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 government." "A Special Congressional Commission should be established to examine the practices already used in the American States, such as Oregon, Tennessee, Hawaii, to come up with specifics from their practices that are adaptable nation-wide. Come on.....it is possible to learn from the States. Rep. John Dingle of Michigan should be placed in charge of this Commission." "I commend this process of attempting to convey the public's views to Congress. I am doubtful that the leadership of Congress has the wisdom, or the caring to cut past their ideological images in their heads, to deal with these problems. As a result, I am considering retiring outside the USA, where health care systems are affordable." 29465 08/02/06 OH Agree "* We talk about coverage for all Americans. What about Americans that suffer mental illnesses or autism ? Right now their insurance costs are much higher. Insurance for a 55 year old with high blood pressure is cheaper than for a 39 year old with an obsessive compulsive disorder who takes meds as directed, only needs minimal counseling and has never been hospitalized. This discrimination must end. Also insurance companies must be required to cover autism. Families with autistic children pay 50-100k per year out of pocket because insurance companies refuse to even recognize autism as a legit. medical condition. ANother suggestion: To have a reasonable forum here, files should not be pdf which require 20 min. downloads for dial-up users. HTML files should be searchable. Is it the desire of the coordinators here that this forum bogs down in a morass because no one is able to read anything in a timely fashion ?" No response No response No response No response No response 29477 08/02/06 WA Agree Agree Agree Agree Agree Agree 29481 08/02/06 IL Agree Agree Agree Agree Agree It is imperative that all Americans have access to high quality basic health care regardless of ability to pay. Agree "One way of providing quality efficient health care is to use more mid-level practitioners, such as advance practice nurses (APNs), including Certified Nurse-Midwives and Nurse Practitioners. Research shows that APNs provide quality care with high patient satisfaction at a lower cost than physicians. APNs are especially good at educating and supporting people to make choices that prevent the development of complex and expensive health conditions." 29482 08/02/06 OH Disagree Disagree Agree Agree Disagree Disagree 29484 08/02/06 OR Agree Agree Agree Agree "* This recommendation is necessary! It is important to include individuals facing critical, advanced, chronic or life-limiting illness as recipients of palliative care from the point of diagnosis through the course of their illness. The term ""End of life"" has been associated with the actively dying process which is important but often inadequate because supportive care interventions have not been initiated prior to that phase. Also important is the interdisciplinary team approach to care of the whole person, body, mind and spirit including patient and family as part of the care team. The team should include spiritual care and attention to the spiritual needs of patients. Bereavement Services also are a necessary part of supportive care. The National Concensus Project clearly describes Palliative Care Clinical Practice Guidelines and should be taken into consideration by public policy makers for the financing and service delivery planning. Services should be comprehensive, life-affirming, flexible, and coor" Agree Agree "Generally agree but Add ""palliative care services"" to the continuum. Add ""spiritual"" to the definition of ""Health is defined to include..."" acknowledging the interconnection of body, mind and spirit and its impact on health. Core benefits should exclude ""futile treatment"" i.e. little or no reasonable expectation of benefit to the patient." The Supportive Care Coalition: Pursuing Excellence in Palliative Care is an organization that would be happy to assist in conversation to operationalize the recommendation #6. www.supportivecarecoalition.org Thanks for the opportunity to comment. 29485 08/02/06 VT Disagree see final comments Disagree see final comments Disagree see final comments Disagree see final comments Disagree see final comments Disagree see final comments see final comments "* ***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" 29487 08/02/06 UT Agree This is absolutely essential and could probably be the first recommendation implemented that could be layered upon the current system without making many changes Agree Another item that could be implementing now with little political debate Agree Funding of research in health care delivery needs to be dramatically expanded. Current federal spending on specific diseases may need to be redirected to this critical area. It make no sense to learn how to treat diseases when the fruits of the the effort cannot be applied to the entire population Agree Doing this will result in increased quality of care and efficiency Agree Political leadership in the US needs to commit to this. The question should be posed to every candidate facing election Agree Additional funding via taxes will be necessary intially while efforts to improve efficiency are realized. The political discussion on what percentage of the GDP we want to spend on health care needs to start--providing every available health treatment will be affordable. We will need a health care budget This will be a contentious political debate which needs to start now. This policy group needs to be set up soon I am very pleased with the interim recommendations. The Citizens' HCWG has done a fantastic job. I await with interest to see what are politcal leadership does with this. I will be prepared to influence and/or reject policical leaders who ignore or drag their feet on these recommedations at the polls no matter what their political affiliation 29490 08/02/06 VA Agree "* Current health process in U.S. is not a system, leaving amlost 50 million Americans without the protection outlined above. They are then forced to forego necessary healthcare for financial reasons, and/or present themselves at Emergency Rooms where they wait an average of 4.3 hours to be seen. This places an unrealistic burden on hospitals, who are required by EMTALA regulations to see them. Some national program must be devised to provide all citizens with a ""card"" that entitles them to the basic healthcare benefits. The" Disagree "* The whole tenor of this recommendation seems to assume that we will be doing a better job facilitating the current thinking. What is needed is a much more innovative approach, one which addresses the basic question of ""who"" provides health care, where, how, and under what financing mechanism. Most family practitioners will admit that 80/90% of what they routinely see could be handled effectively by a PA or nurse practitioner. With predicted major shortages of physicians, particularly in primary care, we need to develop a more practical model for primary access, prevention, education, individual responsibility, group sessions for those with chronic disease, etc. " Agree "* Excellent goal. Current financing mechanism with insuors as a major component provides little or no incentive for improving quality or providing predictive healthcare. Exception could be Kaiser, or federal health care. A major issue is who will pay for the IT capabilities for EMR, PHR, etc.? Also, the pay for performance experiment does indeed get the attention of providers, even tho they are currently grousing about it. Most are working seriously on ""core measures"" and are responding to ensure that they get in the upper two deciles and get the extra payments. " Agree A necessary component. Agree "* Excellent concept. Its been a goal for many for decades. There seems to be no political will to pull it off. Hillary got pummeled when she raised the issue; she was correct, but premature and without significant support. I am convinced that there is enough money being spent on health care to provide all citizens with an FEHBP type of access at a base level, with an ability to choose a higher level if desired. Management should be by those who manage Medicare rather then the insurance companies, as the insurance companies devote 80% of premium to medical care, and 20% to admin and profits, whereas Medicare can accomplish all of the administration, very effectively, for about one fifth of that. As former CEO of an insurance company with HMO and Staff Model plans, I also believe in the capitation of health care systems for populations of 'enrollees' at the lower level, which would entice them to be more interested in life=-time relationships and predictive modeling than a system that continued the fee-for" Agree "If we develop a core package for all, paid for by the government which gets the money from taxes (employers would pay into this pot vs. paying for insurance, so it would be budget neutral for the emnployers), we will minimize the catastrophic safety net issues. Benefit design could be established to provide the correct incentives for all." "A base set of core benefits for all, no more uninsured, proper incentives, profits minimized, healthcare workers that are properly rewarded (no more $2 million dollar/year procedurealists and $110,000 per year primary care physicians, but a reward system well thought out)and no more insurance executives (think Wellpoint, United Healthcare,)making 50-100 million dollars per year." "* As a health care consultant and forty years in the industry, I was at a client hospital recently that had 34 patients sleeping overnite in the emergency room as there were not enough staffed beds to send them upstairs. It was a ""Sophies Choice"" moment wherein a nurse supervisor had to decide where was the best place to minimize harm to the patient. This is the current state of our system, and it is only getting worse. I would be happy to serve in any way possible to increase the intensity of the voices calling for national reform. Thanks for the great work. " 29496 08/02/06 NY Agree Agree Agree Agree Agree Agree 29505 08/02/06 OH Agree Disagree My concern would be how is this to be funded? Some other states have tried and failed. It has put the public in a more difficult position. Agree Agree Agree Disagree I agree We must determine what the exact core benefits will be. I do not agree with putting Dental in the mix even though it is important. We must address the most pressing issues first. I am sure I will. The cost of Healthcare is out of control. Employers are looking for alternate methods to handle insurance needs. The healthy have no problems getting coverage while the unhealthy go without. We must also address the quality of care. It can not be an assembly line and work. 29507 08/02/06 DE Agree We need financial protection for all Americans not just a certain income level - no discrimination Disagree The federal government can no longer responsibly represent the citizens of the U.S. Big business and the lobbyist rule the Congress. We need to clean house if the government has anything to do with improving our health care system. Disagree The federal government can no longer responsibly represent the citizens of the U.S. Big business and the lobbyist rule the Congress. We need to clean house if the government has anything to do with improving our health care system. Agree Agree Disagree New revenues can come from eliminating the waste in the system. Get rid of the middlemen and unnecessary red tape/paper work. Insurance companies seem to control every medical professionals move and discriminate like hell against the public - Why? They want a cut of the money. It should be between me and my doctor. Get rid of the insurance companies - what a waste of money. "We do not need a complicated system which we do not understand as we have today with zillions of deductibles, maximums, not covered, and discriminatory rules. It looks like we are starting to build another discriminatory system following the old rules. Here are your core benefits - if you want more you will have to have the money to get medical care. If I have a health related problem I just want it taken care of - not a bunch of red tape, paper work and rules. " We talk a lot about improving the health care system. I became well aware of the problem when my company of many years decided they no longer needed my services about 7 years ago. Then I found out how our discriminating health care systems really work. To date I have seen a lot of talk and no improvements. We need a better health care system now - today. Let us stop talking and do it. 29509 08/02/06 MD Disagree "* The cost of health care in america has skyrocketed due to trying to provide health care to AMERICANS AND TO THE WORLD. The Government should limit health care to Americans and should require others to pay for such care based on their legal status in the country and the period of time living here. The injustice comes when aged immigrants gain a citizenship thru kin or other means and come here for a few years but receive full medical benefits. This course has taxed the government coffers unduly and has been a burden on tax payers. The idea of health coverage (health care) for all must consider what relief is feasible for immigrant populations migrating to this country. An inverse scale of eligibility and relief might be the best way to allow assistance with health care while at the same time safeguarding the health care availability for AMERICANS. Also consider that most third world countries do not have the expertise and facilities to treat severe medical cases, thus families try to bring their kin to amer" Disagree "* The recommendation seems to be mired in federal government red tape and pork-barreling. While a workable system can be developed, it should feature federal funding for locally autotonomous community based health centers, and include the federal guidelines for its continued operation and funding. We have in America, a plethora of diverse and ghettorized communities which exert influence on the system for their own interests without giving way to the larger interest and to legality. A community based health system, void of strict regulation, would digress into a ghetto-based system which continually fuels its base by codling and even importation of so-called vunerable populations. Therefore, support of community-based health networks must rely on strict enforcement of eligibility, and payment if not eligible. " Agree "I agree with the ""cost sharing"" concept of this recommendation. Such a cost sharing provision could be based on an inverse formula, taking into consideration the citizenry, years living legally in America, contribution obligations of support providers, income (if any) and assets. Obviously I would recommend that Americans be at the low end of the cost scale and non-americans at the high end. The formula would progress up or down the scale based on income, years living legally in america and assets. ""Payers" Agree "Payers should be changed to ""The Program"". I advocate a sliding scale of payment (inverse payment formula) for the health care program. In this case, I would advocate a ""reverse health care mortgage against the assets of the non-citizen infirmed"" in order to reimburse the program for expenses and costs as much as possible. " Agree I agree for Americans. But we should have a payment system based on income and other considerations. Agree "Short term security for Americans at risk should be from the Federal and local tax bases. I say ""yes"" to a sin tax. Also, for each dollar appropriated or diverted to the war machine, a 5% earmark should be designated for national health care for Americans and for those military persons enlisted to fight on America's behalf. " Previous comments apply. "* America is and has been a ""pay as you go"" society. it is fitting that one pays his rightful share of the cost to perpetuate the welfare and ideals of this country thru legal and equitable means. A health care system must be able to identify its client population (Americans) and other populations it will serve, but with conditions of eliglbility, costs and equity as prime considerations. As our brother's keeper, we must also hold our brother to the same standards of participation as we hold ourselves, respecting therefore the law, eligibility, fair share contribution, and obligation. " 29511 08/02/06 MA Agree Agree Agree Agree Agree Agree "* Funding through a single payer system rather than through for-profit insurance industries would eliminate excess waste in the form of administrative paper shuffling, advertising, marketing, company profits, etc. The John Conyers bill before Congress HR676 and models of other industrialized nations should be our guide. Working Americans would pay 3% payroll tax (which is much less than is spent on insurance industry premiums now and there would be no deductibles or co-pays).Currently about 50% of every health care dollar is wasted (Sager and Socolar - asager@bu.edu). Eliminating that waste would put enough money in the system to cover every resident in the US with quality, affordable care. It could also cover job training for those displaced in the insurance industry." I am encouraged by UNCAN efforts toward health care reform and in getting public comment. Keep up the good work. 29513 08/02/06 MS Disagree Health care coverage should be for all legal American citizens with limitations put on prices that health care facilities regardless of insurance or coverage. There exists a double standard with exhorbant prices charged to insurance companies driving the costs. Disagree Too much specific government involvement and ultimate tax base financed assistance free programs. Agree Agree Disagree "Generally agree, but fraud and reckless misuse of assistance programs have contributed to the situation we are now facing to a majority. So, very strict guidelines and usage policies must be put in place prior to the program's beginning. " Agree "Establisment of fair prices for serices across the board will help to minimize cost. Fairness principles, sin taxes, and portions of income taxes could be a better means. The individual/state systems are failing miserably in many cases. " Benefis should also cover visual and hearing if not already included under the physical definition. Language should be clear and precise to not allow misuse and fraud to occur within the general guidelines and policies. 