program in which everyone participates. Agree "Americans already spend more on health care than any other Western nation. A restructuring of the flow of dollars should be more than sufficient to cover every American. Businesses and individuals should be expected to contribute, just as they are now." "All necessary health services should be covered (including medical, dental, eye, rehabilitation and mental health)." 28382 07/28/06 GA Agree Only a private system should be considered. We nned a 300 million payer system not a single payer system! Disagree "When we established food stamps, we did not create separate grocery stores. We all need to be in similar private systems competing in the private market for our business. " Agree Agree Disagree All american should be insured in a 21st Century Intelligent Health System. We need transformation to a system to one based on emplowering individuals with information and greater financial responsibiltiy before we guarantee all Amerticans have affordable health care. The existing third party reimburseemnt system can not be what we are using as the basis of this recommendation. Disagree "I disagree with the premise of the recommendation. The marketplace is given a chance will produce new carriers, new products, new services, more choices and lower prices. We must change to a demand control model and jettison the current supply comtrol model that has driven up costs that would require additional financing to survive. We can not ffed the monster that is destroying us. " "* The Shadegg bill allowing cross state selling is a better way to recognize state laws and regulations defining health insurance. I would add that each state insurance commissioner should be allowed to exclude 20 other states from seeling in their state if the laws and regulation of the other state are so egregious that such policies would adversely affect the citizens of the receiving state. With such a mechanism, we would settle on a national state and market establish benefit design without a commission or national law so defining health benefits." "* Insure All Americans by 2010 By Ronald E. Bachman, FSA, MAAA – Senior Fellow, Center for Health Transformation The Center for Health Transformation endorses the goal of access to insurance for all Americans with care provided in a 21st Century Intelligent Health System. We can achieve 100% coverage through market-based solutions, private/corporate efforts, tax incentives, direct public subsidies, strong community support, and faith-based outreach programs. Personal responsibility, individual ownership, portability, and healthcare consumerism are the hallmarks of such a system. New ideas presented below and existing Federal and State proposals include programs and financial support to advance us towards this goal. In a 21st Century Intelligent Health System, the individual has: accurate, timely knowledge of health needs; access to the best information about how to maintain personal health; knowledge of whom to see and where to go for health services, and confidence that health providers are p" 28383 07/28/06 FL Agree Agree The VA is a role model for this. Agree Ibid Agree Agree Agree A responsibility we should all share. 28384 07/28/06 OR Disagree Sounds like a government controlled health care plan. Good ideas but with the wrong administrator. And the working class picking up the tab. Disagree To much government control Agree Agree Agree Only if it excludes national health care controlled by the government. Agree 28385 07/28/06 IN Agree "I agree with this recommendation; however, there should be a limit per person; also there should be qualifiers. If the person is a on-going smoker and refuses to quit, there should be no coverage." Agree Health counseling must be a part of all community based health centers. Agree Agree Agree "The key word here is AMERICANS. People should not be able to come over from other countries just to take advantage of our health resources and overload our system even more than it already is. Qualifiers could be citizenship, paying into Social Security or participating on some other level." Agree "As you stated, nothing is optimal. We should be open to all suggestions." 28386 07/28/06 MN Agree "Having witnessed first hand the hesitation of struggling low/ low middle income to seek medical help for themselves and their children, I implore the government to have the compassion for the hard working poor!" Agree We need to cut throught the red-tape morass and be able to receive funding immediately and where the need is most critical/ Agree "Bring in outside ""observers"" who have no ties to the medical dictates to help oversee the day to day operations" Agree My mother is 98 and living in an assisted care facility.. she is onstantly worried that she will be forced out when the money runs low and this is causing her last years to be spent in fear and trepedation. Agree This is so humane that it requires not additional comment on my part. No response 28387 07/28/06 IL Disagree "The concept of insurance is self protecion against a financial loss. If you remove this motivation, it will encourage others to drop out of coverage knowning a public or private entity pays for coverage they otherwise voluntarily elected and paid." Agree This focus' resources where the population and payment areas lack sufficient resources to maintain an adequate primary care medical services. Agree So long as evidenced based medicine in market defined and not subject to the political process. Agree Disagree I support the philosophical statements. The concern is providing benefits with no personal responsibility and thereby encouraging otherwise responsible persons to shift the cost onto others. Disagree "Depending upon the situation, all medical care is appropriate. The quesiton becomes - what is affordable and how does the rationing of health care occur. Medicine is not quantitative at this time - judgement still plays a major role in the decision process. My concern becomes all care is paid for by the group/public - creating an individual incentive to get ever increasing more - similar to the HMO experience." 28388 07/28/06 NC Agree Agree "* you are what you eat. diet and exercise. schools are mandatory. health is mandatory. health classes and physical education classes should be requirements at every grade level, pre-school through high school. healthcare is one thing, prevention is another. a child who will become an adult needs to be taught how to live a healthy lifestyle. the place to teach the child is in a health class. it has been documented that the vast majority of americans are not leading healthy lifestyles. start at the beginning. " Agree Agree Agree there should be no interest on the financial assistance. Agree "optional dollar amount donation (like checking the box to donate to a political party) when checking out at any grocery/health food store, pharmacy, healthcare practitioner, dentist, specialist's office, etc. the monies can go into a national health pool for anyone who needs medical financial assistance." "i participated in the charlote, nc forum. i am glad there is a voice for those who cannot be heard. if my son were not in college and they did not require coverage, he would not be able to afford healthcare. he is type 1 diabetic. i hope these recommendations will be received and implemented for all americans. " 28389 07/28/06 OH Agree Agree Agree Agree So important not to force treatment on people who because of an incurable illness are prepared to die peacefully. Palliative care and pain control are key. Agree Agree 28393 07/28/06 NH Agree "I would prefer to see ""Guarantee health care coverage for all Americans"", but I would settle for ""Guarantee financial protection for health care costs"". I would get rid of the ""very high"" health care costs." Agree Agree "I agree, but I think it's a mistake to restrict promotion to federally funded, public programs. The private sector has hugh costs and delivers most of the health care in the country and is also in need of quality of care and efficiency improvements." Agree Agree Agree 28394 07/28/06 CA Agree "In order to correct the problem purchasers have encountered with sky rocketing health premiums (via private insurance companies), I support a national health care program administered through a public single payer system." Agree Agree Agree Agree "All Americans should have access to health care services and be able to do so without financial hardship. Government provides other basic services to all Americans; i.e., public education, public safety, etc., which individuals support through income tax. We can acomplish health care reform through this same mechanism of individual income tax and employer payroll tax." Agree "See comments above; i.e., financing through individual income tax and employer payroll tax wherein everyone supports public health care proportionately and fairly." "I support the establishment of identifying high cost protection and core benefits through an independent group which includes representatives from all stakeholders (patients, providers, payers, etc.). I support a public health care system administered through a single payer plan." 28395 07/28/06 CA Agree "I agree but not in it's entirety. Financial protection for true middle income people is DESPERATELY NEEDED TOO. High healtcare costs can bankrupt a middleclass individual or family. I believe the program must be public to avoid additional costs inherent in the competition. If it is one system - then there is no competition, hence no arguements to raise cost. Public oversight will ensure cotrols on cost and guarantee transparency in policy that private corporations are not subject to." Agree "This recommendation does not go afar enough. But we all need UNIVERSAL HEALTH INSURANCE. No one - JOB or NO JOB - shoule EVER be unable to get preventative care, treatment, testing and medications. I have worked all my life except when unable but because of illness am only one severe medical crisis away from poverty. I once had to spend my entire retirement savings account topay for treatment when i was without a job briefly. " Agree "* This recommendationis also incomplete. Evidenced based best practices whether in treatment or prevention - to reach that ""status"" take years of review after the initial research while they could be implemented much earlier and save lives. I work in the field and work with evidence based programs AND STRUGGLE TO DEVELOP AND IMPROVE ON THEM BECAUSE RESEARCH MONIES TO DEVELOP NEW ONES THAT FILL THE GAPS, OR MODIFY THE OLD TO BETTER SERVE THOSE LEFT OUT, LAGS FAR BEHIND funding to implement already tried program ( none of which are 100% sucessful. So service providers and researchers just keep doing the same old thing so that CDC, NIH, HRSA, and this administration can say WE ONLY FUND EFFECTIVE programs, when indeed - as is the case with HIV, STDS - especially communicable diseases - the finding more and better newer prevention strategies and treatments, and broadening who is GUARANTEED FULL HEALTH COVERAGE will better stem the diseases and morbidities, not just look like cost savings for teh administr" Agree Agree "* Alll american s should have access to ALL preventive, treatment, and medications THAT THEY NEED. BASED ON THEIR NEED NOT ON WHAT CLASS YOU THINK I BELONG TO. Ability to get AFFORDABLE LIFE INSURANCE FOR THOSE WHO ARE ILL SHOULD ALso BE GUARNTEED to protect the health of their families. There should be no discrimination based on healthor disease status in health or life or disability insurance - and that shuld be assured in our constitution and in any new health strategy. Most of the Industrialized world does a better job at this then the US. That's sad." Agree "Profits of health insurers and drug companies and related entities could be limited and ensure that ALL corporate and individuals are contributing t this system according to our ability (their baseline profits) to pay NOT NOT NOT according to our ability to find tax breaks and loopholes, and research recovery costs that in reality are covered by federal research monies to NOT PAY." "* This is not sufficient. Please read entirely, and note the many diverse items below. This neeglects to note that PATIENTS ARE PAYERS!!!!!!!!! Benefits should be as NEEDED not on status of who ( wealthy, job, jobless, race, region,disease)but our economic discrin=minating system that alots core sevices ONLY to poor, rich get all when they WANT IT not NEED IT, is not sucessful. Universal care means equal treatment - I think. Doctor/Provider, required/recommended non-prescription drugs, nutritional supplements, vitamins MUST be included - meds often don't work without approprite heaqlth supplenmentation. Those are real NECESSARY medical costs. THat's health too!!!!!!!!! Alternative cares - especially for chronically ill must be part of this - eeven if is often the excuse ALl the dat is not in, or some political group does not only think interms of scientific benefit in treatment. Explicitly rleigion must be kept out of defining helath care FOR ALL since we ALL do not share teh same religion but do s" 28397 07/28/06 CA Agree But the emphasis must be on Americans with very strict limitations on Illegal Immigrants Disagree "I would like to agree, but honestly I believe that you are aedding at least three more layers of beaucracy at the federal, state and local levels. The idea sounds overly optomistic and also, isn't there already some gov. entity that is already in place that can't make it work but should?" Disagree "* Again, I believe that you are too optomistic. If you haven't noticed, most of those agencies such as VA, Community Heath Centers, Medicare, Medicaid, etc. are already over taxed and running short of money to do what they are supposed to. Additionally, you are re-creating programs that are already in place. and your description of what you are proposing is to full of rhetoric with out details. Sure it would be nice to have all of this, but where will the money come from...more debt and who will all their empire be dismantled beneath them in a gov't bureacratic Department when it is found that they are no longer needed because they haven't done their jobs. It truly appears that the people who drafted this proposal doesn't work in health care or they would have realized that they are trying to re-invent the broken wheel " Disagree "I am sorry, but doesn't some of this fall under common sense? And, If you read the papers and familiar with health care, you should realize that the industry does not have the staff to accomplish these goals. You sorely have missed the target. Why haven't you focused on recruitment of doctors and nurses and properely educated health care workers including those that work with the mentally ill. " Disagree Read my comments above Disagree "Aren't there some agencies currently in place that are not doing their jobs or doing them so poorly that you can take their money. I would be happy to contribute a little more, but I don't want to carry it all for those who don't." Read my comments above 28400 07/28/06 WI Disagree "I do NOT support any public health care system. We already have Medicare which the government can't manage, and I don't think the government should be involved any further." Disagree I don't want government to be involved with my health care or the administration of it. The cost will only be GREATER if run by the government. Disagree These programs can be delivered less expensively WITHOUT government involvement. Disagree These services are aleady available through private health insurance plans and don't need expansion. Agree Disagree This looks like too large of a price-tag as defined here. "I would like to receive a discount because I take great care of myself, I am not overweight, and I pass up ice cream because it is unhealthy. Let the government take care of obesity, diabetes etc. and leave health care up to the experts. " 28401 07/28/06 WA Agree Agree Agree Consumer usable information about health care services is in my opinion the most needed feature right now. Agree Agree No response I believe that by creating regional systems where all citizens in one region participate in the same insurance program we could drastically lower costs to the companies and individuals paying for theses insurances. 28402 07/28/06 OR Agree No response Agree Agree Agree Agree 28404 07/28/06 PA Agree "I agree except that it should not be ""private or public""--it must be public; otherwise more of our tax money will go to fatten the coffers of insurance companies and health providers. It will also enrich the pockets of lobbyists who do not have the general welfare as their highest interest." Agree "Once again--the ""public/private"" conjunction will lead to enriching the corporations at taxpayer expense, and will distort policies in favor of those who have the most money to pay lobbyists." Agree Agree And patients who wish to end their lives must be allowed to do so. Agree Agree "Birth control, including the ""morning-after"" pill must be FREE--the best way to decrease the need for abortions. And abortions must be available to all women, including minors, without making them travel long distances, without mandated waiting periods, without being forced to listen to biased propaganda. And sex education must be science-based, not based on the medieval views of certain religious groups." 28405 07/28/06 TN Agree Agree Agree Agree Agree Agree 28406 07/28/06 CA Agree Agree Agree Agree Agree Agree 28407 07/28/06 WI Agree But high deductable plans and MSA's that do not cover prevention are not the answer. We need comprehensive health care that includes mental and dental health Disagree We need large scale pooling at the state level that will streamline the administration of healthcare and provide the leverage to control costs Agree Agree Agree People need advocacy assistance to make sure that they get care when they need it. Agree Everbody should contribute at some level. Make sure the policies that are punitive toward the poor are not tolerated. "What about outreach?? Do not persist with a ""if we build it they will come"" attitude. We need structures and strategies that link people to needed care and coverage" 28408 07/28/06 FL Agree Agree Agree Agree Agree No response 28409 07/28/06 CA Agree Agree Agree Agree Agree Agree 28410 07/28/06 PA Agree "i'm told by some,who claim to be in the know, that one major problem with universal health care is the long wait for service. This is some different than our present system in handling health care. Here, some nurse sitting miles distant, representing some insurance company, tells your doctor that the procedure--or medicine--is not covered---GO HOME!! no waiting. david l and joan m riggle" No response No response No response No response No response 28411 07/28/06 CA Agree Disagree * My problem with this recommendation is that it seems to assume a two-tiered system like we have now: one tier for private care covered by a multiplicity of insurance programs and another tier for those who don't have insurance for one reason or another. What we need is a single payer health care program for all. We need to get rid of the discriminatory system we now have. There is so much fraud and waste in the current multiple payer system that its elimination would pay for a great deal of quality health care. Agree Agree Agree Agree "What I find lacking in these recommendations is any discussion of a single-payer healthcare system. The current multiple-payer system is collapsing under the weight of fraud and waste. The administrative costs that go into running each and every one of these payer organizations are tremendous. Instead of paying hundreds of CEOs, we should be paying only one and this example could be duplicated all the way down the line of administrative and governing board positions in these organizations." 28412 07/28/06 MI No response No response No response No response No response No response "* It sound pretty good but one thing that I didn't notice was a sence of costs. I mean costs to me. As an example if I buy a stero I can compare cost and features at the store. I recieve ads outlining the best deals and choose which one I want based on easy to get information. But when I go to the doctors I have no idea how much it will cost. The prices the doctors post are not the same ones that my insurence pays. There is no price list for services available. If they give me a perscription, I have no idea how much this will cost until I get the pharmacy. Even drug ads don't mention the costs of drugs when advertised. Plus I have no information for alternatives. It is almost impossible to shop around for the best deal. How can anyone plan ahead and set aside the money needed to pay for services." 28413 07/28/06 PA Agree Agree No response I particularly like the consumer-usable information including pricing. Agree Agree Making affordable health care available to all should be one of the highest priorities of our government. Agree Mental and dental health should certainly be included in the health care services that are available under a comprehensive plan. 28415 07/28/06 OR Disagree "* The idea of having all the goals mentioned above guaranteed to all americans is fine. PROBLEM: We presently have all that (basically) for all our seniors (age 65 and over). Result....doctors and hospitals are not paid enough to break even, let alone make a reasonable profit. They have to charge more to those under 65 and on health insurance plans to make up for lost revenue from Medicare. You don't believe....then ask around. If doctors can't make a rewarding income from their services, we will see a steep decline in young men and women who will put in all the time and money it takes to become licensed medical professional. Capitalism feeds off competition....which keeps our medical professionals sharp and also promotes the finest technology available to service our needs. If you want to see how nationalized medicine DOES NOT work, take a good, hard look at Canada's program. They have been feeding off the american medical services for many years now. If they don't want to wait for their services (" Disagree "The federal government does not need to be involved in america's medical care. We can't afford to have our bureacracy impede a program which is one of the best in the world. I know, we do have lots of problems that need to be resolved and it's not going to happen overnight. When it comes to dealing with america's health problems....the federal government is not the answer. " Disagree "* Efficiency of programs and techniques and how to deal with various types of health problems is going to be most successful via a competitive system of professionals who are trained and talented in these areas. As far as fraud and waste in administration, I feel that our government is at the top of the list (just my opinion). Alot of that just mentioned I thought was already a priority of our ""federal services"". The HIPAA law was passed several years ago which included a LAW that required medical service payers and providers to respond immediately to queries related to medical claims and those who didn't would be fined for not being able to do so. For several years, Digital Healthcare, Inc. has offered a solution for this law (which, by the way, would have saved the Federal Government billions of dollars each year). Just another little reason why I don't have alot of confidence in the workings of our Federal Government. " Disagree "All of this is high and mighty. Sure, it would be nice to have ALL people have these benefits....but it is not practical. Our system of government is based on all people having the OPPORTUNITY to provide for themselves and their families. If people don't take advantage of the opportunites offered them, then it is not up to the government to be totally responsible for them. Earning your way is where pride comes in. We are not promoting that enough." Disagree See above. Sounds great but is not reasonable. Agree What has been mentioned in the previous questions is definitely going to require alot of money (including alot of waste). "Committees, made up as mentioned above, may be helpful in providing providers and payers ideas on how our health benefits may be dispersed more efficiently and less costly. The results of these ""committees"" should not result in the government dictating required changes to our system. Our providers and payers should make the changes, based on what makes them ""Leaders"" in their trade or practice." Please remember that we have the best healthcare system in the world. We do not want to reduce the quality. We do want to serve more people. Our competitive system of providing medical services and insurance will be our best vehicle to provide us the answers. 