29514 08/02/06 KS Agree "Establish a national program. Public, NOT private. This is the way it Guaranee coverage for everyone for all health costs except minimal copay, and no coverage for any advanced care until everyone has basic care. WORKS in every other industrialized country. It is in no conceivable way appropriate to tie the health of the American people to the profit of private companies. Get real. Are we about ensuring health or profit for corporations?" Agree Sure. Private only if it is guaranteed to be controlled by and work in the interests of the public. FQHCs are great; what we need is CARE FOR EVERYONE. Why is this such a hard concept? Why do you keep having to play with it? Agree "Absolutely decrease waste, increase quality, use evidence based practices. Start by eliminating excess profit in the private sector." Agree That they choose within reason. It is not reasonable for some people to choose to use incredibly costly services which will not benefit them while others are denied basic services. Agree "Yes. And simple. Everyone in, no one out. Single payer, single payer. Choice of private or public physicians, choice of hospitals, one insurer. " Agree Yes. "* This has become unnecessarily complex. We don't have to invent the wheel; there are wheels aplenty out there in other countries. Programs need to cover a minimum set of benefits for EVERYONE (not 2/3 of the children here, 1/8 of the poor people there, 12% of the Caucasian people from Missouri whose grandparents made less than 200% of povery there), and NO ONE GETS ANY SERVICE BEYOND THE BASIC UNTIL EVERYONE GETS THE BASIC. If people with wealth want to buy more, they should pay 100% of the cost out of pocket. The mission of government is to meet the needs of the least, not increase the wealth of the richest and most powerful. That is not good government, that is cynical and evil." 29516 08/02/06 GA Agree I totally support health care coverage for all Americans with a low out of pocket cost with equal benefits regardless of one's income. Disagree There has been a history with this administration in not effectively listening to advisory boards which tend to get nothing done? Disagree My concern is patient-centered care that has not happen since the beginning of our health care problems. Disagree "Government should get out of the business of trying to ""assist"" or regulate people decisions regarding end of life care for their love ones." Agree Agree I disagree with asking the public to pay more when health care costs and premiums have already drained most Americans wallet/pocket books. 29522 08/02/06 RI Agree "* Some people are impoverished even withoutpaying for health services. Many other hover on the brink of economic collapse even if out-of-pocket expenses are not ""high"". With a few exceptions, most Americans seek out expensive health services (e.g. hospital ER) because a less expensive, more appropriate services (e.g. primary care doctor) is not available/accessible or because the ""system"" directs them into revenue-positive services. Don't blame the victim for the high cost of a non-system that was set up to fail!" Disagree This is an attempt to set up a second tier of services for the low income and uninsured while we make them uninsured because they are low income. Let's let Corporate Executives and Congressmen/Senators use the community health centers while we seek health insurance coverage for all Americians and let them--not us-- choose where they get services. Agree "* Lets use the Medicare-like insurance system for all Americans (4% overhead costs) to provide Veteran's Health System (the world's largest national health service)quality of services for all Americans. Cost and quality information is not effective for most consumers; since these decisions are usually based on other criteria (who's my doctor? where does he/she practice? what service do I need to stay alive, get better....?? We keep re-instutionalizing the ""underserved"" and ""uninsured"" into our proposals and then propose inadequate approaches for providing them with safety-net services. When are we going to learn???" Agree I think it is awful that we spend so much on people during the last few days of life--and so little on people at times when adequate health care (also jobs and education) can make a real difference in the rest of their lives and that of their children and future generations. Agree "If we had a single-payer system, we could accomplish this. It would probably save the nation billions of dollars!" Agree "I think a single-payer system IS optimal. The ""efficiency"" and ""shared responsibility"" buzz words are business-speak for ""don't make us pay for high use/low income people""--when we are already paying a thousand times over through categorical progams, emergency services (when prevention works), tax deductions for charitable giving, and other various indirect subsidies. Who do we think is paying now????? Let's face up to the problem and fix it--all the other developed nations have........!!!!" "I agree that we should establish a comprehensive benefit for the single-payer, national system of health insurance for all. I think the package should be based on need and evidence-based effectiveness, not on cost alone." "* The solution to America's health care non-system should include (1) a national system of health insurance coverage for all Americans (2) Financed primarily by individual and business taxes (one-payer) (3)one system of administation to eliminate the inefficiency of multiple, contradictory plans (4)national/federal negotiation for best prices of administration, services, equipment, pharmaceuticals and facilities (5)a national wellness benefit to promote reduced risks and promote healthy behavior for all Americans (6)taxes, subsidy withdrawl and other penalties for companies/industries that promote unhealthy behaviors (e.g. tobacco, alcohol, fast food, environmental tobacco exposure, saturated fats and high fructose corn syrup) (7) full coverage for rehabilitation services related to alcohol, tobacco, drugs (instead of jail) (8)national policy that addresses access, quality and underserved populations directly (as above) rather than indirectly (and ineffectively/inefficiently) through subsidies, categorical g" 29527 08/02/06 KS Agree "* As a registered nurse for over 25 yrs. I can tell you that the gap between the haves and haves not has widened. To me having health care should be no different than having food and water. We only spend more money by waiting and having to deal with the consequences of days/months or in some cases years of neglect due to no health care. WE would be better served spending that money up front trying to PREVENT. It is also ridiculous that anything with medical attached to it jacks up the price. This is seen a lot in supplies. Things such as crash carts that are also used by automotive repair personnel cost 3x as much when ordered from a medical supplier. Medications shouldn't cost as much as they do either. It is ridiculous to have to pay $5.00 for one pill, etc. " Agree "This sounds good in theory, but I see a lot of red tape here and too much money used for implementing, instead of actually getting the money to the front line to take care of the patient. " Agree "Again, good in theory but concerned about cost of implementation. As a nurse case manager for special needs children, I haven't experienced Medicare and Medicaid being efficient either. Quality of care is not their first priority." Agree "AMEN! It is about time. Everyone should have hospice instead of being in a hospital and receiving ""traditional"" care when it is clear there is nothing else that can be (or should be) done. This is one area that has improved since I started, but I think access to it is still difficult." Agree See #1. Agree "Shared responsibility equally is going to be difficult to accomplish, especially for those with limited financial resources. What else will motivate them to be responsible for their own health?" "Members need to be current in the practice. I realize this is hard to do, but they can't be out of the clinical arena for long before they forget the reality of it. Hence, their recommendations aren't always realistic, pertinent, etc." "* Something has got to be done and I'm glad that I was able to offer my opinion. Especially since I have over 25 yrs. of experience with the healthcare system, I can vouch for the fact that the current system is NOT working. We have gone from one extreme with providers running the show to now insurance determining everything. Healthcare should NOT be a business like regular business. It is not in the best interest for the average patient to be caught in a capitolist system with hospitals, doctors and other providers competing. We should all be working TOGETHER! Otherwise, this is only going to become worse with more shortages in the various healthcare professions and more patients falling through the cracks because the safety net can't catch them all." 29530 08/02/06 OK Disagree "* 1- Social Security approved disabilities - those unable to work for an earned income should be allowed to pay a nominal even zero fee/cost. 2 - Those waiving employer provided healthcare should pay a higher portion than one without the option of employer sponsored plan. Possibly on a sliding scale basis. 3 - Not ""ALL"" Americans, only those that cannot get it through their employer and those mentioned in no. 1 above. 4- if we focus on ""very high"" out of pocket expenses via reducing the cost of health care via free market, the problem would not be as bad as it is. REDUCE THE COST FIRST, then let's talk. " Disagree "I am unfamiliar with the potential ""trickle down affect"" this program could cause. Sounds good, just not enough information to offer a sound opinion." Disagree "* The more programs for the low income and uneducated are available, the more more abuse occurs. Why do they have to be prudent health insurance purchasers/users when there are programs out there for them to utilize . .and the government will pay for it. Many employee refuse to purchase health insurance through their employer because of such programs. FOCUE ON REDUCING THE COST OF HEALTH CARE, THEN LET'S TALK. The Federal Government getting further involved is not the answer, the cost will continue to rise." Disagree "Hospice care needs to be reflectd on a ""Matrix"" of all health related service based organizations within each state to be used by the public. NAHU is currently working on this for each state. Social Security is available, right? Also, Long Term Care insurance is available and should be purchased. " Disagree Without government involvement. Public Policy means government involvemnt. Government involvement among many other things means raising taxes! WORK ON REDUCING THE COST OF HEALTH and then let's talk. Agree "If anything, sliding scale according to current income. What is reported to Employment Security. No such thing as ""free"". WORK ON REDUCING THE COST OF HEALTH CARE, then reevaluate. " "Preventive for certain. Above that, each qualified participate to receive a flat dollar amount (debit card type) based on income to spend according to their own medical necessity/specific needs. Everyone has special/different needs. Preventive is the only core that is certain as all human beings need that if nothing else." "* We MUST focus on reducing the cost of health before we simply cost shift or look to the government to fund it. We can effectively begin by 1) Tort Reform to stop ""defensive medicine""; 2) Transparency; and 3) remove ""networks"" because they nogotiate everything behind the scenes which takes away the ability for consumers to price compare and conflicts with ""free-market"". Free marketing is the only avenue that reduces anything . . including health care. Networks were good in their day but they have become a big part of the problem. RX needs to be addressed as well. They are financially raping the american people and it's plain wrong! " 29531 08/02/06 OH Agree "Healthcare should be a right for humans, not a choice that is made by how much money you make." Agree Agree Agree Agree Agree 29535 08/02/06 NY Agree I mostly agree -- but I don't think it is possible to establish a private national program. The only practical solution is a national single-payer health program -- and I can't imagine how one private insurance company would be chosen for this. A government plan makes more sense. Agree "Again, of course there should be a ""safety net."" But it would not have to be called that if there were a national single-payer system. Everyone would be covered. One large underserved population is young people after they graduate from college and before they have established themselves in a job that involves health insurance. Most simply aren't covered because they and their parents can't afford to pay for the premiums independently." Agree Agree But this could all be part of a national single-payer system. Should the burden really fall on the community level? Agree Agree Having multiple insurance companies requiring complicated paperwork really ups the costs. We need to eliminate the insurance companies and have a single-payer system. Marcia Angell and colleagues have worked out a viable way of making the transition. Please see her work. 29537 08/02/06 PA Agree "It is important to me that insurance companies create more clear, reasonable, and fair guidlines regarding what they will and will not pay in terms of co-pays, deductables, etc. Many people feel that they ARE covered and pay for years into insurance policies that leave them stuck with unreasonably high bills when they actually need to use them. " Agree It is also important that these centers will be staffed by qualified medical personel. The current medical education system leaves young doctors with such tremendous debt that it is often difficult and/or impossible to take positions that do not pay well. School loan repayment programs like the National Health Service Corps should be expanded in order to ensure that new doctors are financially able/motivated to take lower-paying positions in community health centers. Agree Expanding electronic medical record usage and perfecting this technology is really key to improving the quality of care that patients receive as well as improving efficiency/cost-effectiveness of care. Agree The importance of discussing and obtaining truly informed advanced directives from patients should also be emphasized and could potentially save a lot of money that is now wasted providing unwanted and futile drastic measures during the last months/weeks/days of life. Agree "Every patient should also have access to organs for transplant. Currently, patients who are deemed to have ""inadequate financial or social support"" to maintain thier post-transplant care are not eligible for transplant. Programs should be developed that can provide these resources for patients who need transplant organs in order to allow them to be candidates." Agree 29538 08/02/06 IA Agree "* something needs to be done. For instance, my husband is a heart transplant recipient 12 years ago in Rochester Mn. at ST. Marys Hospital. He works full time, never has been on any kind of disability. Was transplanted in May of 1994, and went back to work the following end of August. Doctors have been amazed. He has never been hospitalized since. Now, the company he works for just changed insurance they are denying him to go to Rochester for any tests. He needs to go yearly, to have blood work done, to check bone density etc. We have called the insurance com. they do not get it. Mason City, Iowa doesnt have a transplant team. He needs to see his doctors up there. It is not fair, I hope this gets some attention. Starr Lang. PS. My husband and I are only 51.He received his heart at 39. " Agree Agree Agree Agree Agree 29540 08/02/06 DE Agree No response Agree "A program that does not address the excessive costs in the health care system, is not effective. Out of $ 10,000 paid in premiums, only $ 6,000 reaches the patients, the balance is administrative costs. No brainer? " No response Agree "Everyone receiving healthcare should also pay towards this care, modest or more dependent on income." No response cut waste from system and reduce admin costs 29541 08/02/06 TX Agree Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. No response Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. No response Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. No response Agree Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. No response Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. Coverage for all is essential. A single-payer system is by far the best way to fund it. I support the comments submitted by Public Citizen. 29542 08/02/06 CA Agree Agree Agree Agree Agree Agree 29543 08/02/06 NY Agree Agree Agree Agree Agree Agree NOT SURE WHAT THIS MEANS?? I JUST GOT THIS E-MAIL. SORRY IT'S A LITTLE LATE TO BE PART OF THE RECOMENDATION BUT I FIQURED A LEAST YOU'D HAVE MY POINT OF VIEW. 29545 08/02/06 OH Agree "* According to the World Health Organization’s ranking of world health systems, “The United States, which spends a higher portion of its gross domestic product on its health system than any other country, ranked 37th out of 191 countries.” Not only does our country spend such a high amount of money on health care, but the fear is that due to health care costs the families will be put into such debt that they won't be able to survive. On a personal note this incidence has occurred to someone very close to me. Due to a terrible accident this woman's husband is now paralyzed from the waist down. The health costs from the surgeries that saved his life have destroyed her credit and made life very difficult for her and her family. The day to day costs as well have risen as complications over a five year period have arisen. This problem for the family I know and others in the United States can be avoided by allowing for better coverage. If looking at the example of the Canadian system, everyone is pro" Agree "* Having a system in place that allows resources and networks empowers the individuals seeking aid. Many that are uninsured and from a lower socioeconomic status face difficulties when seeking health care. In creating a funnel system that would filter down from the federal government to the national level and then to the local level would help ensure that the policies are in effect for those that need them. Accommodating the community health centers to reach those in need would allow the people to feel that the government was looking out for their wellness and would open the doors for better use. There