28418 07/28/06 CA Agree It's long overdue. Agree Needed. Agree Agree Agree Agree "I have had personal experience with British National Health program and found it marvelous. We are way behind the times in providing health care for all. It's worth the extra taxes it inevitably will require, but we ought to tax those gouging pharmaceutical companies to pay for it. They are charging unconscionable prices!" 28420 07/28/06 AZ Agree We need to be careful here that no-0ne should be turned away but also with safeguards to make sure no-one is taking advantage of a situation. Disagree We already have a bill that would allow National coverage and it would provide coverage for 44 million Americans - it has been sitting waiting to be heard by our Senate Small Business Health Plans SB 1955 and has been passed by Congress. We need the bill being pushed by the REALTOR assn. passed and if these issues need to be addressed in the bill then they should be addressed. We should not let insurance companioes drive this process. Agree Be careful here as other federal institutions that have been created do not always seem to work most efficiently. Agree Having just gone through this in my own family this definitely needs to be addressed. Agree In the richest country in the world - to allow our federal employess and elected officials to have better coverage than its citizens does seem kind of backward. All americans should be covered and no elected official should receive greater coverage than the average American. Agree Short cycle thoughtto identify and implement as this process could go on forever. 28421 07/28/06 LA Agree Agree Agree Agree Agree Agree "I am a Mental Health Advocate... I am concerned about long-term Mental Health Care for Hurricane/Disaster Survivors and Children raised off the streets, and our People coming home from Wars. " 28423 07/28/06 WA Agree Agree Agree Agree Agree Agree 28424 07/28/06 AZ Agree Agree Agree Agree Agree Agree Increase the tax levels of the wealthy! 28425 07/29/06 CA Agree Agree Agree Agree Agree Agree A single payer/Univerasl healthcare system. We already pay more per capita than other developed nations for less than optimal results. There should be no need for increased health costs. 28427 07/29/06 NY No response No response No response No response "* I am a Registered Nurse and have worked in a city hospital for twenty years. I fully support restructuring the way that palliative care, hospice care and other end-of-life services are provided and financed. I have seen technology used which has prolonged the patient’s suffering and dying thereby decreasing the patient’s quality of life. Many healthcare professionals delay initiating the conversation about the issues involving death and dying. Many times, by the time the issues are addressed, the patient may be too sick to participate in the discussion and express their wishes. This leaves an unnecessary burden on the family members. It should be mandatory that all healthcare professionals receive formal education in the care of the dying patient." No response No response 28428 07/29/06 KS Agree "This is an important recommendation given that nearly 50% of all bankruptcies are caused by health care crises. ""Defaulting on commitments"" is extremely disruptive to the family system and the healthcare system. It is contrary to the primary value our country has on healthy, functioning families." Agree "I interpret this recommendation to mean that the FQHC concept will allow reimbursement to other aleady-existing systems. I would NOT FAVOR expanding funding to the local FQHC. Our community has one of two Kansas FQHCs. My professional experience in working with them as a community collaborator does not give me confidence in the agency's ability to provide seamless, efficient and effective services." Agree Agree Agree Agree 28430 07/29/06 MD Agree Agree Agree I am afraid that training medical personnel using underserved populations teaches a calousness on the part of medical staff that should be shifted. The powerless (which is often what you are when you are in medical care) need advocates. Agree "My dad had Parkinson's Disease. Nursing home staff had little understanding of it and were often scolding and impatient. This prompted an urgency on my dad's part to leave this painful, impatient, insensitive world behind. I could not hire nursing care at anything close to the cost of nursing home care, which seemed expensive enough. Yet the people actually providing the care were not being paid so much. I had a lot of empathy for them. There were a lot of demands being made of them." Agree "This subject is the subject of REAL ""family values."" How do we want to be cared for when we are in need? How do we want our loved ones to be cared for? Why is it that 9-11 did not immediately spark THIS kind of debate rather than vengence - which still is not ours. (The Iraquis had nothing to do with 9-11, but I digress!)" Agree Yes! At last these issues are being addressed! I have been contemplating such a plan for a few years now! So glad SOME INDIVIDUALS actually TOOK ACTION! Congratulations! 28431 07/29/06 UT Disagree "* I believe that the govt. should stay the heck out of health care. Everything they touch ends up costing everyone far more than they would have had to pay if the feds stayed out of it. Look what the 235 program did to housing. It separated rich and poor people by one dollar. we need to get back to the basics. What made this country great was allowing people to fight their own way out of the paper bag. Taht builds strength and character. I was on the welfare roles for a couple of years and I believe that the good it did was way overshadowed by the harm it did to people's (mine included) self esteem. Buy a man a fish and you feed him for a day,. Teach a man to fish and you feed him for a lifetime. Everyone thinks that Roosevelt was such a wonderful president, but he started us on the road to socialism that we are on now. People think that the govt. owes them a living and we are promoting that idea. Everything that made this country great is being taken away. People no longer have consequences for their beha" Disagree "We produce a class of low and No income people by teaching them that govt. is responsible for their well-being. Teach them to ""fish"". Now!! the welfare generations are growing at plague rates. Help people to overcome their situations, instead of band-aiding the problem. No more govt. NO NO NO" Disagree Disagree The govt's role in health care is to oversee the health care professionals. To make sure that they are qualified. To eliminate fraud. There is tremendous fraud in the gavt. health care system and the programs they support are not established with any fraud prevention systems. The cost far more than they need to. Disagree "Please show me one govt. that has provided ""high quality and accessible"" health care. Show me one program our govt. has that is fair and efficient." Disagree "* Allow Americans to help each other, and make people responsible for their own decisions. If they choose to participate in an unhealthy lifestyle, allow them to find a way ot pay for it, or allow individual people to help others without the govt. telling us who and who not to help. When we let the govt. decide, we lose more and more of the freedoms that made this country great. Go home and read the federalist papers and the constitution again and see if it is the govts. place to provide health care to everyone. We have been spoon feeding a nation for far too long. Let them feed themselves again. The only financing I would approve for this type of program is for the govt. to stop immediately paying out to ALL special interest groups. Then every American who has any productive job would have enough of their own earnings left from their paycheck to pay for the services they need. This country gives away billions of dollars yearly to groups that oppose govt. principles. Special interests should be paid by the """ There is no such thing as non-partisan in this country today. The only way to find an non- partisan group is to find out who votes and who doesn't vote and only use non-voters and people with no opinion. "* I am so afraid for the direction this country is taking. Muy grandchildren will not be living in an America that promotes self reliance and a self sustaining life stye. Please don't sacrifice all of our freedoms for ""safety"" A hand up is what we need to get back to, not a hand out. The fraud is rampant in the systems we have now. Clean those up before you consider having another. There are many charities and organizations in this country who give hand-ups, not hand- outs. Let people have enough of their own moneyto help themselves and others. They help people to recover from their situations. Let the govt. do what it is supposed to do. Idealistically, this is a wonderful idea, but the govt. is filled with partisan and self serving people who ruin all of their good bills by adding non-related and non relevant things to every package and then criticize anyone who votes against it without saying why. This will be no different!" 28432 07/29/06 NY Agree "This national program must be the same for everyone, including elected officials, government employees, and the rich. If not, we will be back in the same place at some point. " Agree all populations must get the smae coverage. Agree "At some point all these programs have to be merged into one system, to prevent duplication, or missed persons, and too much admin." Agree "This must be a part of a seamless plan, not separate pieces. Oterwise you will continue to have too much admin. and people will drop through the cracks. " Agree Agree "A graduated income tax on all forms of income is the best system. The lowest levels of income are exempt, but above the poverty level it is graduated upward to reflect ability. No other cost should be invloved. No co-pays. No deductions. No fees. Just an income tax. " "We need to go for one health care plan for all. No waiting, no tinkering with the present system, just plan for and impliment a new system, however long it take and do it. " 28433 07/29/06 SD Agree People should be responsible for the way they live and what it does cost for care. Agree Disagree Agree Agree Elective care should not be covered. Disagree Wouldn't we be creating another IRS which is very costly and ineffective. This is trying to include to much. Do the primary health to start with. 28434 07/29/06 NY Agree "* The sticking point is what is the definition of very high costs. I believe making available major medical coverage for all Americans is a reasonable goal. I believe that the premiums should be set so they take into account lifestyle choices such as tobacco use and charge higher premiums for choices which will increase medical utilization. I believe that these accounts can be combined with Health Savings accounts to help individuals and families make wise choices. everyone, regardless of income should make a payment for their coverage. subsidies can be made available for the poor." Disagree "I believe that if we are to put funding into community programs, they should focus on preventative care in order to drive down useage at acute care centers." Agree "To the extent that we introduce computerized patient records into the system and remove paper, we can increase the sharing of data which will make medicine safer for the public. Drs should be able to access my web based,confidential records to save my life or to coordinate treatment. making the information available in a secure manner is critical to improved efficiency." Disagree "while end of life should be treated with dignity, I don't believe it is the best use of scarce resources to allow terminally ill patients to waste these scarce resources. Therefore there needs to be a better definition of ""accessing the kind of care they want"". We can stand to train people better in these issues." Disagree "Unless we take into account the choices people make that drive up utilization, we will be subsidizing bad behavior. It is OK to want affordable health care but we must work first on preventative care issues with appropriate rewards and penalties for making healthy lifestyle choices or not. the definition of core services is the devil in the detail. " Agree the bulk of the cost should fall on the shoulders of the user. HSA are a good way to begin and low income workers could get tax credits directewd to their HSA. We need to define the terms so I'm ok with figuring out what should be the minimum for good preventive care. 28435 07/29/06 KY Agree Basic health services should be available and accessible to all U.S. citizens Agree A consumer over-sight group should be appointed in order to assure that the major providers (physicians) and insurers do not design a system which is to their benefit and not the consumers. Agree Agree "* At my last check, approximately 50% of US health related expenditures occured during the last 6 months of people's lives. We need to really examine end-of-life options more realistically and begin to expend more money on preventative and restorative interventions. Putting a terminally ill patient on dialysis simply because it is reimbursible is an outrage- both morally and fiscally. Money spent on teaching and enabling healthier life-styles would do more to improve the nation's health than all the money spent on keeping dying people alive a few months longer, and would afford those who are dying more acceptable options for leaving this world with some modicum of dignity intact." Agree "I believe as I stated earlier that basic services should be available to all. This should be a right in a free and wealthy nation such as ours. Extraordinary measures should be available through contractual agreement only, through insurance plans or on a sliding scale adjustment according to income level." Agree "I believe the best option is a single payor system. If the focus is on health maintenance and disease prevention, enough money could be saved within the system to pay for other services without additional revenues. The U.S. already expends more money per capita on health care than any other nation with poorer healthy indices." "I basically agree, but would reiterate that a majority of consumers should make up the planning committees with access to and advice from experts in the fields of health provision and costs/reimbursement." 28436 07/29/06 TN Agree "* It is important that health care costs are regulated so that money should not be the primary reson why some Americans do not seek out the medical treatments they need (as it is now). In addition, financial protection would give some insurance against the continual rising price of health care and provide balance and regulation in terms of what health care manufacturers and related companies can charge for thier services legally. Currently there are no such measures in place and the companies can charge whatever the mraket permits. Realitstically this program will have to be established in the public realm because that will allow it to have the most regulation, controll, and uniformity to it. Regardless of how it is established it is a recommendation that is long overdue and could not be implemented sooner." Agree * This measure is long overdue. There is a serious problem with communication between the various factions in community health networks and federal health networks. The programs that have been most sucessful in combating this problem of communication and healthcare distribution are integrated in nature and are sensitive to the needs of the community. It makes sense to use the resources that are available in a community to improve it. Recognizing the diverse means by which people receive healthcare in thier community and giving them appropriate funding to distribute these sevices is an integral step to ensuring the continuation and effectiveness of these valuable oragnizations. Agree "Again this is another measure that is long overdue. However, each of these issues may require thier own funding and organizaion and should not be lumped together into one concept. In order to address all of these issues federally-funded health programs would require alot more money, time, and resources than they currently have. In reality the current programs may only be able to address and implement some of these ideas unless some dramatic restrcuturing and financial gain occurs within these programs." Agree * I agree that this is an essential area of medicine that is currently overlooked and even avoided by both health services and the medical community. There will only be an increasing demand for such services as the population gets older and sicker. It is important that people are able to receive the health care they need at any stage in life and that they have knowledge of all the realistic options avialable to them. Being able to make an informed decision and have some control over thier personal health will allow people to conduct thier lives with dignity. Living with dignity is important to most people and is a central issue surrounding end-of-life issues in general. Agree This is yet another measure that is long overdue. Finacial reasons are among the top reasons why Americans do not recieve the health care they need. This concern does not only effect individual health but public health as well. Providing affordable means to get health care services is an essential step to ensuring Americans will use the health care sevices they need both for the treatment and prevention of disease/ illnesses. Agree "* I can easily say that it will be complicated to enact a finacial strategy that will please everybody. A fair strategy will ensure that no one faction of the population has to bear the entire finacial burden of the American health care system and at the same time leave no group impovershed. Everyone will have to contribute finacially to the health care system and thier contribution will probably be based on thier income, but it should consider other factors as well. I have one concern about exclusively using income to obtain funding. There are many people that make an income that places them in the borderline between two tax brackets of income. In additon there are many people that have multiple finacial burdens placed upon them such as: being the sole provider of income for a family, having multiple dependents, having to take care of multiple generations finacially, being an adult student with little or no income, having student loans to pay off etc. These and may other circumstances could effect the amoub" I agree that a definition of the package is needed before the package can be properly constructed. What exactly is the process defined in law that will be used to appoint these members? How exaclty will they meet and decide on a definition together? This sounds intersting and I hope it is effective and accuratly defines the basic health care needs of Americans. "* These recommendations sound like the first step in a long line of steps to getting the health care sysem in America to imporve. We can only hope that these issues will come to the forefront of American politics and get the attention they deserve (instead of some of the popular ""Litmus test"" issues that play on the emotions, but realistically have little to no impact on America in general). I am curious is to how long it will take for these recommendations to be voiced politically and how long it will take for these ideas to becime action." 28438 07/29/06 OH Agree "What a disgrace, the richest country in the world has people dieing because they dont have health care. The american people want national healthcare if you dont do it you wont be in office long. Quit being paid off by lobbyist not to have it and do whats right. our founding fathers are turning over in there graves to see how greedy you all have become. bob thompson" Agree Do what the people that voted for you want Agree Agree Agree Agree "I know people pesonally that didnt have health care and where not giving the right tests because of cost, and have died because of it. It should be on your concience. Money and Greed over life. you should be ashamed" 28440 07/29/06 CA Disagree "I take exception to the option of private or public. Private always means profit. Public means government service based on tax money. We should have a service for the public good, not another corporate scheme to make money. Our group in Los Angeles made this point quite clearly." No response Disagree No response No response Disagree "* Our great majority of our group in Los Angeles agreed that we wanted a health care system for everyone without any restrictions based on financial resources or health status, with benefits that could provide high-quality health care without threatening an individual's or family's security. Private programs cannot provide this. No matter how you cut it, private efforts seek profit. Govenment's goal is to look after its citizens, and therefore it should be public financing only. I think Medicare works just fine, and with only a 2-3% spent on administration. A universal system should do th same." "Core benefits implies only basic services, which implies that access to other appropriate care depends on one's finances. But our group clearly were seeking universal health care in its fullest meaning. Maybe private rooms, and other amenities can be extra, but treatments should be for everybody." 28441 07/29/06 WA Agree Best practise care should be available to all Americans regardless of income. Agree Services must have an ongoing feedback process that rates care. Agree Reduce paperwork through development of standardized claim forms. Develop a quality assurance plan that protects the most vunerable populations. Agree Provide training model to teach provider about end of life issues. Agree Coare health care services must include dental. Agree Taxes if used must be progressive. Companies who currently provide health care that at least core benefits and over 70% of both part-time and full-time employees participate should be rewarde for this. Choice and cultural differences must be taken into account when developing core benefits. 28442 07/29/06 UT Agree "This is very well stated. I feel very strongly about this. We simply have too many gaps for those who are low income, those who work for small businesses and those who work on contract. " Agree Agree "No one can be against fraud detection and prevention or increased efficiencny. However, some such past efforts have become witch hunts that have discouraged providers from participating in certain programs, to the detriment of patients. Care should be taken to root out genuine fraud while not become overzelous to the point of engaging in these ""witch hunts.""" Agree Agree "I'm not sure how this differs from recommendation #1 above, but I strongly support them both." Agree "* We need to be careful to insure that persons with signifcant,mutliple disabilities or challenging conditions such as some psychiatric conditions obtain the treatment and services they need, which may fall outside of any identified basic core benefits. Also, Medicaid currently list some treatment as optional to the states when it should not be. For example, dental and vision should be core in any plan--seeing and eating are not optional. In particular, when dental care is lacking people develop life threatening infections and often end up with digestive problems from not being able to eat properly. " "I understand that this is a process that will have to be carefully phased in. Please look first at those who are most vulunerable, who rely on Medicaid and have disabilities. " 28444 07/29/06 IA Agree Disagree "* History shows us that a public-private group such as this will fail. Such ventures have been plagued by corruption and inefficiency. The emphasis should be on public (federal) mandates of standards and establishing responsibility, and perhaps quality issues. The government works best when it weilds financial incentive to perform. The private sector works best on the efficiency aspects, following financial incentives that the government can offer. Identifying and disseminating best practices could certainly fall under the pervue of a public entity, but it would have to be far more free of political influence than the FDA." Disagree "* Integrated health care systems means large multispecialty clinics. Those will exist in large metropolitan areas, and some even expand out into rural areas. But vast portions of this country are still served by individual physicians or single specialty groups. Integration of these is illegal thanks to the governments dogged refusal to allow antitrust exemptions to groups of physicians trying to achieve such integration. Reduction of ""fraud and waste"" is a classic misdirection campaign. More money has been wasted BY the federal government on pursuit of so-called fraud than has actually been lost through genuinely fraudulent schemes. Waste is the definition of a massive government bureaucracy that overburdens providers with insane regulatory and process issues while bemoaning the high administrative costs it has generated all on its own. Health information technologies and EMRs don't need specialized teaching hospitals and clinics to teach medical residents how to use them, any more than Microsoft need" Agree This ultimately requires that society as a whole come to grips with the fact that death is a natural part of life. The best role for government in this effort is in education and these types of initiatives. Hospice programs shouldn't have to rely on donations and fund raising programs. Agree "As opposed to the Big Brother approach proposed during the administration of President Clinton, I would favor a ""no fault"" system of insurance similar to what is done in the automotive insurance field. Again, enable and support the mechanism through government action, and let the private sector achieve the efficiencies." Agree "This is a lofty goal. The only hope to achieve such a goal is to insulate the agency/entity responsible from the political machine. Otherwise, we will just have yet another government program that is profiled at least once a week on ABC's World News Report under the title of ""It's your money"" (that is being wasted)." "A lot of toes will be stepped on with this one, and I mean toes with powerfull lobbies at their disposal. Again, insulate this ""group"" from political influence, or don't bother." "No mention was made of malpractice reform. Unless some form of reform that achieves a greater degree of fairness and stabilty is enacted along with these proposals, we will see no progress. Following ""best practices"" did no good for the makers of silicone implants, Vioxx nor countless physicians and hospitals across this country. This is a monumental oversight on the committee's part." 28447 07/29/06 SC Agree "It's a crying shame that the greatest country on Earth has so many citizens having to choose between food & health care, or between gasoline & health care, or between...well, you get the idea." Agree "Every citizen has a right to affordable health care. Along with life, liberty & the pursuit of happiness." Agree The biggest problem I see is eliminating fraud! The second biggest is - How will it be paid for? Agree "As long as assisted suicide is not included, I believe I can support this plan." Agree Please see my comment on the second recommendation. Agree "No new taxes! My pension has not increased 1 cent in 15 years & now my co-pay has increased 3fold, plus I have to pay a portion of my premiums (which I never had to do before)." Sounds like a plan to me. 28450 07/29/06 NY Agree For a country as rich as ours to not provide affordable health care is morally unaceptable. How we treat the most vulnerable and poor among us is a good measuring stick for our own health as a nation. Up till now we are failing miserably. We must remedy this. Agree "Your proposal seems like a very good outline, and a fine place to start." Agree Agree Any finalized public policy on end of life care should always put the dignity of the patient through compassionate care first . Agree "Core health care sevices should be looked upon as a fundamental right just as important as free speech, religous freedom or any other concept which we hold dear." Agree "I applaud you for your work on this pressing problem . You have established a viable blueprint a starting point which will hopefully lead to a resolution of this long overdo national disgrace. The American people need to know of your work, and its relationship to their own current and future healthcare needs." 28451 07/29/06 ME Agree Definning what is covered is the hard part. How do you tell parents you aren't covering some unproven folk remedy to cure their terminally ill child? Agree Agree Agree "Very few people in our society will even talk about end of life issues. Many have no advanced directives and even when asked to complete one never do. It is very hard to find patients or healthcare providers who can discuss these issues,especially before the crisis hits." Agree "Core services is the hard part. Where do you draw the line. Congress and States keep mandating more and more things be covered and our country can't afford ""State of the Art"" luxury care for everyone. Older meds that are taken multiple times a day work as well as once a day expensive meds if you take them. Very few people seem willing to draw lines on what core care is and where the rationing starts. We ration care now we just do it based on money and influence not ""the good of the whole""." Agree governments pay for almost half the expenses now. A transition to an employee/employer tax to cover everyone plus what the government is already spending could pool what is currently being spent with everyone paying a little more for the currently uninsured. We all pay for them anyway through ED care and cost shifting to insured payers. Individual responsibility for their health is key to making this work. If people don't prevent illness with healthy lifestyles and compliant treatment of chronic illness there is no way we can pay for this plan. We must do something to help get in place a basic package of health care benefits for all US citizens!!! 28452 07/30/06 WA Agree "it is time to let business know that walmart is not the model to follow to be a responsible employer in the U.S.A.. let's show the few companies who care about there employees that they are doing the right thing and should be rewarded with tax breaks, and all unresponsible companies should have to pay for all medical and welfare benefits all there employees receive" Agree Agree Agree Agree No response 28455 07/30/06 FL Agree "In the long run we all pay these costs anyway, I believe it is less costly and more fair to have health care available for everyone. Universal coverage." Agree "I agree with this in principle, however, I do not believe it is helpful to identify special populations. The operative term for me is universal access to health care. Whatever it takes to make that happen I favor." Disagree This will kill the initiative. Disagree Agree Agree "The present ""system"" is not efficient. Who ever heard of providing insurance to those who are most likely to need use it and denying it to those who will not need to use it. Make medicare universal." 28458 07/30/06 MO Agree THis is the only way to ensure care for all Americans!! Agree Government oversight and action is needed! Agree None - Government is on track with this initiative. Agree Lets give poor and indigent people the same consideration that the rich have always had! Agree STRONGLY AGREE!!!! Agree If we have to raise taxes then do it to support this initiative. I would like to participate! None at this time - lets stop talking and move this agenda forward quickly!!e 28459 07/30/06 FL Disagree Privatize Disagree Privatize Disagree "Immigranst are abusing our health care system, throw them out or it will be broke like social security!Privatize" Agree Agree "It should come from thhe private sector, not the Government" Agree I am against uninversal health care it has not worked in Canada or any other countries people die waiting tobe triaged in 28461 07/30/06 MN Agree "We spend too much money on heroic measures and neglect the basics that keep people healthy and prevent disease and disability -- for example, immunizations, prenatal care, well child screening. The WIC program has documented positive outcomes. Why aren't we putting additional dollars into that program. We shouldn't be cutting it." Agree "Supporting the infrastructure is critical, but giving agencies enough to build their infrastructure and then holding them accountable is foundational." Agree It's wonderful if the federal government will actually serve as a role model and not a clog in the system. Agree Individuals at all pay scale levels are entitled to have a peaceful end of life. Agree "We can only accomplish this if we ""ration"" the ulta-expensive options of healthcare that we currently spend an excessive amount of our healthcare resources on today." Agree "* 1) Ration healthcare to avoid high price items to those who have minimal chance of survival on a long term basis. There are plenty of models for this. 2) Increase TAXES those items in society that are deterrent to the broader Community's health -- for example,cigarettes, alcohol, and GASOLINE. If gasoiline were taxed at a greater level, the automobile industry would be forced to create more fuell-efficient cars and the public would be forced to purchase more fuel efficient cars. This would benefit our environment, and our energy reserves. " "The core services MUST include family planning services for women. To ignore the fact that women can get pregnant once they begin menstruating, regardless of age, is detrimental to a woman's health, and potential future health/ earnings/ longevity." 28462 07/30/06 SC Agree Agree Agree Agree Agree Agree 28463 07/30/06 MA Agree The President and Congess have the authority to establish a government funded national program to provide health care all. Disagree "The federal government can oversee the national initiative, however, the individual states can and should, develop and expand the community networks for the provision of healthcare. " Agree "The federal government can oversee the national initiative, however, the individual states can and should, develop and expand the community networks for the provision of healthcare. " Disagree "Palliative care, hospice care and other end-of-life services are provided the issue is that the programs require the financing to be restructured to provide increased access to ensure people get the care they desire and do not end up dying on a stretcher in the corridor of an emergency room, which also is more costly. " Agree Absolutely. It is a disgrace the amount of money provided to third world countries and resident of the United States live in squalor with costly health care services that are out of reach of the majority. Disagree "Financing structures have been initiated by other countries and there is absolutely no excuse that the United States needs to start from nothing and reinvent a system of payment. Many countries have not sent a man to the moon, but are providing health care for all residents. " "The above statements are too encompassing. For example the process and discussion of determing ""core"" health care services could last through generations. Cut to the chase and start with the BASICS, and expand from there. For example: annual medical physical examinations, a simple prescription drug program for partial re-imbursement for the elderly, and payment on a percentage cost basis for NECESSARY surgical procedures. " 28464 07/30/06 ND Agree "This would save on bankrupties that occur due to these costs, and improve the financial health for all" Agree Along with identifying a federal group make sure that local entities are nvolved to soem degree on a process for reporting that is effective and efficient. Agree It would be nice if the federal governement would also negotiate drug prices for medicare D the same as it does for mediciaid and tricare. Agree Also if it is possible for VA to contract out to local providers much like the same process oin which it does for tricare so patients would not have to travel so far for this care and it would be close t home and accessible. Agree If prevention of diseases is emphasized in greater education and insurance practices cverd these procedures I beleieve in the end we wuld all spend much less. Agree be very careful with sin taxes due to it ususally requires a judgement call and it can be a very slippery slope. Dental health is a big problem in rural areas and so greatly effects ovrall health it is good to see it included. The military and state and federal employees have always had health care coverage can we use them as an example of how this could work better for all. If a senator or congressman could not get coverage for awhile it would change their attention span to this problem. 28466 07/30/06 CA Agree Agree Agree Agree Agree THIS IS KEY - we need to cover all. Up preventive care and stop having it so those with the least are forced to get care in extremely expensive emergency rooms. Agree "We need to look to see how we first can start covering everyone - then look to fix the problems. But we have to start now, even if it's not perfect. If we can spend $80 billion on a war in Iraq, I think it's about time that our Federal goverment begins to consider how it spends its money. Our money. Health care is a basic human right, in my opinion. It is our moral imparative to make sure that we take steps to end this crisis." 28467 07/30/06 VA Agree Agree Agree Agree Agree Agree 28468 07/30/06 IA Agree Agree Agree Agree Agree Agree "I don't understand the ""sin taxes"" you're talking about. Who's to determine what's a sin and what isn't? This is a ""morals test?"" How about we talk about ""preventative care and education"" instead." It is absolutely essential to include mental health. Thank you so much for this recognition. 28470 07/30/06 NY Agree No one should ever be deprived of needed care because they cannot afford it. Agree It is important that people have access to needed care. Agree "It is very important that health care costs be brought under control. People live on dog food to be able to purchase needed medications, while the CEOs of major drug companies receive huge bonuses and this is just one example of how this system has been allowed to get so out of control. " Agree People with advanced incurable conditions are entitled to have quality of life up until the end and it is time it was provided. Agree I agree that all Americans deserve access to care and those that have the resources should be paying into that care while those that do not have the resources should never be denied care because they cannot afford it. I do not mean a nose job but I do mean needed care. Agree "All people should have access to the care that they need, irregardless of their finances. Those that can afford to do so should contribute to their care but those that cannot should not be denied care that is necessary. " "The people who make up this commission should not have any ties to the businesses that currently have to much say in public policy, e.g. AMA, Pharmaceutical Industry, Managed Care Companies, etc. " 28471 07/30/06 CO Agree Agree Agree Agree Agree Agree "* Comments to the Citizen’s Health Care Working Group: Health care needs to be universal in order to avoid the cost shifting and the gamesmanship that occurs in the system today. Money needs to be shifted from bureaucracy to actual end point delivery. Too much money is spent setting up roadblocks to care that takes place anyway. We have enough money in the system already to care for people. It is just not making it to them. Liability needs to be reasonable on both sides of the equation. Too much defensive medicine is practiced and not enough of honest liability awards go to the victim. They are eaten up in things like contingency fees. The cost of litigating frivolous suits is also wasteful. Going to you physician should not be a get rich quick scheme. See trusting relationships below. The health care system needs to focus on the trusting physician patient relationship as a means of building relationship that avoids law suit and unnecessary tests, because there is trust. As such, prim" 28472 07/30/06 FL Agree Agree One simple way of ensuring good coverage for everyone is to have the same coverage for EVERYONE including those in government. Agree "Again, the same insurance for everyone" Agree Agree "and again, the same insurance coverage for everyone" Agree unable to make further comment none no 28474 07/30/06 PA Agree Agree Agree Agree Agree Agree 28475 07/30/06 CA Disagree "Govt. is the problem and while can guarantee low cost it can't guarantee good healthcare, in fact I am sure it will be worse." Disagree Federal Gov't has no constitutional right to be involved in healthcare. Disagree Programs such as the ones Gov't already runs are costly and fraudulent. Disagree "Best healthcare is through private sector, free market and choice. THe only reason healthcare is bad now is because of gov't inpimging on healthcare throught runaway lawsuits, skewed tax systen, indigent care forced on hospitals who then cost shift, politically biased FDA etc." Disagree "WE are either a constitutional free market society where rights come from GOd as our Declaration says (with Gov't's job to protect those God given rights), or we are a socialist republic where the gov't can take over everything and decide what rights are and can run our lives as it sees fit. I for one believe our nation was founded on the former, and anything else in not compatible with a free nation. Socialism impinges force and corrutpion on innocent people and always hurts more poeple than it helps." Disagree There will be no fairness if you implement these recommendations "Who are all of you to be defining what my basic healthcare should be? Gov't in this case is the problem, not the solution." "Like I said lets do it all the way, either decide we are a free people and get the gov't out of areas where it doesn't belong, or scrap the constitution and decide we are not a free poeple and should have all of our lives managed by big brother." 28476 07/30/06 CO Agree Agree Agree Agree Agree Agree 28477 07/30/06 NC No response No response No response No response Agree Current structure increases cost but involvement of too many people who profit form either restricting appropriate care or providing ineffectual or unnecessary care. Courage is needed in our legislatures to see the needs of the American people through the haze of self interested propaganda. No response 28478 07/30/06 MS No response Agree I VERA KENNEDY MASSAGE THERAPIST THINK INSURANCE SHOULD PROVIDE THERAPEUTIC MASSAGES FOR PEOPLE IN NEED . WE AS A SOCIATY SHOULD FOCUS MORE ON NATURAL HEALING VERSES 50 PILLS A DAY..... Agree INSURANCE COMPANIES ESPECIALLY MEDICAID AND MEDICARE SHOULD RECOMMEND MASSSAGE AS A PART OF HEALTH CARE. Agree IMPLEMENT MORE MASSAGEING AND THERAPEUTIC WORKS. Agree No response 28479 07/30/06 OK Agree "* Health care is not a social privilege, it is something ""all Americans"" should have the inherit right to participate in. This does not mean ""second rate"" care or unfunded rhetoric by politicians. It also does not mean an insurance company that gets rich and provides substandard service. In addition, a cost incentive feature should discourage individual from over using and require some form of payment according to the need and ability to pay - even if it means public service of a respectable type. This also doesn't mean the middle or upper middle class should pay exorbitant rates and shoulder heavy responsibility just because they worked hard and improved their net worth. Finally, the Congress should do away with their privileged no payment complete medical coverage program. They should should participate - this will ensure those making the policy are also taking a personal interest in it. One way this could be done regarding Congress is to limit their medical full coverage program to cover only during" Disagree "This is just political bureaucracy - kind of like FEMA. The government has a very poor record when it comes to managing assets intended to go to the private sector. It won't work based on past “current” performance of government agencies, and the cost would absorb more funds without effective results." Disagree "This reads like a government employee put it together and has very little direct substance. This recommendation is exactly what I am talking about - not definite plan but push it off on someone else. This program is going no where with kind of verbage in the recommendation. It is losing it credibility with me. Thsi is more government employess getting paid, but not meeting the objectives." Disagree Individual in the final stage of life are not in very good frame of mind to make these decision. The structure of hospice is pretty good under its present form as it does provide some competition for the hospice unit to do a better job - don't take that out of the system - quality is a least showing some degree of inclusiveness because of the competition. Agree I agree but each needs to have the incentive to watch their cost so you structure their cost to their ability to pay. They must pay in some way to contribute value (according to their ability) or they will not have any respect for the system or perform their own self monitoring of their cost. Past give-away programs have proven that - remember federal welfare? Disagree "Generalization - not specifics. The upper class should pay percentage of taxes accordingly to the lower income, but this doesn't seem to work either. We take resource away from the masses and give to the irresponsible few................ie oil corporations. Restructuing must be very carefully done. IT DOESN'T GIVE THE GOVERNMENT A CARTE-BLANT MEANS TO LEVIE ANOTHER COST OF THE WORKER WHILE LETTING THE UPPER CLASS SKIP BY - A TWO STRUCTURE HEALTH CARE SYSTEM WILL DEVELOP - NOT WHAT WE WANT." " “Core system” is too stagnant and would virtually discourage implementation of new treatments. We see that problem, even now, as some procedure are in place in Europe and still the FDA drags their feet. In my opinion, not a good vehicle as stated above" "* Yes, I would like to see a drug program that has no cost window (an uncovered liability to the patient) as current in place. This ia a farce and provides greater profits to the drug companies and limited benefits to the individual. We must, as the Government, not be courting business when it comes to providing drugs to the individual. We must be asking the drug companies for bids and getting a very favorable price break for volume - otherwise, we go somewhere else or provide them with less incentive to charge exorbitant price. A good balance in management is needed to get a good price and a fair return to the drug companies. They are willing to take less - otherwise they would sell the same drug for mush less to other countries." 