are over 40 million uninsured in the United States that come from the vulnerable lower income areas where there are no resources. In opening doors at the local levels, the federal government then has the ability to see that those in need are receiving their aid." Agree "* I feel the two best aspects explained here are consumer usable information and health education with health promotion. A large problem in health care availability is that the greater population doesn't understand the language in which it is written. Information is meant for the consumer not the provider. Also, if the person cannot read, see, etc. having education and other avenues open enables the people to take better control of their health. Health promotion and education is also necessary because health is not about treatment alone but prevention and wellness. It is much more affordable for the government to offer programs of education and promotion in health then to spend the money on treatment." Agree * This is yet another that I have personal experience as I am sure many do. My grandparents were forced to sell their homes and spend everything they had saved to move into a nursing home facility. It was not only devastating to them but to my family as well in that we didn't have the ability to care for them the way they needed. Had care not been so expensive we would have been able to keep them in their home where my grandmother could have died at a more peaceful state. Nursing facilities in my opinion from experience are cold and empty places where people are forgotten. There is no longer dignity in life or your body and age. It’s bad enough to have your health begin to fail but to loose your dignity and possessions for a few extra years kills your soul. Hospice care and end of life care should be made more affordable to allow for more time spent with the family and those you love in a place that makes you feel comfortable. Agree "* Lawrence Brown in his article ""Comparing Health Systems in Four Countries Lessons for the United States"" published in the American Journal of Public Health in 2003 explains, ""Most American physicians and hospitals continue to view health insurance as an economic, not social, enterprise and organize and strategize accordingly."" Although health care is an industry and a business it is important to look at those that are being harmed while others get ahead. The government and businesses should look at other systems and allow for coverage that everyone can have that is the equal. If the care was more affordable to the people perhaps there wouldn't be so many uninsured or underinsured in the U.S. This is a difficult problem to address but something must be done and only the government can allow for change." Agree "* Again Lawrence Brown in his article tells us ""70% of Canada's health bill comes from national and provincial general revenues."" This is one example the U.S. could use as a model. Out of all the problems with health care in the U.S. system funding the programs is the largest hurdel to overcome. With so much change and people to consider many compromises must be met in an equitable manner. It is vital for those in our government and the companies to understand that health is a fundamental human right as explained by the World Health Organization and by not allowing proper financing a great injustice is being created. The role of the government is to protect the wellness of the people and until proper financing is made available the government is failing the people. I am not an economist nor am I a politician so I would have no idea where to begin in recommending a solution to this problem, but as a citizen I can say that I am depending on my leaders to fix this problem in the best way they can." * In developing a core package that encompasses the needed services is difficult because of the multilateral collaboration that must occur. Health is not simply about the physical aspects of the body. Mental health is the silent killer for many and very difficult to receive help for without the proper resources. Another issue that is often forgotten and which contributes to severe discomfort and morbidity among those in poverty is dental care. Dental care is very expensive and depends a great deal on nutrition and personal care. For those in low income coverage and care are difficult to find and pay for. Having a package that recognizes the three basic areas of health and wellness would ensure better quality of life and would increase the economy because fewer people would miss work and productivity would increase. 29546 08/03/06 OK Agree "* I agree with some of this recommendation and I disagree with other parts. I do not believe it is the government's responsibility to provide coverage for all people. It is an individual responsibility to seek health care benefits. I do think there should be some protection against high out-of-pocket expenses for low income citizens, who are responsible enough to seek out some kind of insurance. I also believe costs for drugs are out of control. The pharmaceuticals have so much power that they pretty much regulate pricing of medicine. We need caps on the pricing of drugs and more oversight for the pharmaceutical industry." Agree I agree. I think that research is needed to establish what is the best practices for all populations. The rural population is in the most need in my opinion. Agree "I agree with this recommendation, with the assurance that privacy for the patients is top priority. I do not want my information shared with anyone outside of the health community for ANY REASON without my written consent." Agree Disagree "* I do not agree because I believe that it is the individual's responsibility to seek out health insurance in some way. If there were caps on the pricing of medicines and procedures, then maybe. Otherwise it is too costly for those who take the responsibility to have some kind of insurance. I do believe there are a few citizens who cannot afford any kind of health insurance and it is no fault of their own. In those cases, I think they should be entitled to some kind of benefit as long as they can prove that they are taking measures to prevent illness. It should be required that these people get a preventative examination yearly and then prove that they are taking the recommendations from their family physican before benefits are given. I also know that many low income citizens, who fit this category do not know how to use the health care appropiately. Going to the doctor for every little sniffle is not appropiate. Also I do not agree with giving any person who is not a United States citizen any kind of" Disagree "* I am not willing to put out more money for those people who lose their health because they smoke, drink excessive, drive under the influence, etc. If a person decides to put himself at risk by choosing to live dangerously, then that person chooses to give up his right to assisted health care when a related illness his or her way. Example: A person smokes. Despite all warnings, that person continues to be irresponsible, then that person has given up his right to expenditures when a catastophic illness comes his or her way. Responsibility lies with the patients." "* I think this element goes beyond the basic of care. I do not want a government health care plan. I do want the health care system changed. I want more oversight on health care services for the poor. We have Medicaid for welfare cases. The working poor need something as long as they know how to use the system. It would be taxing our system to give everyone everything. ""Prove that you are taking steps to help yourself and then the government can step in."" Example: Those who don't brush their teeth daily don't get benefits." "* Some of my recommendations are: 1) Make doctors' recommendations to exercise and eat healthy for overweight or obese a prescription, anti-smoking and alchololics programs for addictions. In some way, insurance companies could pick up part of the cost of fitness consultations, diet support, support groups, and etc.; if all the following apply. a) A physcian writes a prescription for health consultation or support groups. b) The patient follows through and meets the goals in a prescribed period of time. c) The patient continues to maintain a healthy status in the areas of concern. 2) Provide incentives for communities to provide bicycle paths so that people could use bikes for transportation instead of cars. I can see that these paths could be a community ""freeway system."" Better health would come in better fitness and less pollution to the lungs. Walking tracks would also be included in this. I could go so many places if I had a place to walk. 3) Make every person responsible for his or her " 29547 08/03/06 MI Agree Agree Agree Agree Agree Agree "Use the royalties derived from resourse extraction (wood, coal, oil, gas, iron, gold, etc. and all natural resources, to fund our healt care system. These resources belong to ALL AMERICANS and the earnings from them ought to be used to finance such a core program and the core values of our people!!!" "But don't give the Pharmaceutical Industry or Insurance companies a seat on such a group - it would no longer be independent and would certainly become just another mouth peice and rubber stamp for these industries, thus sidetracking the whole effort." 