28480 07/30/06 WI Agree "* OK, except for the part about protecting the ""non""-low-income poulation against ""very high"" costs only. All Americans should indeed have health insurance that protects them against ""high"" health care costs. It would be a mistake, however, to design a program that provides dramatically better financial protection for low-income Americans than for the rest of the American people. Creating a welfare-like, means-tested program for the poor--while the rest of Americans get some sort of bare-bones, ""very high"" out-of-pocket maximum plan--will inevitably create animosity (why do they get a better benefit package than I do...I make only a few dollars more, and pay more for it all?), impose complexity (who's low-income? do we count all forms of income? do we count assets? who's a family member?), require costly bureaucracy (to design the complex rules needed, enforce them, and prevent error), and result in marriage penalties and high effective marginal tax rates or ""cliffs"" for working Americans (i.e., people will " Agree "OK, but having the federal govt. perform the roles indicaed won't do very much to solve the real problem of 40-50 million uninsured & out-of-control costs." Agree Agree Agree "* Yes. But of course you've avoided (at least in this recommendation) answering the key questions: How is this access to be provided? What is to be done for the tens of millions of low-income families (mostly workers, who pay taxes) who can't afford insurance, and whose employers don't provide it? To the extent that this costs billions of dollars, where does the money come from? Do you support imposing an employer mandate? An assessment or tax on employers? On someone else? It's easy to present generalities, but you've ducked all the tough decisions (in this recommendation, at least)." Agree "* Well, at least in this recommendation you've acknowledged the financing question, and identified options. But we all KNEW about the financing question, and KNEW what the options were. You've actually recommended nothing specific...nothing that can be turned into a federal or state law, debated, and enacted. There are only three ways to generate the kind of money needed to finance a rational American health insurance system. Increase the income tax dramatically (or close a lot income tax looples). Increase the state sales taxes dramatically (or close a lot of state sales tax loopholes), or create a national Value Added Tax (VAT). Or impose a payroll assessment or tax on employees and employers. While the first two may be preferable from a tax policy perspective, the latter--a payroll assessment or tax, akin to the way we finance most other major social insurance programs (i.e., unemployment insurance, social Security, and Medicare)--is the best way to go, especially as it will largely REPLACE a de fac" "OK, I guess, but need clarification about the effect of these recommendations. Are they binding? On whom?" 28481 07/30/06 PA Agree Agree I have personal experience with federally qualified community health centers and integrated community health networks. They do really work. They provide the needed health services and they are cost effective. Agree Agree Agree Agree 28482 07/30/06 MN Disagree "This is step towards socialized health care. Look at the mess Medicare and Social Security are in and we don't need to add another layer. If this is to be done privately, I'd reconsider." Disagree Too much federal government involvement. This will lead to more waste of resources like other federally run programs. Agree Coordinating programs might work to streamline some practices. Agree As long as euthanasia is not a consideration. Agree Everyone will have to pay regardless of their financial status. Agree HSA's are a step in the right direction. Keep government out and remove the mandates that add tremendously to everyone's cost. Limiting lawsuits and court awards will also help. 28483 07/30/06 FL Agree "I totally agree. At present, my husband and I are retired. I carry our medical under my retirement. I have been retired for 5 years and with the yearly increase in medical insurance there will come a point that my medical will be greater than my retirement income. Along with that, the higher my medical becomes, the greater out of pocket expense we incurr." Agree Just do it! Disagree "Everything here looks like a lot of run-around. What seniors and everyone else wants is immediate action, not a lot of programs." Agree "Just do it, and do it now." Agree Other countries have systems in place that are addressing this issue. Don't reinvent the wheel. We need this now. Agree "Americans want action, and want it now. Stop all the reterick, like: it will take time. We need help now. " Let's get going. "* As an American, per our past experiences, I know that we as individuals will incurr expenses as far as healthcare is concerned. There have been times in the past when I had good healthcare at a reasonable cost. That is all I am asking for now; good insurance at a reasonable cost, not outrageously high insurance with high deductables and high out of pocket expenses. The few times that I have had to use my insurance, in recent years, after the insurance company paid it's part I still owed so much that I had to go on a payment plan to pay the balance. I don't want a handout, just a little help." 28484 07/30/06 FL Agree Agree Agree Agree Agree Agree "The last sentence says it. Can we have some ideas of what would be involved, and the cost?" Glad to see dental health included as it effects so many other things. "My only comment on the recommendations is that this President and Congress have very definite ideas and do not veer from them. Will they listen to science-based reasons, to science findings?" 28486 07/30/06 UT Agree "altho no one should be impoverished by health care costs, the wealther patients SHOULD have to pay a larger portion of the bill, BECAUSE THEY CAN AFFORD TO." No response "too much federal control, federal requirements, NOT ENOUGH FUNDING FOR THE FEDERALLY MANDATED PROGRAMS!!" Agree there have been very small increases paid to providers in the past 10+ years - EVERY YEAR THEY SHOULD RECIEVE THE SAME COLA THAT social security and other federal programs receive. Agree "once again, the medical providers' recommendation/orders should be honored above the decisions of the insurance community BECAUSE the healthcare providers KNOW the individual!!!!!!!!!!!!!!" Agree Agree "the government has never managed to do this before, what makes you think the impossible has become possible?????" "the doctor of each and every patient NEEDS to be a large part of the decision on what services are available to HIS/HER patient!! after open heart, 5 way by-pass surgery, I was denied the recommended CARDIAC REHAB by my insurance (medicaid), provided in the hospitals' heart center, but some 6-8 weeks later finally approved a DIFFERENT rehab program that was NOT monitored by my surgeon & cardiologist!! who better to monitor it???????????" 28489 07/30/06 KS Agree "I want this ""insurance"" to PREVENT ""very high health care costs"" whether the ""brain surgeon's"" fees or the expense of a box of tissues in the hospital room. I don't want this ""insurance"" to just pay the ""going rate"". I want enough ""socialism"" built in to lessen the individual and corporate greed that is rampant in the American system of health care delivery." Agree "Maybe we just need to look at the ""public need"" for a nation of healthy citizens and be willing to adopt a full and formal socialization of our health care delivery system." Agree "At last a ""wiser"" more ""compassionate"" use of my federal taxes." Agree "I agree but only if each individual or their duly appointed representative (if the individual is mentally incapacitated) is not thwarted in their ""end of life"" choices by others with differing religious or moral convictions." Agree "I believe the publicy policy statement should be : ""Every American citizen has a right to affordable health care and the means to obtain it.""" Agree "If my taxes can be taken in ""fearmongering"" to bomb and kill and maime other residents of this planet then I whole heartedly endorse the use of my taxes to care for at least a portion of the planet. Lets tax the ""off shore"" companies which pay little or no taxes and make certain their hard working citizen employees remain healthy. " "If ""dental health"" is to be singled out from the general ""physical health"" then so to single out ""visual health"" and ""auditory health""." "While we (the United States) may have the best health care system in the world, that is no solace to those who cannot afford to fully participate. I believe that our competitive capitalistic system is not really compatible with the compassion required to care for the health needs of our fellow citizens especially when fraud and individual greed are added to the system. Maybe a ""spoonful"" of socialism might help obtain and get the medicine down the throats of those in need. " 28491 07/31/06 OK Agree access to healthcare needs to be a basic right for the citizens of the united states. no one should have to choose between healthcare and their abilility to provide food or housing for themselves and their families. how can we have the best healthcare sysytem in the world yet approx. 40% of the population has minmal if any healthcare access? Agree "funding for these benefits and services needs to done by assessing fees to healthcare service companies, including those who manufacture products related to or used in healthcare settings based upon their performance and outcomes for providing cost efficient and quality services and/or programs. everyone who is profittting from healthcare in this country needs to give back some of their earnings to support an equitable and fair system for everyone." Agree there needs to be more closely scrutinized spending so we don't end up with a run-a-way train like medicare is now. Agree "we should incorporate 'voluntary community programs' for people to earn ""credits"" they will need in the futue by volunteering a minimum number of hours (monthly, weekly or yearly etc.) to perform services for the elderly, disabled, impoverished by donating their time and talents to accomodate the various needs. " Agree Agree americans should have a financial incentive involved to obtain services for healthcare. there needs to be more emphasis on wellness and prevention of disease so that the people in this country have a vested finacial interest in making the right lifestyle choices as it relates to their health. 28492 07/31/06 TX Agree Agree Agree Agree Agree "Our seniors should have free health care across the board. The system like it is, is very confusing to our elderly and very expensive." Agree Everyone should have free preventive services and there should be a national push to use them and possibly a penalty or tax if not used. Remove the isurance carriers right to determine which doctors have to be used. As companies change insurance carriers people are being forced to constantly change doctors. There is no consistant care and there is no doctor patient relationship. Both are essential in best practices of patient care. 28493 07/31/06 OR Agree I completely agree with this part of the recommendations however they are 90 degrees out from the current administrations point of view and I am confidant they will receive no consideration until Democrats get hold of some power Agree "Sound awsome, again I say nothing will happen with this administration." Agree Evidence is not a criteria for judgement in this administration. Agree Private payers are not going to give up the horrendous money they are making to give any kind of fair health care without a big fight. Agree I agree but we saw what happened to Hillary. Agree We need to cut the cost of health administration. The Medicare model would provide effective health care for all for much less than it is costing now. Fighting the government to get an independent non-partisan private-public group will be interesting to see. I am all for all of it. I just say good luck. This is about as likely as world peace. 28495 07/31/06 MO Agree Agree Agree Agree Agree Agree 28496 07/31/06 FL Agree Our present healthcare system is available for anyone who can afford its high costs. This system needs to be abolished and affordable health care should be the priority for our citizens. Agree Agree Agree "Federal, state, community and private organizations should pool ideas and resources for the goals and good of the cronic and seriously ill patients so help and support will be available to all." Agree Healthcare should not be based on the ability of the patient to pay. Everyone needs to be able to access quality healthcare. Agree The system should be developed to insure that everyone pays something to insure that all are covered. At the start the system should cover physical and mental health as the development continues and the problems are conquered it could be expanded to include dental health as well. 28500 07/31/06 GA Agree "Of the three above recommendations, the second and third are, I think, possible and are priority." Agree "Too complicated for me to understand, as I do not know how these entities operate. Must be good ideas, I suppose." Agree "These are wonderful, high-flying ideals. Lots of people talk about them, but we see little of them in actual life." Agree "I don't think the average person, like me, has any idea how much older and very ill people have to suffer from the absence of conditions of treatment etc. like the above. Why not a campaign to make us more aware?" Agree "That would be ideal, indeed, but whether it is achievable is highly doubtful." Disagree "Either the common man has to pay more in taxes all around, or the big entities who have lots of funds will have to work out ways to return to the society some benefits from what they have accumulated." "It is very idealistic and sound like a recipe for constant haggling, political ploys and insurmountable head-on fights." I don't think the national health problem will be addressed with success unless there is a sea-change in the mentality and will of the American people. 28501 07/31/06 PA Agree It is important to provide support for Americans who suffer catastrophic events that require large financial outputs. There should be greater financial assitance for home health care and convalescences. A catastropic event should not bankrupt a family. Agree Disagree It is extremely important to reduce unneccesary law suits against physicians. High rates of malpractice insurance are cause the cost of care to increase substantially. It is important to incorporate behavior change programs that educate the public about personal responsibility for their health and realistic expectations for doctors. Agree I strongly agree. These services should be provided for Americans at all income levels. Disagree Only the safety net of basic health care services should be improved for those unable to provide health care for themselves. Agree Vision should also be included. 28503 07/31/06 IN Agree Agree I think it's important to keep a public/private group involved and working together. Agree Consumers of health care need information to make informed decisions. The current health care system doesn't treat patients like consumers. There needs to be more transparency of costs in advance and the system needs to be easier for consumers to make choices. Agree Agree I would put this first on the list. Agree It would help the costs if there were a mechanism that rewards personal responsibility for maintaining good health. "I am impressed with the scope of this work and, while we all know that the devil is in the details, I would encourage this broad, objective approach continue as specifics are identified. Unfortunately, I fear that once these recommendations become ""political,"" all this good work will be lost." 28505 07/31/06 VA Agree "Employers, on behalf of full-time employees, should be able to apply for federal healthcare coverage subsidies based on profits, number of employees, type of business (non-profit), employee wages, region, and other economic and social factors." Disagree "I think this is too broad and unrealistic. The Federal Governement should be creating a system by which full-time employees are offered free health care, period. There should be a way for employers that cannot fully afford to garnish wages or pay the coverage fees to apply for subsidies through Medicare. Basically, ""Medicare"" needs to be opened up to the average American and/or employer who cannot afford standard medical coverage to their employees." Agree "Also, providing subsidized healthcare reform to employers for full-time employees (and even part-time under certain circumstances)." Disagree We need to introduce the idea of euthanasia. Everyone's against it until they're faced with a death sentence of MS or other terrible fates. Agree "It's simple and true. Like we have highways and schools for everyone, we should have healthcare." Disagree "I currently pay over USD$5,000 per year in Medicare taxes that I never use nor see. It upsets me that these go towards Americans who are no longer productive members of our society. I don't have a problem with this sory of charity, but I do when it means that those who are productive members of society are denied the very thing they are paying for. Our current system encourages the masses to be unproductive." This has already been done by Medicaid. This effort is a complete waste of taxpayer money and hsould be avoided alltogether. Piggyback on Medicaid. The Federal Government needs to shake down Medicaid the way it did DHS. 28506 07/31/06 MO Agree Agree Agree Agree Agree Agree 28507 07/31/06 CA Agree "* We want to avoid the pitfalls of a totally public health system that often diminishes quality by tying up doctors in bureaucracy and diminishing speed of access to healthcare delivery because of bureaucratic red tape. However, it is a moral duty to provide all Americans with a base level of health care--we need a massive long overdue extension of the healthcare safety net first put in place 40 years ago as part of Johnson's Great Society, and also demand that our larger employers who are capable of affording it provide their workers with adequate coverage. " Agree "Make sure this is not an unfunded (or dramatically underfunded) mandate. In consulting work with elementary and high school teachers, I have seen how No Child Left Behind has often complicated their teaching responsibilities without always improving the quality of instruction, in large part because NCLB regulations have not always been accompanied by the promised increased federal monetary support for our struggling public schools. " Agree "Again, these ideas sound good in principle as long as this is executed through increases in federal healthcare spending and not merely by siphoning money off from other Medicare, Medicaid, and VHA programs." Agree "Sounds good in principle, but it is a very vague recommendation. I am particularly wary that the last component may be a way to foist a federal program onto communities while demanding that they raise a large portion of the necessary funds themselves, thus further disadvantaging low income communities." Agree It is a moral obligation. I agree wholeheartedly. Agree "Taxes to finance this should be raised as much as possible through progressive taxation (income, property, and estate taxes) and not through regressive taxes like sales tax, surcharges on necessary treatment, or payroll taxes." "I am wary about how depoliticized this process will be, since presumably politicians will choose the members of this committee. The more independent, diverse, and medically expert the reviewers, the better chance of meaningful recommendations not skewed by other interests." "* I think this kind of thinking is long overdue in our government, but we must be sure that there is a real investment in implementation and that this is not mere rhetoric. In 2000, President Bush ran a campaign promising to similarly revamp the way we think about education, a plan in which no child would be left behind. The version of NCLB that has been passed by our Congress (and signed by the PResident) however has done little to improve our educational system, and often has dramatically worsened it by creating universal standards that have hamstrung our teachers' creativity in facing serious pedagogical challenges in the most underprivileged rural and inner city districts while also creating an excuse to continue underfunding these neediest schools. With NCLB, we have often done a major disservice to the American children who most need the support of the federal government. I hope that any national healthcare programs do not turn out the same way. If carefully implemented, and amply funded by progre" 28509 07/31/06 MO No response "I agree with the basic coverage for all Americans. We need to define the type of high costs we are discussing. There are high costs that are emergent (not planned by an individual while reciving medical care, or cancer etc) but there are others that people choose like self enhance ment medical issues. Hard choices will have to be made to achieve the ideals we are looking for. " Agree I agree with this recommendation because I have has the opportunity to work with some of these Federaly Qualified Health Centers. The provide high quality care with very limited resources in very low income areas. These are provided within the communities where the people can access them. Agree "I agree with this recommendation, however there should be accountability attached to this. Although the entities listed above do reach the underserved popultion but most are also riddled with waste, so making sure there is strict accountability will enhance the use of tax payers money." Disagree "I do not agree that more spending shhould be put in this area, rather just make it a part or choice in the provision of health care, hoever educate people more of it availability." Agree I fully agree. Agree "Seroius choices must be made on what to cover. There is the general idea that people must be kept alive at all costs, even when the individuals quality of life has completely detoriated. It should be equitable and fair. Public funds should be used." Citizens should also be given the opprtunity to help in defining the core package then the experts can work with that imput. 28510 07/31/06 CA Disagree "I disagree as regards a public plan because national health care programs do not work in the U.K. or Canada as evidenced by the myriad private health care providers that are florishing by providing a back up system to the unworkable, costly, and inadequate national plan." Agree Might work. Need to know more about it. Downside is that it sounds like another costly government beauacracy will be created. Agree Agree Disagree I agree it should be the goal of our government to try to develop an affordable health care program that covers all Americans and legal residents of the country. I do not agree that illegal aliens have the right and access to such public policy once the government determines the type of affordable public/private plan will work. Agree "I agree with the above statement. However, the proof is in the pudding. If the government is going to create another bureaucratic layer of costs on the American taxpayers, who will ultimately have to pay for it, and happen to be only the top 10% of the wage earning population who pay income taxes, then I'm against it. I'm also opposed to any such plan that does not include the participation of competing private programs, which are usually for cost efficient that public plans." 28512 07/31/06 CA Agree Agree Agree Agree Agree Agree 28513 07/31/06 LA Agree It is essential to assure that no one is left out of the system. Agree I agree with reservations because this concept of bringing all these services together will be extremely difficult. Some one or group must be in charge - or there will be so much duplication and disorganization it could be a tremendous mess. Agree Agree Agree I feel this is essential - and it supports recommendation number 1. Agree "payment has to come from somewhere - but also, more efficient presentation and implementation of health care services is essential. That is how things got in such a mess in the first place, the ever present rise of cost of health care" 28514 07/31/06 KS Agree "I agree, but obviously Americans will have to accept some limits to this right to affordable health care. For example, can we afford organ transplants for every American? Preventative and basic health care should be available to every American just as it is in other developed nations." Agree Avoid waste by coordinated effort. Agree Cut the enormous administrative costs of health care by using the Medicare model. Standardize health insurance forms and records. Agree "We may have to look at ceilings on dollars for health care after the age of 70. Can we afford to give every American a million dollar death, while we fail to provid prenatal and early preventative care for infants?" Agree Yes. Agree I do think we would be smar to look at what is working in (all the other) industrialized nations and selct strategies that seem to be working efficiently. ( A mixture of national and private health insurance as well as helath care delivery) Great! 28515 07/31/06 IL Agree Coverage should include infertility and family planning services. Agree Agree Agree Agree Disagree "Develop and enforce parameters for liablity clams against health care providers and health care institutions therefore decreasing one of the contributing costs of health care. Several physicians, advanced practice nurses of my acquaintance pay more in annual libability insurance than they take home in salary. Elimiate lawyers advertising for clients on TV and/or let the public know how much a lawyer makes when he wins the case - how little goes to the injured party." "This approach has potential problems: tends to focus on current proven approaches - decreases incentives to find new solutions to health care problems, tends to focus on problems rather than prevention and health maintainence, tends to focus on middle aged and elderly men and women and ignore mothers and babies/children unless they have a major problem." 28517 07/31/06 NV Agree "* I think there should be some baseline coverage that everyone has, and can buy up to more comprehensice coverage from there. The big problem is how does it get paid for? Who pays? Additionally, if you have a $20,000 out of pocket baseline coverage for instance, low income families and illegal immagrants aren't going to pay for those out of pocket expenses, so it still becomes a burdon that everyone else has to pay. On the flip side, I don't think that the answer is a full-blown government plan. They already can't manage their own multi-billion dollar budgets, Social Security and Medicare." Disagree "If they do this, what's the point of a national system? There also needs to be some more refind rules on helping ""vulnerable populations"" and who they are. Why keep rewarding the single mother who keeps having multiple kids?" Agree "The more information available to the public will create competition withing hospitals and physicians, which should reduce price gauging." Agree "I am not in 100% agreeance with this last statement, ""At the community level, funding should be made available for support services to assist individuals and families in accessing the kind of care they want for last days."" Who's the community level? I think that most private health care plans already provide for Hospice care, so why get the community, ie, the government involved?" Disagree "Again, I don't 100% agree. This statement contradicts itself. It says, ""financial assistance will be available to those who need it."" it then goes to say, ""Americans should have a health care system where EVERYONE participates."" To me, that means everyone is contribution. " Disagree "My biggest concern is that the government is already overspending and they don't know how to stop-they don't want to stop. Medicare is broken, Social Security is being run into the ground-so now let's let them controll all of health care too-sounds great!(sarcasm, just in case it's not comming thru)" "To supply all of this will cost billions if not trillions of dollars-where's this money coming from? Well maybe if congress did not vote themselves a raise this year,we could start the cut-backs there!" 28521 07/31/06 MA Agree "I agree that we should have a national health program but I think it should be public. Businesses, etc. can pay into it. We are the only industrialized country without national health insurance and it is a sad commentary on one of the richest industrialized countries in the world. We can go to war and find the money but we can find the monies to entitle our people to basic health care." Agree I would prefer that we just make one system for everyone. The administrative costs with just one system would help pay for the program. I work in the health care field and the paperwork and diffeent administrative systems become a nightmare. Agree "Couldn't agree more, but still think that everyone should be under the health care system. If someone wants to have coverage for heart transplants and other transplant they could buy supplement insurance. If everyone is on teh same system, we do not have to compete with each other for monies, ex. Elderly vs. children" Agree I work in the hospice area and this would be such a wonderful humane program. Agree A universal health insurance program. - One not dozens. Agree 1. Companies that now pay premiums for health insurance for their employees could contribute a set amount into the national program as could employees. It could all go under Medicare. "I think when you have a universal health insurance plan it is important to identify core benefits, such as immizations, regular health checkups etc." "This is long overdue. I can not believe that the U>S> is so far behind. You wonder whether the lobbists, such as BC/BS and other private insurance companies have kept this from happening along with our politicians where some of them seem to be in the pockets of businesses. Of course, our politicians don't have to worry because they have one of the best health plans and they have pensions that are like no other federal employee. For shame. " 28522 07/31/06 CO Agree Agree Agree Agree Agree Agree 28523 07/31/06 NY Agree Agree Agree Agree Agree Agree 28524 07/31/06 GA Agree Coverage for all Americans - Is that everyone living in America or only citizens? Agree I understand there is a need to help keep small rural hospitals open and expand regional hospital to provide high quality health care to those in rural areas. Agree Agree Agree Agree 28525 07/31/06 NJ Agree Agree Agree Agree Agree Agree 28526 07/31/06 OH No response No response No response No response Agree "* As citizens and recipients of healthcare, the people should have a valued voice in the decisions that impact and affect their daily lives. Are health and healthcare a fundamental human right? If so, the practices and procedures as they pertain to healthcare should reflect the views of the people. As more research is conducted to progress towards a more unified healthcare, special attention needs to be drawn to vulnerable populations, and those people who are currently most disadvantaged by the current healthcare system. Women, children, the elderly, people with disabilities, and those living at and below the poverty line need not just a national healthcare campaign, but protection and aid in helping to meet people’s most basic needs. As the framework develops, a focus on comprehensive healthcare in terms of acknowledging and restructuring political, social, economic, psychological, emotional, and physical is needed to help reach as many people as possible. As much emphasis as there is on cost effec" No response 28528 07/31/06 FL Agree "I agree, Insurance coverage should be affordable for all. I have too many working friends with children that cannot afford to pay high insurance premiums, even through their employer. This has got to change.." No response No response No response No response No response 28529 07/31/06 NM Agree Agree Agree Agree "We desperately need, however, to have a frank discussion and analysis of end-of-life care, taking into consideration cost of interventions, quality and duration of life gained through such interventions, and though difficult, best use of scarce healthcare resources. " Agree "Again, my concerns are that while financial assistance should be available, where do we draw the line. Is every ill person entitled to assistance, even those whose illnesses require millions of dollars to treat? My hope is that we provide first basic care to all, then work on expanding to reach the expensive cases." Agree "We should move away from a financing system that is tied to employment, which is both a burden to employers, putting them at a competitive disadvantage in the global market, and an obstacle to the free flow of labor to suitable jobs, since people will stay in jobs just to maintain the health insurance even if the jobs are not the best use of their potential or interests. " "I would include vision care, as well, if it is not already contemplated within physical health. " 28530 07/31/06 NH Agree Agree Agree Agree Agree Agree 28533 07/31/06 KY Agree "Failure to establish such a program will eventually add to the population of folks who live below the poverty level. A mandatory, universal, single payer health care insurance system must be developed--quickly. " Agree In combination with the single payer system in my comments on the first question. Citizens must have geographic access to providers and preventive health care and education must be a part of the system Agree Absolutely. Agree Agree Agree Yes. All of this is possible Go for it! Its long overdue. 28534 07/31/06 RI Agree Agree Agree Agree Agree Agree 28536 07/31/06 FL Agree The lowest administrative costs should be a stated goal. A single payer appears to make sense to acieve this goal Agree "I would add that local heatlh departments, where they are also service providers, need to be integrated into local community systems of care" Agree "Patient safety, pharmacy safety must be a priority forcus area. Public Health agencies should be integrated into this effort" Agree "I would add that all adults should have mutliple points of access to choice of living wills, and that this be routinezed with the various state's driver's license renewals" Agree Don't forget the list of basic core services from the Oregon Health plan of the early 1990's Agree A sustainable financing system must be the goal. To increase the GDP rate of health care spending to 20% of national GDP does not appear to be sustainable. Hard choices must be made of what will not be covered and major incentives for saving costs need further development and implementation 28537 07/31/06 NY Disagree It is the nickel and dime (normal day to day expenses) health care services that need to be covered. Disagree "We need ONE Health CAre Financing system for all Americans, not a patch quilt for people that have money and people that do not. " Agree Disagree There are no cookie cut solutions for end of life services. It is a shame but people die and no one leaves this earth alive. The least we can do is to help them depart this earth with dignity. i Agree Agree The existing metodology by which we finance health care services is financially discriminatory at best. A sliding scale based upon income should be utilized to determine HOW MUCH someone should pay for health insurance protection. Any US health care financing reform should consist of three components: 1) minimum level of benefits; 2) guaranteed issue; 3) community rating and 4) universal access. 28538 07/31/06 TX Agree This is a very important guarantee about which there should be high-level brainstorming. I don't have any suggestions except to say that it is necessary and that something should be done about it. Agree Care of our Veterans who have fought to keep us free MUST be first-class and ongoing. They must not have to fight to prove that they have been affected by something that happened to them while they were serving our country on battlefields. They should have convenient mental health care as long as needed. Agree It would be in the best interests of the US if this kind of medical care were put in place and operating smoothly BEFORE there is a crisis brought about by Biological Attack or other kind of terrorist action. Agree "Hospice care for all could greatly relieve the burden that affects hospital crowding and free up beds for the acutely ill. Also, hospice-like care is much less expensive and lets people remain in their own homes in their last days." Agree "Poor people should not have to fill out lengthy forms, sit in lines for hours only to be embarrassed by questions about their poor financial condition. Many of them might be able to hold good jobs if they had decent health care." Agree "Actually, the health care of non-covered U.S. citizens is being paid by those who do have coverage, because our premiums keep going up to pay for the care uninsured persons have in Emergency Rooms, to which they go after being ill for some time because they can't afford to see a doctor at the beginning of illnesses. This is the most expensive option and these are the busiest facilities in most cities; this is no way to run a health-care system!" "* Mental and Dental health insurance is vitally important and has been seriously lacking in most health insurance programs, even those that have good physical health coverage. Some low-income U.S. citizens have never seen a dentist, and the abysmal condition of their teeth sets them up for other serious illnesses, even leading to death from brain abscesses and other infections. All citizens deserve dental and mental care from birth to death. Treatment for mental illness might lead to lower out-of-wedlock birth rates, lower crime rates, and much less homelessness. Child abuse would also be lessened. It's outrageous that this most-wealthy country lets millions of its citizens go without care. There's also the danger that illnesses, like TB, which were once wiped out in the U.S. population, will become a problem again because so many citizens are not seeing doctors for wellness check-ups. The state of our health care is ABYSMAL and MUST be improved, vastly." "* I am a retired Registered Nurse. I want to be sure that nurses and doctors are not 'short-changed' in whatever system is set up for the U.S. Nurses are not being paid what their education and skills warrant, and Congress has allowed foreign nurses to be employed here for wages that are higher than they could expect at home, so that U.S. nurses are being undercut for jobs. Also, there are not enough nurse educators to train U.S. nurses because the salaries are so low. Doctors are being swamped with paperwork for Medicare; one of my doctors continues to treat his Medicare patients without cost because he says it's cheaper than paying an employee to file Medicare forms! I am being treated under Worker's Compensation, which is another nightmare of heavy paperwork and seriously-low payments to doctors. There are other countries who have streamlined their costs and paperwork, yet have all of their citizens covered by health insurance. The U.S. MUST insure ALL of our citizens and make sure that health ca" 28539 07/31/06 CA Agree Agree Agree Agree Agree Agree Taxes and other funds that are taken from paychecks should cover costs for others. Tax the rich more. "Consider more funding for recovery/treatment programs and other services low-income people often can't afford but truly need. Think about helping not just LEGAL citizens, but those who are in the lenthy immigration process or working here regardless. HELP THESE FOLKS!" 28540 07/31/06 NV Disagree How will this program be funded? Who will administer? The private sector does a much better job providing benefits. Competition makes it work. Disagree "This is being done in some areas now... but it difficult to fund.. find providers, etc. " Disagree Federally funded programs described above are already overloaded.. it sounds wonderful... but will it work? I don't think so! Agree "This would be a huge undertaking and again... who is paying for all this wonderful ""warm and fluffy"" sounding services to our population that is aging quicker than we think..?" Agree All Americans do have access to health care... they just don't want to pay for it! Or cannot afford it... Again the cost of financing those who don't pay or won't pay is the question. Agree In addition to those taxes mentioned there are other ways to raise money which tax/taxes do you use and how much? "It is hard not to agree with the recommendation... but, this again will be a huge undertaking... and whatever core benefits are decided upon will be nit-picked forever by special interest groups...all wanting coverage for certain ailments... " * How this vast program will be administered (private sector or Govt.) will be a big deal.. who will distribute and get people enrolled is a big deal... I believe our current system of Carriers and agents is working well. Agents are the frontline and advocates for their clients and should be a key ingredient to the success of any plan public or private....someone has to do the education and handholding for people who want to have coverage and this system sounds good on paper but will it work on the street? There are many moving parts in this proposal and getting them to work smoothly will be an undertaking of immense proportion. 28541 07/31/06 OH Agree "* My former next-door neighbors are some of the greatest people you would ever want to meet, but because he was a self-employed trucker and she stayed at home to raise 6 children, they have no real health insurance to speak of. He is suffering from some type of dementia but don't know for sure since they do not have the money for him to be fully tested.This is happening to millions of people across this country. This is a national tragedy, and in my opinion, a violation of one's human rights. Please get something done to help these people." Agree Agree Agree Agree Agree "I would like to keep the health care coverage that I currently have, but something needs to be done to help those who are under or uninsured." 28542 07/31/06 MN Agree Agree Agree "* Don't forget about illnesses about which much isn't know yet. Evidence-based models don't apply well to chronic illnesses or illnesses about which the etiology remains unknown. Some patients receive sub-par care because Dr.s don't read the latest research (even when it's brought to them!) This is HARMFUL to the patients (Hippocratic Oath). In the same vein, urge the discontinuance of Dr.s either: 1) writing prescriptions for antidepressants (or whatever) when they don't understand an illness, and 2)assuming a patient has a psychological or pschiatric or somatic illness, again simply because they haven't done their 'homework'! BOTTOM LINE: Western medicine is largely about prescription medications, which are designed to 'mask symptoms'. These meds are rarely designed to CURE anything! And far too many patients suffer needlessly from lack of regard, and from adverse reactions to those meds, etc. This isn't GOOD MEDICINE." Agree Agree Affordable and Accessible. No response "-->Get rid fo all of the many middlemen that have cropped up in healthcare, in the past decade or so!!! They are unnecessary; complicate issues tremendously, and run costs up dramatically. Also: Costs need to be true costs. Not made up figures. Not gro" "Again, chronic illness is increasing dramatically, partially because so many baby boomers are aging now. A different illness model may be beeded to adress chronic illness needs. " "This is an excellent outline and a good place to start. I hope something actually happens. Soon. (But I am remembering how good the Clinton's healthplan was, and how politics destroyed it:( Please do everything you can to ensure that Congress actually acts on this!!!!!!!! Thank you for your significant efforts," 28544 07/31/06 NH Agree Coverage for all is the priority. Agree Federal support is key but the states need some decision making power also. Agree Agree Agree Agree 28545 07/31/06 IL Agree Agree Agree Agree Agree Agree 28547 07/31/06 IN Agree Agree Agree Agree "I hope that a public education component will be added to this. Advanced care planning needs to become commonplace in hospitals, doctor's offices, nursing homes & other healthcare facilities so that people will realize that these discussions are necessary NOW; not in the ICU while the family is deciding whether to remove a ventilator. Training healthcare workers is one piece of that; however, educating the public is also critical so that people will be able to talk about such normally taboo subjects." Agree Agree "Changing our healthcare system is absolutely necessary but it will not be a change for the better if it is not done in a way that is well-thought out, using best practices and ideas from other nations' experiences. This directive appears to be coming from the right direction." 