29552 08/03/06 NC Agree Would keep folks from not being truthful in order to qualify for Medicaid and Health Choice benefits offered by the govt. Agree "Such centers would help w/ preventative care.....w/out preventative, our hospital costs sky-rocket" Agree Prevention is the key; availability fo affordable clinics will aloow this to happen more. Agree Agree All should have some co-pay...even if $1...hold folks accountable for having this possibility Agree 29557 08/03/06 FL Disagree "While I agree that the cost of healthcare is significant, I do not believe what sounds like a socialized medicine program would be the proper way to go. I believe that proactive healthcare, ie preventative care, is a better option but does require an individual to take responsibility for their health to the extent possible." Disagree Agree "It is my belief that with the complexities of current medical care, it is crucial to develop and implement improved evidence based practices, an electronic comprehensive medical record, and improved education." Agree Disagree "Indivuduals need to take responsibility to the exten possible for their health. This means that providing educational resources is important, but it is an individuals responsibility to implement this in their lives." Disagree "Again it is important to have a proactive, preventative care focus. The healthcare technology available today has advanced much more rapidly then our ability to pay for it." 29559 08/03/06 MN Agree I feel all people should work to get health care and don't give it to people that will not work for it. Agree Agree Agree Disagree We should make people work for the health care and just not give it to them. Agree Makea the poor people do some kind of work and make them help themselves besides us taxpayers paying for everything for them. Most of them are capable of working and helping get them off the welfare roles. 29560 08/03/06 MI Agree "It is way past time we had a universal health care system that works for people, not the AMA and pharmaceutical companies." Agree Agree Agree "Having just dealth with the death of both my parents a year ago, I have a new appreciation for the work of hospice agencies and very much support their funding under government agencies. This care provides for dignity at the end of life." Agree "I believe in universal government paid systems with no associated direct cost to individuals, 100% paid through taxes. We can afford it if our government's spending priorities are correctly aligned." Agree "Again, we spend our money on dangerous adventures around the world, a bloated defense structure and maintenance of a completely insane nuclear arsenal. We should all be more responsible individuals, take care of ourselves and insist on a goverment FOR the people. Simple as that. We have the money already, is my point, and it is wasted." 29562 08/03/06 MI Agree A single-payer national system is the most likely to achieve this goal. The private system simply is not working. Agree Agree Agree Disagree It should be public policy that all Americans have a right to health care. No response "If we need to increase taxes to cover health care for the uninsured, that should be the way that we go." 29565 08/03/06 IL Agree "SEE, THIS WOULD HELP PEOPLE THAT HAS LOW OR NO INCOME, AND THIS WOULD HELP THE SINGLE PARENT, WHETHER IT BE A MALE OR FEMALE WITH CHILDREN." Agree Agree Agree Agree Agree "IF THEY CAN GIVE A GOOD STRATEGY DEALING WITH THE FINANCIAL ASPECT OF HEALTH CARE, WHERE ITS REASONABLE TO PAY, I AGREE." 29571 08/03/06 IN No response Agree No response "This should not be a top priority. Access to care is a much greater problem that quality of care, once accessed." Agree Agree Agree Employment-based health care insurance should NOT be the foundation of the health financing system. The system must greatly reduce the growth in health care costs. We are getting relatively little benefit for the dramatic increases in health care costs over the last decades. 29578 08/03/06 CT Agree Too many people have had to file bankruptcy because of illness. Agree I can see problems--amply demonstrated by the Bush administration--in how the advisory group would be chosen. Agree Agree Agree "Wholeheartedly agree. This lack of health care interferes with this country's economic competition, as well as leaving millions uncared-for and under-cared-for." Agree 29580 08/03/06 WI Agree "Clearly the basis of any recommendation; however, right in the initial statement the word ""quality"" is missing. This disturbs me. Providing health care to everyone that does not have adequate standards associated with delivery is worse than not delivering care." Agree "I agree with the intent. However, increasing layers of bureaucracy does not equate with improving a system. We have a broken system now, expanding it will just magnify the problems. This is a very poor implementation of an excellent goal." Agree "This is excellent and captures well the means to implement. However, with the poor track record of the current system, I don't see any built-in systems to determine whether any particular implementation actually affects health care delivery. The on-going outcomes assessment of innovation should be crucial to new systems development, otherwise we just repeat the same pattern we have for the last 30 years." Agree "This is good, except it should be clearer in the initial bullet that the goal is to integrate the patient's and patient's family expressed needs with the external opinions. I see it later, but when it is placed later, it implies there is less importance to this goal. The problem that I perceive now that this is the stated goal but is influenced by personal caregiver philosophy more than by patient's needs." Agree I agree. Agree "* This is blowing in the wind rhetoric. Nowhere do I see an effective alternative, just reworking old systems. An example of an innovative system that builds on current infrastructure would be mandated service of 2 years for all health care professionals after completion of training. These individuals would work in established clinics, private and public, hospitals and government facilities and be paid an equivalent service grade salary with benefits. Eliminate all fee-for-sevice payment if an individual does not have private insurance. Use current Federal funding of facilities to take care of facility-based sevices like surgery. Care would be provided by all providers not just the government salaried providers. If you want more detail on this plan, please contact me." "A lot of what is recommended here is already in place, but in a non-integrative way. None of this is new and most of it will just create more expense and more layers and there is no built-in system to monitor whether it is achieving desired goals." 29583 08/03/06 FL Agree "As a person that is STILL trying to get medical help after being diagnosed with a life threatening disease I urge that ALL Americans are given the attention that is deserved as TAX PAYING CITIZENS, that is given freely to immigrants without a question." Agree "WE NEED HELP. To keep being a working, tax paying CITIZEN of the UNITED STATES. No medical help=no work=no taxes" Agree Agree Agree Agree 29584 08/03/06 TX Agree I find it ironic that the federal government who will bring this about is essentially the same one which shot down a national health care plan in the Clinton administration and personally doubt the integrity of these individuals now. Disagree "Speaking as a health professional, I have experience that this type of cookie cutter medicine does not work. Health care has to be decentralized, not centralized." Agree It has never accomplished this in the past but now is a great time to start. Agree Excellent! Agree Past due! Agree End the war in Iraq and no new revenue will be required. Limit participation of physicians-they are the root of the problem. 29585 08/03/06 CA Agree As the richest country in the world no one should have to go without basis healthcare and if this is available people will get the help they need before they get a serious sickness which will cost more to help the patient. Agree Agree Agree Agree Agree 29586 08/03/06 TN Agree "* People, this is the United States of America, the grandest world power, most advanced country in the world--where is the health care that should be available to everyone. I suggest Health Care/Clinics be set up and monitored by a Government Agency, like Housing and Urban Development manages multifamily and single family low income properties. Make this type of health care available to anyone who wants or needs it. Those Americans that are rich and famous or who have other means will continue to use their private or paid for facilities; but give the other people who need it and who want to use the Government-run facilities the option of having continual health care. One knows the rich will continue to pamper themselves, but we have people in this country, who are making a fairly good living, but a hospital/illness crisis could take everything they have. Make the Government-run facilities available to Everyone, and let me head up the Government Agency that will monitor the health care/facilities and res" No response No response No response No response No response 29590 08/03/06 CA Agree Agree Agree Agree Agree Agree "* I believe that All Americans should financially participate in some way whether poor or wealthy. If you don't pay for something, then you don't value it. The insurance companies have caused havoc with the medical industry because of the extremely high cost of insurance payments that employers and citizens are having to put out monthly. It's rediculous! We should have catastrophic insurance that would cost $100-$150/month or less; pay our doctors directly for a visit which make the doctors more accountable and have better bedside manners because they would have control over their business; and pay a minimal amount for lab fees/x-rays/etc. " 29592 08/03/06 CA Agree Agree Agree Agree Agree Agree "As the wealthiest nation in the world, I think we owe it to the people who contributed, in one way or another, to making it that. A great deal of blood, sweat and tears went into building this nation. If we can't take care of our own, What does it say about us? About our priorities?" 