28548 07/31/06 CA Agree Agree I would support this with the assumption that health care insurance would be available to everyone Agree Agree Agree Agree 28549 07/31/06 OR Agree "I'd also add care for the middle americans who aren't eligible for free coverage yet budgets are too tight for buying health care. there should be basic care fo everyone and levels of additional policies that those with more money are able to buy optionally. It should have a lot of PREVENTIVE features in the policy. Possibly deductibles could vary according to age, earned income and net worth income scales " Disagree private insurance will cost more No response No response No response No response 28670 07/31/06 MN Agree "* There are many examples in both the public and private sectors of the concept of reinsurance, essientially offloading the risk of very high expenses in limited circumstances. Most insurers use reinsurers to offload risk, and the government currently provides terrorism insurance to protect insurance companies. Since a relatively small number of health insureds generate a large share of health costs, having the federal government (or a government chartered corporation) provide a reinsurance program for high-cost insureds could be effective. I think it is important that consumers both share in the cost of their medical care, as well as have choice in how they cover that cost (i.e. a choice of insurance plans). However, that can be accomplished while also providing a safety net for low income earners, and a reinsurance plan to cover high-cost insureds." Agree "While we must be careful not to create a two-tier system in which poorer insureds recieve low-quality care, the current system already has done that in a defacto manner. One idea would be to encourage doctors from overseas to volunteer for community health centers, and to provide tuition reimbursement for doctors (who are US citizens) who choose to work at these centers for a period of a few years." Agree "Standardization of record-keeping is useful, second-guessing doctors decisions is not (as has been shown from the HMO model)" Agree Providing community-based care locally is very important for hospice care Agree Agree It is important that the majority of insureds continue to have choices of insurance plans available through multiple insurers (and therefore bear personal responsibility for their health-care decisions) "Although core benefits make sense, some provision should be made to cover rare diseases that only a small percentage of the population faces." 28757 07/31/06 KS Agree "I agree with these goals. They are essential in any advanced, industrialized country. The United States has been lagging behind other developed countries in many areas of health care. The statictics underline this present lack of care for many of our citizens. Where I disagree with the commission is in the recommeded methods of financing. I will detail my concerns below where you provide an opportunity for such statements." Agree "* I have qualified agreement with these goals. Mainly my disagreement is with the ""public-private group at the national level."" The private input needs to be left out at the national level. The private health insurance corporations are driving up the costs for health care in the United States. At state, and especially the local level, public-private cooperation makes a lot of sense. At the federal level public-private cooperation is mainly a boondoggle to convey more money to corporate officers and shareholders. In other respects emphasizing community-based health centers and practices makes a lot of sense. Some federal support for these networks may be needed." Agree These recommendations make a lot of sense. In Kansas our Insurance Commissioner is currently working to put some of these practices into place. Agree "* Again I have qualified agreement: get the private payers out of the pictures and we will have more efficient, more cost effective health services. Most of us want to stay in our homes, or perhaps in group situations, as long as we can. As a taxi driver in San Diego I talked with several retired people who wanted to maintain their independence in their homes as long as possible. Normally having a visiting nurse, and other visiting workers come to a home is more cost effective than time spent in a nursing home. What might be added to these recommendations is to make available in local health care centers the forms and information giving directions to health care providers as to what one wants done during the last days of one's life.....living will, power of attorney, etc." Agree "* Health care should be considered ""an essential public service."" Education and roads and public transportation are considered essential, why hasn't health care been treated the same way? (Looking back the answer is fairly simple: insurance corporations have found health insurance, by excluding various groups of citizens, to be a fairly lucrative means of wealth for some members of these corporations.) Other advanced nations from Japan to France to Canada provide health care for all. Their corporations are not involved, and they do so at lower costs than what we're spending in the United States, while neglecting 15% of our citizens!" Agree "* As long as we continue the present involvement of health insurance corporations in the collection of premiums and distribution of payments, health care in the United States will continue to spiral upward. (Note the outrageous provision for NO bargining with pharmaceutical companies over prices, in the recent provisions for insurance covering medications.) Perhaps you are ignorant of the following information, or the public in testimony did not mention this, however here is the situation as has come to my attention: 1. On average private health insurance corporations spend 15% of money recieved (premiums) on overhead - the paperwork, the profits and the executive pay. 2. In Kansas, and Kansas probably isn't unusual, 30% of the payments recieved from the private health insurers goes for doing the paperwork. This is required to conform with the diverse terms of the various insurers' terms of policies. They require extra paperwork to justify continued treatments. They endeavor to decrease treatment," I agree except leave the current private health insurers out! 28771 07/31/06 MN Agree Health care should not be only for the wealthy. All Americans need to have the right to health care. No response Agree Need to emphasize that these should be essential required components and not just be promoted by the government. Agree As a culture we need to all become more sensitive to quality of life vs life-saving measures regardless of inability to enjoy or benefit from prolonged life. Agree The health of all Americans greatly impacts our whole country. We need to be sure all have access to health care. Agree "Improvements in efficiency is essential and is coordination of care to reduce unnecessary tests/treatments. As a nurse, I cannot count the number of times that tests are repeated because specialists order something that has all ready been done. We need to get back to more holistic care...specialists have there place but not for everything! Health care has become too fractured! We need to realize that universal coverage will cost more in the short term but will be more cost- effective in the long term." "America is far behind other countries in the ""health measures of its citizens. It is high time we changed this!" We need to make basic health care a right of all American citizens. The sooner we do this the more our country will prosper as a whole. 28772 07/31/06 NV Agree Agree Agree Agree Agree Agree 28779 07/31/06 CA Agree Agree Agree Agree Agree Agree "Since our government was able to ""find"" (allocate)and spend billions of dollars in Iraq (with absolutely nothing to show for it), they should have no problem finding the money to fund health care for all Americans!!! " 28781 07/31/06 NM Agree Keep it in the private marketplace. I'm distrustful of government run healthcare as I just received a Medicare card from CMS for some other individual. What a disaster! Disagree "I mistrust the government. They will misappropriate funds. The communications will get lost. The staff won't be enough and won't be trained. There will be no legal recourse. I believe that the communication needs to be better streamlined and simple policies and procedures need to be in place for physicians, facilities, pharmacies, and insurers. HIPAA seems to have fragmented the system more than ever and that was a Government solution!" Agree "* Transparency, health education, and integrated health care systems is where it is at for containing medical costs. Our American public has grown lazy and fat. We are looking at medical care costs for preventable diseases that could bankrupt any insurer including diabetes, heart disease, and cancer. We are also looking at social pathologies in this country that are nearly impossible to predict on a monetary basis for health care budgeting purposes. Why would the Federal Governement even want to take this on more than it has with Medicare and Medicaid. Medicare and Medicaid are already overburdened with budget overruns - the states that have expanded their Medicaid programs are overburdened with budget overruns - what makes us think that we can do a better job now through more government programs? " Agree Agree "I agree with this, but if we look to the government to fund and administer the program, we will not have an affordable system. We will have a system that will be laydened with taxes and rationed care." Disagree No new taxes!! We should not be looking at how we tax on a socialized basis for health care. The rewards need to be based on good health and actuarily sound criteria. This is the management of risk. It is not the management of tax dollars. Has the Federal Government dropped the notion of just being a reinsurer on a defined contribution basis rather than being a first payor of benefis and premium collector on a defined benefit basis? This is impossible to define. Look at Medicare Part D. The basic benefit package that the Feds developed has been modified by every insurance carrier that offers Medicare Part D. It comes down to choice. Americans need choice and one plan does not fit the needs of all Americans. Keep it in the private marketplace with insurance agents. Please don't skew this toward National health. Your process has been insulting to the Amerian people. You pre-scripted this whole endeavor. America is founded on freedom of choice. Let's keep it that way. 28783 07/31/06 NY Agree Agree Disagree This proposal includes too many government agencies and will choke the hospitals and doctors with regulations. There should be a single payor system. Agree Agree "It is a lofty goal, but the basis for financing the care should be fair and reasonable." Agree "I would support an increase in my income taxes to finance the necessary coverage; however, it would be a mistake to further tax business. That would only make the USA less competitive in the world economy." 28787 07/31/06 FL Agree Agree Agree Agree Agree Agree 28790 07/31/06 NY Agree Agree The best way to do this is through a single-payer Medicare for All system. Agree Thees efforts are superb. But they should be done by the governing board of a single-payer Medicare for All system. Agree Agree "At the meeting at the School of Public Health of the University at Albany (New York), the majority of the audience favored Medicare for All (so that financial assistance would not be needed to access health care)." Agree "The simplest, most efficient, fairest, and least expensive way to financing health care is through a single-payer Medicare for All system. This has been shown repeatedly on the national and state levels (e.g. by the Lewin Group) to save enough money through reductions in administrative costs to more than cover the extra costs of providing health coverage to everyone. The monies distributed by the single payer can come from any combination of the sources mentioned above." "A single-payer solution is often discarded as politically undoable even though many, perhaps the majority, of Americans would support such as system (as shown in multiple polls). If the Citizens' Health care Working Group came out in support of Medicare for All, it would suddenly become politically very doable." 28792 08/01/06 NH Agree Agree Agree Agree Agree Agree "Do away with the current federal income tax system, going to a flat tax, simplifying the tax laws, and allowing the IRS to reduce it's number of employees by more than 50%, saving tremendous federal payroll expense which can be applied to health care." Lets not get carried away with overthinking this process and forming too many committees that resemble typical government bureaucracy. Use the KISS principle; Keep It Simple Stupid!! 28794 08/01/06 MT Agree Without addressing the fact that medical care is a monopoly over health care in the USA none of your recommendations will work and only add to inflationary pressures. Agree De-emphasize medical care and promote health care and this would be extremely beneficial. Agree Emphasize health care and minimize medical care and this would be very beneficial. Agree De-emphasize medical care and emphasize health care and this will have a positive effect. Agree It is imperative that you define health care. If you simply dump more money into the medical care monopoly it will fail and only lead to increased medical care inflation. Agree Without addressing the monopoly medical care has over health care this will only exacerbate the hyper inflation evident in the medical industry. First address the medical monmopoly over health care in the US. Define health care and medical care and quit subsidizing the medical community with this intentional obfuscation. 28941 08/01/06 NH Disagree "I agree with all of the above except the use of ""Private or Public"". The government should still continue its responsibility." Disagree "Again, I agree with all of it, but the Pubic/Private seems to be a way that the government will shed its responsibilities." Agree "Interesting, for the first time, the use of the word, ""private"" is not used." Disagree "I generally agree with the above. I suggest a definition of public and private. I noticed that this section does not your the words ""federally funded"". That was only in one section? Why? The statements about ""honoring"" the wishes of the person's last days need to be stronger." Disagree "* The common italized message is different that the preceding statement of ""financial assistance will be available to those who need it. How can you blend the two. Sounds like the very, very poor will be cared for and there are more people in that financial catagory. The very rich can probably afford and even pay for their own. So that leaves the dwindling middle group, who might not quite qualify or all of their savings and earnings go to the care providers. This needs more explaining. Philosophically I agree with the common message. " Disagree No trasition is seamless. It is a trasition. You can make it less impacting as possible and I agree that it takes time. The United States has not examined other health care programs of other countries as comprehensively as they need to. And a smoother trasition really means putting forth and EDUCATION PLAN TO HELP PEOPLE UNDERSTAND THE DIFFEERENCES AND THE GOALS INVOLVED. "Generally, I agree with all of the above. But what does ""staffed by experts"" mean. Who will do the appointing? What does ""evidence-based science and expert consensus"" mean? Does it mean Western type treatments? What about alternative health care ideas? Why can we not be open to other possibilities? " 29112 08/01/06 NC Agree "Absolutely! However, we have only grazed the surface of what most people understand about these ""very high out of pocket costs"". We need to investigate these thoroughly, and question our fears surrounding heroic intervention." Agree "Yes, and hopefully this will dramatically cut the overbearing and overwhelming administrative costs of current health system. Let's put the money into services, and allow people to make informed decisions about those services. Also, community based services allow for a more intimate relationship with health care providers that I believe is crucial to healing." Agree I am especially fond of the last recommendation which encourages self participation and responsibility for each of us. Agree How could we do otherwise and still pretend to be humane? Agree Self evident! Let's stop pretending to support family values and do it for real....(and why should we define what family means for anyone else?) Everyone is family! Agree "I absolutely support universal coverage. It's insane to try and plow through all the small print and ""lawyerese"" in coverage plans to understand what the heck they are talking about. Sometimes the coverage that people have worked to pay for actually gets in the way of providing them what they need when they need it! I support rethinking our whole system which seems to revolve around surgery and drugs and explore less invasive and more cost efficient means of supporting health." The trick here is to define what each of these categories really cover. I would expect LOTS of conflict of interests here. "You have done a marvelous job, and I admire that you organized community gatherings to open dialogue and elicit opinions and information. I wish I could have participated in one of these meetings. If there was such here, I am not aware of it." 29142 08/01/06 CA Agree "The actual ""bill/law"" must be written by a credible group of diverse interests. Any 'benefits' that is written in closed door or secret meetings and who stand to gain financially, i.e. oil company executives who write our Energy policy or pharmacutecal companies that write our Medicare Prescritopn drug bills, are UNACCEPTABLE!" Agree Who pays and does the federal government have outside 'auditors' for overseeing the costs? NO MORE HIDDEN COSTS please!Businesses MUST continue to pay for their employees health care with shared responsibilities by the government and the individuals. Agree Can FRAUD also be punnishable especially through FINES and JOB loss if it happen under a boss' watch? IE Micheal Chertoff should lose his job for the cost overruns and fraud found in his Homeland Security department. Agree "The state and federal governements must keep restaint on religious and political persons who 'interfere' with organzations, services and providers who deal with 'personal'issues such as dying and birthing." Agree "If Americans could have affordable policies that really cover what is needed, we would be freer to change and develope our lives for the better and for those in our family. We wouldn't be forced to say in jobs where ew cannot grow and thrive just because of medical incurance concerns..." Agree Do not allow BUsinesses to get off the hook...look at the Labor movement to provide WORK STANDARDS!!!!! including medical benefits... PLease make sure that this current administration cannot turn another GOOD thing like this into their own private playground for their own corporate friends. Take care of our soldiers 100% forever who come home injured by the wars we put them in! We have been waiting and hoping for a real change in benefits to Americans...please pay attention to us and help us stay healthy so we can continue to be productive citizens...show us that you won't WASTE our money like the current administration is doing...we cannot be BLANK checks for the over zealous and power hungry! 29202 08/01/06 PA Agree I do not believe that these resources should be used for costly end of life interventions. Agree Agree No response "While I support palliative care in a hospice environment, I would not support this proposal if the individual/family were choosing as an option technologically advanced life sustaining interventions for which the liklihood of recovery is not probable. If this effort is soley targeted toward moving terminal patients out of ICU's/hospitals to a better environment for end of life, then I would be in support. " Agree "This is a critical piece of the puzzle, and corporate entities including small businesses who don't provide any health care benefit should assist in supporting this type of coverage. " Agree I don't believe that businesses that already provide a basic health care plan for their employees should have to pay additional amounts to support this program. By virtue of providing a health care benefit they are already doing their part. They should however be required to contribute if they have on payroll employees who work limited hours and as a result are not eligible for a health care benefit. 29244 08/01/06 MD Agree "* No rational person would disagree with this recommendation. But studies have shown that having insurance from a private, for-profit insurance company is no guarantee against impoverishment, and a large percent of personal bankruptcies are caused by medical costs, EVEN AMONG THOSE WITH HEALTH INSURANCE. I have private health insurance from United Healthcare, the largest for-profit company. It was recently revealed that the CEO of this company has $1.6 billion in stock options, while I have to FIGHT to get the treatment and medication I need. For example, the policy I have claims to cover out-of-network services, but when I had a 45 minute consultation with a charge of $275, United claimed that the cap on usual and prevailing charges was $62.16, and after a $55 copay, they reimbursed me $7.16. For-profit health insurance is siphoning off billions of healthcare dollars from actual medical care, and diverting this money to shareholder profits and elaborate administrative processes designed to discourage the us" No response No response No response Agree "Under the present system of private, for-profit health insurance, financial assistance will be needed by those presently regarded as middle class, not just by the poor. For-profit health insurance elevates the cost of healthcare enormously, while often acting as an OBSTACLE to the provision of needed medical services, and adds not one scintilla of value to our healthcare system!!" No response "* Your report fails to refer in any way to the problems in the way private for-profit health insurance operates in this country (see above), and seems to suggest that more of the same will fix our problems, when, in actuality, it will only make things worse. Currently, only a little more than 50 cents of every healthcare dollar is actually spent on delivering healthcare! The profit motive needs to be taken out of the health insurance system, and it needs to be radically simplified and restructured. National Health insurance is the only solution!!" 29274 08/01/06 MN Agree We need to encourage all individuals to carry some kind of comprehensive major medical insurance with a high deductible so that the catastrophic illnesses would be covered should they occur. Every person should be accountable and pay something for their health care. Agree I do feel that everyone should have to pay something for the health care they receive or there is no understanding of the benefit. Agree We have taken our excellent health care system for granted and as a general population we do not take care of ourselves. We need to do a better job of educating our population on the importance of taking good care of yourself. We are so fast paced that everyone is working so hard to get ahead that our health needs take last place in our life. Agree We all want ourselves and our loved ones to die with dignity. Agree "To many times I see the selfish individuals who will go out and buy new cars, campers, toys, etc. not thinking about their families welfare. We have become such a self centered society that everyone should have to pay something for their health care coverage. Otherwise the responsible individuals end up paying for the others and learn to do without those extras so they can continue to pay their health insurance premiums." Agree Everyone should have to pay something according to their means for their health insurance coverage. I was brought up to believe there is no free lunch in this world and you must work hard to survive. If we all lived by the golden rule this would be a lot better world to live in. Please make sure you utilize individuals that have a good understanding of the current health care system and it's strengths and weaknesses. "* I have worked in the insurance industry for 15 years and health care is one of the most misunderstood issues. Employees do not understand the huge benefit employers are providing. Our current medicare system has not kept up with today's medical costs.This has put a huge financial burden on our medical system, but am not sure how this can be fixed. Our senior population has become very demanding as to what is covered under their medicare and medigap insurance. They have become accustomed to having everything paid so Medicare Part D has been a complicated process for them and has caused much confusion with the senior population." 29278 08/01/06 IL No response "I am a bit concerned about how ""Americans"" is defined. If this proposal would deny care to undocumented aliens, it needs to be rethought. I must develop some plan that will provide preventive care rather than crisis care to those who live in the US but are not ""citizens""." Agree Agree No response "Unfortunately, studies have shown that the ""kind of care"" individuals WANT -- even when they are informed and aware of their ""end of life"" status -- tends to be, ""I want everydone possible done for me to prolong my life"", and thus is extremely expensive. Because so very many health care dollars are spent on the last few weeks of health care for people, we need a better system to address lowering the costs of care for terminally ill. Hospice and pain control >>> YES! ""Do everything possible"" >>> NO!" Agree "I am a bit concerned about how ""Americans"" is defined. If this proposal would deny care to undocumented aliens, it needs to be rethought. I must develop some plan that will provide preventive care rather than crisis care to those who live in the US but are not ""citizens""." Disagree "I believe there should be some patient contribution for EVERY service, even if the contribution is small." "I do not believe that we can finance a system that includes ""mental health"" -- that category is far too broad and subject to abuse." 29288 08/01/06 ND Agree Agree Agree Agree Agree Agree 29295 08/01/06 TX Agree Agree Agree "I would include working with the over 10,000 Parish/Faith Community Nurses in the US to increase preventative Health Care initiatives." Agree Agree Agree "Attempt to make all of these provisions for universal health care for all, a fraud free entity. Add punishment clauses for misuse of funds associated with this program to give authority to law inforcement agencies to prosecute. " 29302 08/01/06 CT Disagree Disagree "CT already takes care of it's people through the HUSKY plan for low income, uninsured individuals." Disagree Agree Disagree "In CT, all individuals have access to medical coverage, regardless of their financial resources of health status through the HUSKY plan." Disagree I like the current health care system and do not agree with universal coverage. I like the current health care system. 29309 08/01/06 MI Agree IS THIS STILL THE GREATEST COUNTRY OR ELSE!!!!!!!!!!!!! Agree Agree Agree Agree Agree 29313 08/01/06 NY Agree "* My 24 year old son has no health insurance. he can not afford to see a dentist or a doctor when he has problems. he has been struggling with the Department of Social Services for the last 3 months for Medicaid coverage. He is in a halfway hoouse for treatment of drug addiction and was told that if for any reason his Medicaid is not approved he will owe the facility $1,000 a month for the care received . This is America , we can do better. We need to get our prioities straight. people should not lose their homes & their life savings bevause they need long term care. " Agree Agree Agree Agree Agree 29318 08/01/06 CA Agree "The national program should be public, not private. Healthcare should not be based on profit motives. This should be an all-encompassing program, not a piecemeal expansion of existing programs. The program should cover all people within the U.S., regardless of immigration status. This is only good public health sense. The national program must recognize that many people do not have ANY money left over for paying for healthcare. Cost sharing should not be a barrier to healthcare." Agree "The system should take into account healthcare providers that already provide care at the safety net level. All people should have access to the same high level of care, regardless of income or ability to pay." Agree "Electronic medical records are good, but they must give primacy to patient privacy, and there needs to be better protection against theft. Prevention services should be free and encouraged. Information on pricing is dumb--no one should have to ""go shopping"" for services when s/he's sick and least able to shop around." Agree "Services must be culturally competent, including translation and interpretation for limited English speakers." Agree "However, this should NOT include a mandate to buy insurance on the private market. The benefits must also recognize that some people will just need more services than others, and we as a society should help pay for those who need more services and are least able to afford them." Agree "Financing should be based on revenue streams that tax higher income people more than lower income people. The tax should be progressive, not regressive. We should move away from employer-based coverage and tax credit financing, but ONLY if it is replaced with a national health insurance program." "The group must also include people with disabilities, people of color, and consumer healthcare advocates. Healthcare must also include vision coverage. Coverage must recognize that some people just need more healthcare than others. It should encourage community-based care rather than institutional care." "I am in favor of a universal, single payer model. I am opposed to any market-based model. Healthcare is not appropriately provided for under market-based models." 29336 08/01/06 RI Agree Our insurance and employment based system has utterly failed and cannot be fixed incrementally. Agree Agree Agree Agree Agree "It is specifically the plurality of payers in our system that creates its enormous innefficiency and onerous administrative overhead. Some form of ""single payer"" even if the work may be contracted as in Medicare would save enormous amounts." "Our ""system"" is doomed by not being at all systematic. No one is planning across the broad spectrum of needs as to how it should be structured." "Although I got this survey from a union, I am not a member, and in fact I own a business that provides health coverage for several hundred workers and their families. I need help fast! " 29354 08/01/06 CA Agree "We are the weathiest nation in the world, with a strong economy and successful businesses. Those resources should be brought to bear on solving the problem of health care for all citizens - a healthy population will then support continued growth and prosperity for all." Agree No problem is solved without an owner. Agree "The health care ""industry"" should be about care, not profit. " Agree "The natural progress of life should be supported, not avoided." Agree Universal health care. Agree "Businesses that benefit from health care industries should be motivated to improve those industries - either by paying higher taxes if their profits are significant, or by having reduced taxes for serving greater numbers than their ""competitors"". Ultimately health care should not be a profit-driven system, it should be care-driven. This would help to reduce costs since businesses only interested in a profit would go elsewhere." "Must include non-western, non-traditional health care and representatives." "Health care must include non-western therapies and treatments. Often they are more effective (and cheaper) than ""traditional"" alternatives - reducing costs, improving the health of the population, and providing greater individual control and participation which then results in a healthier population. " 29364 08/01/06 AZ Agree "* I am concerned about the possibility of requiring all Americans to have coverage for high-cost services and that the recommendation makes no note of regulating insurance companies, which is a necessity if an individual mandate is going to be instituted. Also, this does not address cost-control issues such as reducing administrative costs. I would also like to note the importance of preventive care and that a high deductible catastrophic coverage plan would not be sufficient to ensure the health of our country." Agree Agree Private programs should also be evaluated for quality of care. Agree This should include expanding funding for Medicare Agree I strongly agree that affordable health care is a human right and that a single payer system may be the best approach to universal healthcare in the U.S. Agree I believe that a single payer system is the best approach to universal health care. Please include in this recommendation a method of evaluating and enforcing the package. 29368 08/01/06 MN Agree Agree Agree Agree "Once made, especially if made logicly long in advance of actual implementation, those choices should be respected/honored, not questioned during the emotional last days." Agree Agree "Cost containment must also be included, esp in lieu of escalating pharmaceutical costs, CEO reimbursement abuses, i.e United Healthcare" "However, the core must include more than allopathic medicine. It should also include CAM therapies, e.g. chiropractic, massage, acupuncture, etc. demonstrated to be effective or promising in the healthcare arena." 29372 08/01/06 TN Agree Agree Agree Agree Agree Agree 29377 08/01/06 CA Disagree Get government out of health care - people should be responsible for themselves. Disagree Get government out of health care - people should be responsible for themselves. Disagree Get government out of health care - people should be responsible for themselves. Disagree Get government out of health care - people should be responsible for themselves. Disagree Get government out of health care - people should be responsible for themselves. Disagree Get government out of health care - people should be responsible for themselves. Get government out of health care - people should be responsible for themselves. 29378 08/01/06 CO Disagree "I agree with the aims, but feel that the best approach would be to establish a way for uninsured to buy into Medicare. Low-income people could get a waiver of some of all of the buy-in costs, or be put into the Medicaid system." Agree "* The private insurers should be required to be truly non-profit, or only have limited profits. The typical profits for a private health insurer now is about 10% (based on a study of Blue Cross plans). Those Blue Cross entities that are supposed to be non-profit report this as ""surplus"" which they are supposed to put into a fund to address rising health care costs. However, I have seen annual reports from Independence Blue Cross (Philadelphia, PA) in which annual surpluses of in excess of $200M are reported for 5 years running (increasing each year), but somehow the fund never exceeds $1,000M. There is obviously diversion of the surplus funds, not being reported. I expect that this is common practice among ""non-profit"" Blue Cross Plans nationwide, as they co-ordinate their policies and strategies. I believe that a significant amount of the rise in health care costs is actually this excess profits for health insurers." Agree "* There is one glaring weakness in using ""evidence-based best practices"", which is that they do not address recently discovered or defined diseases or syndromes. There is also the problem (notably with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis) that some of the evidence is slanted to support a particular doctor or group's views. In the case of CFS, a large number of studies have been published by a group of psychologists in Britain, using a different case definition that brings in large numbers of people who actually have primary depression, that show that graded exercise and psychotherapy (cognitive behavioral therapy) are beneficial. This flies in the face of much evidence from researchers without the psychological agenda, who find that exercise is detrimental to people who have CFS/ME based on more restrictive definitions used in the rest of the world. The sheer number of these slanted studies has already influenced medical practices in the US, because they influence the ""evidence-based"" practice" Agree The patient's wishes should have priority over evidence-based medicine to whatever extent it is possible. Agree No response 29379 08/01/06 CA Agree "* The United States is the greatest nation on earth. Yet our healthcare system by every imaginable measure except one lags far, far behind that of nearly every other industrialized nation. This is a travesty. We are behind in: expected lifespan, infant mortality, outcomes for patients with diabetes, high blood pressure and many others, population disease screening, time spent with patients, medication errors, duplication, follow through, toddler mortality, administrative costs, physician:patient ratios, rates of uninsured ... the list is endless. The one exception: spending. We spend twice as much per person as any other nation on earth (and in absolute terms we blow them out of the water). " Agree Agree Agree "We need to facilitate people near the end of life being able to die with dignity, rather than grappling for months on getting a last breath, until (after much needless spending) it eventually finds them." Agree This encompasses two points. 1. All Americans deserve and should have access to health care. 2. The health care must be affordable. Agree "* Managed care first appeared in the 1970s with the Kaiser network. The format gained prominence in the 1990s with the admirable goal of reducing waste by overseeing utilization. Patients would benefit by getting the care they needed, more effectively and at a lower cost. Doctors would benefit by no longer having to play the role of ""gatekeeper"", determining who can receive care. While the model secceeded briefly, within five years the system had created more problems than solutions. Now we are worse off than we were 15+ years ago, and, under the current system there is no end in sight to our vertical downward spiral. The unfortunate outcome is that medicine has become a business with few happy doctors, fewer happy patients, and quite a few happy businesspeople. Let us refinance health care with a formal regard for the former two, and an almost wanton disregard for the wants of the latter. If managed care organizations want to constructively contirbute to the process, let them do so only by offering" "As long as HMOs are not allowed to profit by reducing benefits, this plan sounds good." 29380 08/01/06 NE Agree "I strongly believe a nation as great as ours only lives up to its obligation to its citizens if coverage of health care is available to all who live and work here, citizens, residents and undocumented workers as well." Agree "I am very grateful to those who are working to develop feasible, just proposals." Agree Agree Agree I strongly agree. Agree It is very important to include mental health benefits. 29381 08/01/06 AZ Agree Other countries can do this at a lower cost than what we currently pay. We can certainly get this going. Agree Agree Agree Agree Agree 29384 08/01/06 FL Agree Agree Agree Agree Disagree "Personal health care should come entirely from the federal budget like all national needs, fudned thru income taxes on all income and not just earned income. This would be a boom to small employers and yes and added burden to those who derive income from interest and dividends." Agree "Personal health care investment/expense should come entirely from the federal budget like all national needs, funded thru income taxes on all income and not just earned income. This would be a boom to small employers and yes and added burden to those who derive income from interest and dividends." "Explanation of the plan should fit on no more than three standard sheets of paper mailed to every household. Something like ""Our national well being depends on your well being."" A section on how to live healthly A section on what health care services you can expect and A section on what you can expect in death." 29386 08/01/06 IL Agree Agree Agree Agree Agree Agree 29387 08/01/06 NY No response No response No response No response No response Agree "* I agree with the core health services statment. We in the United States need to focus more on preventative services which will improve our general health status.We as a nation focus entirely too much time and money on illness rather than wellness. We need to take an active role in maintaining our health. We need to look at developing better access to care at the community level, which would encourage people to seek care before they become ill. The most important core benefit is prevention and wellness care; if we can improve in that area of basic healthcare our need for acute care and medications should decrease. " 29389 08/01/06 FL Agree Agree Agree Agree Agree Agree 29390 08/01/06 NH Agree "I have seen too many families and individuals who are struggling to deal with difficult medical issues- the focus should be on healing, not ""how are we going to pay for this"". In the long term, medical costs could be lower if the problem is dealt with early." Agree Agree Agree "My family has been struggling with identifying services and resources for our mother, who is dealing with several issues of aging. This has been even more mind-boggling than what I experienced during treatment for breast cancer. The difference is that my mother and I are both lucky enough to have good health insurance and some knowledge of the medical infrastructure. I can't imagine what it would be like if we didn't. " Agree See above comments Agree "I am afraid that those with power and money will find loopholes much as they do with the current income tax system. I have no suggestions other than counting on those designed the funding systems to be very careful with wording, and to attend to details. As an educator, I often find federal law and statutes vague and difficult to interpret consistently." Assuming that physical health includes vision and hearing- 29391 08/01/06 NC Disagree Only if it is run by a Private comapany. Competition should be present to keep everyone sharp in serving the customers. Government involvement invites people to abuse the system including low income as well as the medical institutions. Disagree Make it all private. Disagree Privatize Disagree Avoid government involvement. Agree This will work if we let capitalism work its way through the system without government intervention. People abuse the system when they are not paying the whole bill while doctors overcharge because they can without the competitive incentive. Put competition into play and efficiency improves and costs come down. Disagree "* The government can get involved by allowing everyone to make a Health-Care account that is tax free if we fund it through our payroll (like a Roth IRA). This is an incentive for everyone to take care of their side of the business instead of depending on Big Brother. If you give someone a Fish, they eat for a day (but are dependent on Government to eat again tomorrow). However, if you Teach someone to Fish, they eat for a lifetime (becasue they are self-sufficient). Most people fall within the confines of the 68% of one deviation of the Bell Curve. Please to not hold up the less-than-one-percent that fall three deviations from the norm; they only prove the rule and the government can easily take care of these numbers if the majority of us take care of ourselves. Quit holding up the 3-deviation cases as poster boys for more taxes. There will be plenty of money available if Big Brother no longer has to pay for the 68%. " "Again, most Americans do not need a ""core"" benefit if they put money away tax free to take care of themselves. We have become so conditioned to expect others to help us out that the people who really need it suffer because the pie gets cut for everyone. Teach us all, and expect us all, to become more independent so that government can become more lean and thus focus on the exceptions to the rule." See all of the above. 29392 08/01/06 CA Agree "* It must be public, funded by taxpayers. For profit health insurance companies are not needed. Study after study shows public administration saves enormous sums on administrative costs. Those savings are more than enough to pay for a complete benefit package for all. It must cover everyone, citizens or not, just as in other countries. It must be structured so that everyone and every business pays an affordable, predictable and fair share premium, and not be penalized with further out of pocket expenses if they get sick. There must be financial protection for all. It must not leave prevention and education as ""self pay"" services and should not concentrate on only protection against high medical bills." Disagree This recommendation ignores the simple solution of a one payer system with free choice of doctor. Let health providers compete on the basis of quality of service rather than establishing a complicated multi-tier system. As in education separate but equal is never equal. Agree "This fits in very nicely with a one payer system. No need to have insurance companies involved to accomplish this. However, asking for patients to shop for prices is ludicrous. The system is not transparent now and this proposal will not make it so. Getting health care is NOT like buying a shirt. " Agree "Should include ""right to die"" as in Oregon law." Agree "This can be done without private insurance, or multiple insurances. " Agree * Your plan to cover all does NOT have to cost more if you adopt a one payer system. Your recommendations totally ignore years of research and economic modelling showing the savings. Our country needs to face the reality that the for -profit private insurance system NO LONGER WORKS. Including it in your proposal dooms it to eventually cutting benefits and raising premiums in order to balance budgets driven by uncontrolled inflation and siphoning off of dollars to stock holders and CEO's. Don't your researchers read the papers??? CEO McGuire of United Health walked off with over $1 billion in stock. " I don't want to see ""core"" benefits turn into ""bare minimum"" benefits. I praise your inclusion of dental and mental health benefits, and relying on evidence based science. I would hope that substance abuse treatment would be included as well." "* I found the whole process rigged from the beginning, and totally unnecessary. We have had all the studies and all the financial analysis we need in various states and nation wide. What politicians continue to avoid is confronting the waste of the present system and the need to adopt a VA type one payer system where medical equipment and drug prices are negotiated, and where the is a simplified, one tier, free choice of provider, one payer system. The recent National Coalition on Health Care is the most recent study, showing over a billion in savings for a one payer system. Why not allow one state to try a one payer system, another to try your way, and another to try tax credits, with federal waivers for use of Medicare and Medicaid funds, and then evaluate how it works. The Institute of Medicine made this suggestion years ago, and indeed the Federal Goverment funded studies in 20 states in 2001-2002. You have the evidence, just not the courage to challenge the monied interests." 