29593 08/03/06 VA Agree Protection for all Americans is important. It shoulc also cover middle class Americans. People who have worked hard all their lives and been contributing members of society should not lose what they have due to medical bills. Low income people also need this protection. The rich always manage to take care of themselves and each other. Disagree "But again provide this for middle income people also, there are plenty of middle income people who work everyday of there lives and cannot afford health insurance" Agree It is crucial to do something about fraud and wastee. We all suffer because of it. Agree Agree This is stated perfectly! Agree "Please look at frivlous lawsuits, waste, and fraud." "I am lucky enough to have a good health insurance plan and my employer pays 98% of the cost. But there are many hard working Americans that cannot even afford the insurance that is offered. This is criminal, that a man or woman can get up go to work each day, contribute to society and not have medical coverage is inconceivable." 29595 08/03/06 PA Agree Disagree "Way to bureaucratic. We need a solution that is 'consumer' oriented, like the former CEO of AOL is talking about. " Disagree I don't know what this means. Too many things bundled under this and again to gov't. centric. Agree Agree Disagree What does this mean!!! Just figure out a way to allow every individual to be able to purchase affordable insurance - allow them to buy into group plans the way empoyers can. GET employers out of the equation. "Find a consumer oriented solution, not a gov't oriented one. " 29596 08/03/06 OH Agree Agree Agree Agree Agree Agree Increase taxes on the people that are in top 5% of income earnings. Increase taxes on companies who post billion dollar profits. Increase taxes on those government officails that don't pay into Social Security. 29601 08/03/06 CA Agree "Through private or partnership between public and private only. I believe a national program under public control would most likely be costly and inefficient, but also distructive of the better parts of our system (research and technology, high quality medical education)without releiving the distribution issues which are at the heart of the problem." Disagree "I agree with the idea of support of community based health networks because they already exist in urban areas ie Sutter health, Mercy system and are very effective. Existing programs for the poor feed into these systems, but are weak in rural areas. The more streamlined delivery is the better underserved are. The more people who are insured by the private system the better off we all are. Public dollars could fund infrastructure but should not control medical practise or create burdensome bureaucracy." Agree * I think that consumer usable information on pricing is totally lacking in our system as is information on how successful hospitals are with outcomes on various procedures. We all know that electronic medical record systems that are integrated are absolutely necessary to the future. The government needs to look to successful community systems to fix the programs mentioned so the populations served are better cared for on the dollars available rather than receiving rationed services in an inefficient bureaucracy. Doctors should be able to practise medicine within the system as independent moral human beings who are still able to make a decent living after they sacrafice their youth to a very expensive education. Agree This is one of the most important things we can due and we have seen hospice funded by medicare help the elderly. Certainly we can find a way to help others. Many group insurance contracts provide some assistance but I do not know how adequate the provisions are. Agree "Everyone agrees in theory with the caviat that I wish to retain choice, of providers and treatments. If everyone were required to have a basic private insurance policy, we would have a start in the right direction and would take an enormous strain off emergency rooms and would help bring everyone's costs down." Agree "* This is the most difficult part to figure out. Improvement in efficiency is essential. Maybe some industries such as tobbaco should be forced to pay more, maybe large polluters of water and air, maybe government run legal drug programs could contribute to reduced addiction and health deterioration among addicts which cost a whole society not to mention the violence that is treated on the public dollar in emergency rooms all over the country. We need to be very careful with burdening small businesses as we all need paychecks and a healthy economy to make our own best personal contributionsto society and to have healthy lifestyles. " "* People who have poor education,poor nutrition,no exercise and bad genes will always be with us as will people with addictions. Core benefits if simple and affordable over time could lift the health of the nation over a generation or two and greatly improve productivity. The benefits need to be basic and limited, paid for by individuals perhaps with some public subsidy. People do not appreciate what they do not pay for. Take a look at public education in California, where kids cannot pass exit exams and teaching is becoming an exercise in making up for what families don't provide their children. " 29604 08/03/06 PA Agree Agree Agree Agree Agree I strongly agree with this. Agree 29606 08/03/06 OK Agree "I think that all should be entitled to the benefits of our expanding medical knowledge, without having to worry about medical bills so outrageous that they bankrupt families. I think this should be a concern of our society, just as we pay for road systems, libraries, public schools, etc. " Agree "I have a concern for low income people who are not afforded insurance through their jobs, especially young people. Many young adults, especially those without college degrees, are forced to work in environments which either do not pay insurance benefits, or in part-time jobs which get around paying benefits by not letting them work full-time. These people need health care." Agree I believe that expanding health programs already in place is an efficient use of our human and financial resources. Agree Agree Studies should be made of the health care models of countries which already provide universal health care in order to have an idea of how those systems are working. No response "I think all should be required to pay into the financing system, but on a sliding scale based on income. Those in poverty should not be required to pay." "* I think there should continue to be citizen involvement in structuring this new American health care system. I believe information-gathering and decision-making meetings should be open to the public, and that the congressional committees which deliberate on these future programs should be required to publish the citizens and industry representatives who supplied them with information. There should be a balance between consumer, industry, and legislative representatives who make the recommendations and decisions. Industry lobbyist input should be limited and documented, if allowed at all." "I attended the August 1 Citizen's Health Care meeting in Oklahoma City. I suggest that this process of gathering information be continued periodically, once we have new programs in place, for the purpose of analyzing the programs' efficiency. Also, maybe smaller gatherings could be done, led by employees of federal programs already in place, which would be limited to hearing consumer concerns." 29607 08/03/06 MT Agree "WE need universal health care coverage. Government has made senior medications a very complex system, not needed for this ite. " Agree "Health centers can do the job. They need to be funded, and not have funds cut like this year. We have a community that has need, and has applied 3 times without getting funded. It is also difficult in rural, less populated areas, as we do not have the numbers, but we have the need." Agree "Health centers want EMRs, but do nto have the financial resources to buy them." Agree Disagree "All people in this country should have access to health care. I fear creating 2 sets, one set of care for the rich and one set for the poor. Also, I fear denying care to Mexican immigrants, because they are not citizens." Disagree The insurance companies and the AMA will lobby for a system that leaves them wealthy. I want a system that makes health care a right. I do not like this 2 class system. The working man should have the smae options as his senator. 