29393 08/01/06 MN Agree It would disagree with this recommendation if it was proposed that this be a public only solution. Disagree Integrated Community Health Networks is a concept that can mean many different things to different individuals. The concept is not well defined here. Agree Agree Agree Agree "Individuals should be required to purchase health care coverage. If their income is below the level at which it is determined coverage is affordable, they should receive assistance. Individuals who don't purchase this coverage should be subject to additional payroll taxes and tax penalties. Health Care Savings Accounts should be used so that individual can put aside money to meet future needs. " "* Establish a list of core services that should be paid for by all plans, and determin the cost for 100% coverage for those services. That dollar amount would be the maximum allowed as a tax deduction. If inviduals wanted coverage for additional items, there would be no tax deduction for those expenses. Members purchasing coverage for less than 100% of those core service would be allowed to put the balance in a Health Savings (type) Account for future use. As account balances grow, the amount of ""core"" coverage required to be purchased, could be reduced. (i.e. if an individual has $10,000 in an HSA, they could purchase a $10,000 deductible)" "* There is a great deal of discussion about large purchasing pools (i.e.large employers can buy coverage cheaper). The truth is that if all health plans could only sell individual plans on a guarantee issue basis, much of the cost of underwriting and even marketing would be reduced. Health plan Companies should offer only one set of plans with one set of rates for all individuals that must compete with all other companies for all individuals in America. Companies could not lose money on one high profile group (to gain marketshare) by charging another group more than necessary. " 29394 08/01/06 PA Agree Health savings accounts are the key with more flexibility than current law allows Agree Agree "Need to increase small facilities such as specialty hospitals to compete with large community hospital, to increase efficiency through competition and decrease costs, especially if consumers shop for price and quality with their Health Savings Accounts" Agree Disagree who decideds whtat the core services are? Disagree Health savings accounts are the key with more flexibility than current law allows core services tried before and has failed. Difficult to define core services "We all want health care for everyone. Most of the above is hard to deny. But a free market system is the best answer at this point and could help avoid the reduced quality seen in other countries who have tried some of the recommendations above. Suggested reading ""Healthy Competition"" by the Cato Institute" 29395 08/01/06 FL Agree The government is pretending to be out of touch. They know we need health care coverge. The government's hands are in the pockets of the insurance and drug companies. Tonight's news says there are 63 lobbiests for every one congress and Senate member. Agree "Citizens need preventative options, not just emergency options." Agree Where is the option about alternative and holistic methods? What about vitamins? Drug companies want us all to be on drugs. I prefer to be responsibile for my own body and what I put in it. Doctors only know what ther are taught in school They are taught by the drug companies. Agree "Don't let bean counters conduct health care. And don't let the drug companies either. Health care would not cost so much if citizens took their own health ito their own hands. Practice prevention. Take vitamins, use herbs and natural products. The health food stores are full of good remedies. And books to teach people. My health is my responsibility, not some guy who gets paid only if I am sick." Disagree "* Baloney. ""Financial asistance to those who need it"" Everybody needs it. Poor people don't have to be treated badly just because their funds are limited. Keep a close eye on the insurance companies if that is who will be responsible for doling the funds. And the professionals who may be tempted to bill the US government fraudulently. Do not penalize those who are sick. Might want to consider tax credits for people who stay healthy: non smokers, health club users, health food supplement and/or organic food buyers." Disagree US citizens will need less health care when the chemicals they consume are limited or eliminated. So don't underwrite the businesses that consume the chemicals. Include health food supplements no matter what the drug companies say. Bargain for good rates for drugs. Or buy them from Canada who apparently is not afraid of the drug compamies. PREVENT ILLNESS BEFORE IT STRIKES. THAT INCLUDES MORE THAN JUST NOT SMOKING. IT INCLUDES ATTENTION TO INSECTICIDES AND CHEMICALS THAT ARE PUT ON FOOD TO GROW IT. AND HORMONES TO MAKE CATTLE AND CHICKEN AND PIGS FAT. STOP THAT. 29397 08/01/06 CA Agree "* Financial protection for low income individuals and families include protection of assets and protection against bankruptcy resulting from excessive medical costs. Protection simply against high out of pocket expenses does nothing to promote preventative care, which is good for patients and good for reducing overall healthcare expenditures. Coverage for all Americans should not involve a single-payer system, but should rather involve a competetive mechanism among private insurers, whereby the market will determine effective means of healthcare delivery." Agree Agree Patients need information about the true costs of medical care so that they can purchase care just like any other commodity. Agree "Individuals should be allowed to die comfortably should they choose to do so, rather than spending their last days with tubes coming out of every orifice in an impersonal hospital setting." Agree "Wealthier Americans should also be able to purchase additional coverage beyond the basic core of health services that everyone is entitled to. If such a universal system were optional, only the sickest would enroll, leaving the system with an unsustainable cost structure." Agree "I support the voucher system that provides insurance for all people. Under our current system, expensive emergency-room care is delivered to uninsured people for conditions that could be much more cheaply and effectively delivered in the earlier stages of disease. By providing universal coverage that allows preventative medicine, or at least enables access to physicians, diseases could be caught earlier, which benefits patients and reduces overall healthcare expenditures." Core benefits need to cover eye care--honor prescriptions for drugs and for glasses. "Healthcare should be portable, not tied to employment or any other status." 29398 08/01/06 CA Agree "* Financial protection for low income individuals and families include protection of assets and protection against bankruptcy resulting from excessive medical costs. Protection simply against high out of pocket expenses does nothing to promote preventative care, which is good for patients and good for reducing overall healthcare expenditures. Coverage for all Americans should not involve a single-payer system, but should rather involve a competetive mechanism among private insurers, whereby the market will determine effective means of healthcare delivery." Agree Agree Patients need information about the true costs of medical care so that they can purchase care just like any other commodity. Agree "Individuals should be allowed to die comfortably should they choose to do so, rather than spending their last days with tubes coming out of every orifice in an impersonal hospital setting." Agree "Wealthier Americans should also be able to purchase additional coverage beyond the basic core of health services that everyone is entitled to. If such a universal system were optional, only the sickest would enroll, leaving the system with an unsustainable cost structure." Agree "I support the voucher system that provides insurance for all people. Under our current system, expensive emergency-room care is delivered to uninsured people for conditions that could be much more cheaply and effectively delivered in the earlier stages of disease. By providing universal coverage that allows preventative medicine, or at least enables access to physicians, diseases could be caught earlier, which benefits patients and reduces overall healthcare expenditures." Core benefits need to cover eye care--honor prescriptions for drugs and for glasses. "Healthcare should be portable, not tied to employment or any other status." 29399 08/01/06 AZ Disagree "I do not favor socialism. I agree that there should be a national health plan option for those that can not afford otherwise, but it should be paid for in taxes on tobacco and alcohol (major contributors to health problems) and not necessarily force the rest of the people to pay for it." Disagree "I have not found the federal government to be particurly able in these regards, but i do aggree with providing incentives for private establishments that would move in this direction." Disagree "I do not support socialism. I have not found the federal government to be particurly able in these regards, but i do aggree with providing incentives for private establishments that would move in this direction." Disagree I disagree with the last point. Disagree "All should be required to obtain health coverage. There should be an option available for those that cannot afford otherwise, or choose not to. That option should not neccessarily provide the highest quality care, but should be appropriate and certainly cover immediate, catastrophic care. That option should not necessarily be paid for by taxing everyone, but taxes on alcohol and tobacco, and perhaps incentives for companies to contribute to the national healthcare fund...or somethings to this effect." Disagree "I agree with the approach and general logistics, but disagree with the method of choosing commitee memebers." 29400 08/02/06 TN Disagree "50% of the much touted ""uninsured"" don't want or refuse to buy insurance. The government's responsibility is to provide safety and defense, not force many people to pay for what a small number do not want." Agree Agree Agree Disagree "If you give a person a fish, he or she will feed their family for a day. If you teach a person to fish, they will feed their family for a lifetime. The more you give a person, the more they want." Agree "There are some people in the country who cannot afford adequate health insurance, but there are a lot of people who just don't want it. They should not be our problem" 29402 08/02/06 CA Agree There is not one reason why all Ameicans do not have a guarantee financial protection against very high health care costs. It is a moral obligation. Agree Coordination of federal efforts would be much more econonamically sound and effective. Agree This recommendation is long overdue! Agree "Again, overdue! The waste and legal paper work is inhumane." Agree This is a necessity! Agree "There is much money wasted in health care. Everyone will need to participate and become responsible, by contributing in a vaiety of ways. Educating,protecting and financially being responsible. This must involve individual, community as well as federal." This is basic humanity. Thank you! 29403 08/02/06 OH No response No response No response No response Agree "* It should be public policy that all Americans have affordable health care. As we learned over the summer, several countries provide healthcare to all of its citizens, and many of them provide it for free. France was ranked first by the World Health Organization (WHO) in the 2000 report for the overall best health care system I the world. The US was ranked 37th out of 191 countries (WHO, 2000). The idea of affordable health care for all seems like a basic human right, in my opinion. Upon evaluation of France, Canada, Germany, and the UK, examples have already been put in place that we could follow if the issue became important enough to the US government. The four nations cover medically necessary and appropriate services (Brown, 2003). All we have to do is look to these four countries and implement their procedures here in the US. Many women and children suffer the most from lack of affordable health care. In this country, where divorce is so rampant, many women are left with not being able to p" No response 29409 08/02/06 OH Agree "We're the only industrialized nation in which there is no national healthcare. How is it with all the money and power we have, we have a higher infant mortality rate than Cuba?" Agree "The only problem is that whenever you incororate a private interest, there's a chance that it can go right back to where we're at now: focusing on the money instead of the patient." Agree "Simply getting rid of most of the redundancy in the administration will save a lot of money and time, thus making healthcare more affordable and easier to get. Going paperless will also serve to further this goal." Disagree "I agree that this is important, but I beleive that we should first focus on those that we CAN cure." Agree Agree 29431 08/02/06 na Agree "I agree with all of the above; however, consideration must be given to service providers that is equitable for the service provided." Agree Utilizing and strengthing the present infrastructure is very important. Do not reinvent the wheel - utilize buildings and qualified professionals that are already in the infrastructure and promote community and teamwork. Agree Utilize the licensed professional counselors (LPC)in rural/urban areas. Agree Agree Agree 29437 08/02/06 PA Agree "In the subtext of this recommendation, I hear an understanding that we cannot pay for everything for everyone, but that we should make sure everyone gets the basics. That's exactly the kind of thinking we as a nation need to adopt. Well done." Agree Agree "Agree, especially with the concept of helping consumers choose more effectively and take care of our own health. I would further note that the government needs to take a role in promoting standards in health information technology. Unless we can ensure that all electronic medical data is stored in a format that can be perfectly translated across systems from multiple vendors, we will end up with a situation where integration is technically impossible. " Agree "Incredibly important, and would help to reduce costs." Agree "I tentatively agree, with the caveat that I do not believe this recommendation should be considered an endorsement of a single-payer system." Agree "* I would like to stress that I do not believe it is the government's responsibility to pay for the health care of every American. I am stronly and adamantly opposed to a single-payer system, and I believe that such a system would be detrimental to America's health. I also believe that attempting to enact single-payer is not politically feasible anytime in the next decade. It is also critical that if we are to tax people on a principle of fairness, the tax MUST be progressive. I am seeing an alarming trend of financing health initiatives through regressive options such as a sales tax, and this is fundamentally inconsistent with a goal of assisting the poorest Americans. " "This is a sound concept. I note the recent politicization of FDA decisions, and am concerned that the same could happen in the arena of determining appropriate reproductive health care. I do not have a clear suggestion for how to protect against that problem. " 29442 08/02/06 FL Agree "* This recommendation is implying that every American should have access to a high deductible, Catastrophic Coverage plan. AMSA strongly support the idea that no American should be impoverished by high health care costs. However, we are concerned about: * The possibility of requiring all Americans to have coverage for high-cost services. An individual mandate may not be affordable to a large amount of uninsured individuals, even with a government subsidy. * The recommendation makes no note of regulating insurance companies, which is a necessity if an individual mandate is going to be instituted. Also, this does not address cost-control issues such as reducing administrative costs. * AMSA would also like to remind the CHCWG of the importance of preventive care and note that a high deductible catastrophic coverage plan would not be sufficient to ensure the health of our country. " Agree * * We support the development of community health centers and the idea of targeting community health networks towards underserved areas. * We believe that it is important to include preventive health measures and means of handling patients with chronic illnesses in this recommendation * We agree that expanding and modifying the Federally Qualified Health Center (FQHC) concept will benefit some of our most vulnerable populations; however we do not support disseminating funds to new health centers if those health centers are not willing to abide by the current guidelines of FQHC's; for example including community members as part of the Board of Directors of their Health Centers. * We agree that federal support is necessary to develop integrated community health networks and ensure efficiency of the process. We support collaboration with state and local governing bodies as well as with appropriate organizations. * AMSA would like to recommend incentives to encourage physicians-in-traini Agree "* * Improving quality of care and efficiency must be a top priority of health care reform; however, we do not want to limit federal involvement only to federally subsidized programs. Private programs should also be evaluated for quality of care. * AMSA would like this recommendation to include improvement of healthcare technology with respect to Emergency Medical Services. We believe that focusing attention on technological advances is the next step in increasing efficiency and quality of health care. " Agree " * We support means that would allow for quality, affordable long-term and end of life care to individuals in need. * We are disappointed that the recommendation does not recommend increasing federal funding for Medicare to deal with the aging baby boomers generation " Agree * It is the philosophy of the American Medical Student Association that access to quality affordable healthcare is a human right. We applaud the CHCWG for this recommendation. * We are in strong support of a universal health care system and believe that a single payer system is the best means of financing this goal. Agree "The creation of an independent non-partisan private-public group to recommend core benefits that every American should have will help to create a national standard of adequate health care; however, AMSA calls for this recommendation to go a step further and provide means of evaluating and enforcing the coverage package." "* As future physicians and patient advocates, the 68,000 medical, pre-medical and international members of the American Medical Student Association would like to express our serious concern for our failing health care system. We strongly believe that health care is a right and no one should be denied access to quality, affordable and comprehensive care on the basis of income, race, ethnicity, gender or sexual orientation. We urge the Citizens Health Care Working Group to represent the comments they are receiving justly and to remember, aside from your personal beliefs, each of you were charged with representing the views of the citizens of the United States. Thank you for all of your time spent traveling across the country and listening to the health care concerns of Americans. We applaud your commitment to fixing our ailing healthcare system. " 29454 08/02/06 NC Agree "Yes, but require everyone to be covered either on group or individual policies." Disagree The federal govt. does not have the experience to operate a program of this magnitude. The better option would be to authorize the private sector to do it. Agree Go for it. Agree "These types of care will only increase as the ""baby boomers"" increase. Politics does not need to be involved in final care." Disagree "Everyone should have health care, but everyone should pay for it. Take the burden off the middle class american who pays for his care, the under-insured and the un-insured." Agree "New revenues means ""additional"" revenues. Better management of what we now have should be the priority." None No 29458 08/02/06 WA Agree Agree Agree Agree Agree Agree 29460 08/02/06 KS Agree "The ""American dream"" for middle Americans and low-income Americans will go down the bankruptcy tubes within a decade unless these recommendations are followed, and soon. Just ask the Congressional Budget Office to provide economic cost-projections." Agree "This has to be done, if Congress cares at all about rural peoples. We have ranching family in far-western counties in Kansas, and all throughout the Western States rural areas, there are no local doctors or medical services, and even buslines do not run anymore to help people get to far-away city hospitals and doctors, and this is particularly critical for the elderly. " Agree "Surely Congressmen and Senators understand that their own health care program operates very well for their families, how could anything be more obvious ?? If such programs work well for themselves to control their own costs, they will work well for the general public." Agree "This is all good, but if end of life health costs, which typically run in the hundreds of thousands, result in the actual end of assets for the elderly, no inheritance, no legacy, no farm, nothing gets passed on to the surviving families. This actualy RESULT of ""end of life health care"", namely, the financial bankruptcy of the elderly, should also be limited by legislation." Agree "Family health costs now exceed on average, $6,000 out of pocket per year. And this typically has about 5% inflation per year. A Legislator with average intelligence should be able to figure that this alone will very seriously erode the American standard of living very soon, unless health costs are reigned in by this kind of reform, as soon as possible." Agree "* Such Efficiency gains are probably foremost. Does Congress realize how wasteful and slow the 3rd party billing process is, for medical services ? As an average family, we are often dealing with ""providers"" a year later when they are so slow in billing. It is truly unbelievable the amount of waste in this ""private"" Frankenstein-like ""administration"". Congress needs to study financing options from other countries experiences, and cut-past the cheap ideological rhetoric about ""socialized medicine"", or else the healthcare beast will eat up the budgets of the States first, and then the Federal go