29610 08/03/06 IL Agree "* Generalist Doctors are spending an inordinate amount of time focussed on money issues and bureaucracy(Medicare/Medicaid/Hospitals/Lawsuits) to the detriment of patient care. Let's move them back to their hypocratic oath commitments rather than their being presented with the impossible dilemma of fullfilling the objectives of 2 counterposing forces. And, psychologically putting the public in a position of putting the profession on an unfair pedestal which tends to lead to the problems mentioned above: this helps neither the doctor or patient." Agree Agree Agree "Focus on keeping the Hospice programs Not-for-Profit. As with Corporate Funeral and Nursing Home companys the ""Care"" takes second place to profit: another untenable situation for the patient!" Agree Agree I would gladly respond to a telephone enquiry. 29611 08/03/06 MN Disagree "Cover all Americans at what level,how?At what cost? There has to be limits and levels. By the way Health Care is an issue I have been working on in the state of MN as a volunteer small business owner and have testified regularly to the Legislature over the past decade. " Agree Agree Agree "However,often the highest expenses are incurred at end of life for many over age life expendancy many times when it is unlikely they will recover because of the family feeling guilty.DNR orders by senior patients need to be setup ahead of time and honored. " Disagree "What does affordable mean? What kind of coverage at what cost?Yes absolutely some coverage for all all the time, not unending,unlimited coverage for all all the time. Maybe a healthcare index should be established.People should know regularly how much healthcare expense they use vs personal money/benefits submitted. " Disagree "* Health care coverage for the individual should be mandated as an individual responsibility(not government or Employer)Reporting of coverage would be on the US tax return and would be a tax credit for premiums to a certain income level then deductible.Employers would pay directly to the employee who would secure and manage own guranteed issue portable coverage. higher premiums for smokers ,obese and unhealthy lifestyles. Lower incomes would be subsidized on a curve.No 100%cost free coverage something has to be paid by everybody sometime. Insurance companies would be required,particularly Non profit,to be transparent.Fannie Mae like insurance companies where the government and private sector formally participate together may be a way rather than one or the other. " "I am concerned about who qualifies as a member.Most people do not study this topic noreven the policy that covers them.Someone should show they have knowledge ,as well as opinion ,which often is emotionally driven,not practically." "Take the empolyers out of the healthcare providing business, level tax issue, inividualize responsibility,geographically underwrite,allow cross state purchase of policies ,Have basic mandates for coverage with ale carte add ons choice by individuals.Get rid of multiple state healthcare agencies that are redundant ,like medical assistance, Mncare and MnChA in Minnesota.One could service all based on above. " 29613 08/03/06 CA Agree "ALL Americans need health care, regardless of how little they earn. In Europe it is a way of life. Geri Marshall" Agree This is vitally important to our nation as a whole. Agree They need to use their power effectively in this area. Agree Everyone has a right to make their own end-of-life decisions. Agree Poverty should not bar medical coverage. Agree "There is enough to give billions away in ""foreign aid."" Yet there is not enough money to take care of our own citizens. WHY??? Because we aren't a priority." We all need a basic core standard of minimally acceptable medical care. "this is vitally important to our nation. Millios are uninsured, but we cas send billions over seas." 29618 08/03/06 AZ Agree "I think it would be beneficial to provide more affordable health insurance for students. Perhaps a student insurance fund to which all universities are a partner, that way each university is not soley responsible." Agree Agree Agree I would also support an aggresive ad campaign for Hospice to help dispell some of the fears and ignorance that keep people from investigation what Hospice has to offer. Agree "With the size of the US budget, it would seem that funds could easily be diverted to support such an initiative, such as a small amount from the bloated defense budget." Agree "As mentioned previously, I feel that our defense budget could easily survive with a small cut. I also wonder if it would be more cost effective to have companies participate in cooperation under the same 'umbrella' to receive and offer lower rates. Ideally, every small business should be able to offer affordable rates by cooperating with other companies." "I especially support preventive services. This maybe more expensive in the present, but the future savings will make it worth while." 29620 08/04/06 CO Agree Agree Agree Agree Agree Agree 29622 08/04/06 LA Agree Every year health care premiums go up and the coverage goes down. It is now to the point of those of us who are retired and on fixed income are having to choose meds or food. Agree Their are too many of our citizens who are not able to obtain proper medical and health care due to the outlandish costs. Agree "* It about time for the government to take fiscal responsibility for the medical health care. AS it is there is no oversite to cost of meds or proceedures and we are at the mercy, or rather the lack of mercy, of the drug companies. They can sell meds to foreign countries and the US at lower prices but the consumer is charged profits in excess of anything reasonible. There has to be some one to be able to say enough is enough. Why should a pill that cost the drug store less than a cent cost the consumer $40. or $50. for that pill. Profit is what business is all about but highway robbery should be illegal." Agree No one should have to spend their final days and hours alone and suffering due to lack of finances. Agree "About time. It should be limited to citizen of this country. That is what all Americans means, not some illegal alien who broke the law in entry into the US and has continued to live, off the taxes of the law abiding citizens and legal aliens. WE have to draw the line in the sand. " Agree We should and need to provide to those individuals who are unable to provide themselves. Not to those who choose to be unable to pay due to lack of desire or are willing to live their lives dependin on others to pay their way without contributing on their own. "We should be able to choose the benifits we need. As a retired 65 yr old I don't need pre-natal, well baby care and a lot of other thing that are being provided at my expense, that are not needed or wanted." 29624 08/04/06 ME Agree "I am a medical student and have seen first hand how the inability to afford medical coverage compromises people's health care. Health care is a right, not a privilege. Everyone should have access to health care, not just the rich." Agree Agree Agree Agree Agree 29640 08/04/06 MA Agree Agree Agree Agree Agree Agree 29642 08/04/06 LA Agree "Should be provided to the ""paying"" public through the private sector. Should be provided to the low income with the coordinated efforts of both the private or public sector." Agree "As long as we are not establishing another beauracracy which has no effectiveness in the final outcome of the major issue at hand. I live in a stae that offers care under a charity system...so no one can be turned away regardless of health, wealth, or coverage. The end result is we have a huge population who could well afford private isurance, but choose not to participate because they know, if and when services are needed they will receive care." Disagree "If we are to use the systems that are already in place to ""fix"" the problem, please tell me how the same systems that are not operating efficiently now, are going to somehow deliver the solution?" Agree Agree "Wholeheartedly agree, as long as the care that is provided at a lesser cost or no cost is for those genuinely in need. I would not mind as a private paying insured contributing a ""premium"" to pay for catastrophic care for those in need. If somehow the carriers could then share in the risk of those same in need, using those ""premium"" dollars from the private payors to offset the liability shared by all carriers." Agree See above. 29643 08/04/06 NJ Agree Agree Agree Agree Agree Disagree Please do not submit my email address to anyone. I sign these emails and then for some reason I get bombbarded with junk email. 29644 08/04/06 LA Disagree get the Gov't out of this Disagree No Govt involement Disagree Disagree Disagree Disagree "Faith based, and health care system should work to provide health care for poor" 29649 08/04/06 MD Agree Healthcare is a necessity. Health Ins. Co. execs make millions; average Americans risk financial ruin at any point in life trying to stay healthy. This is not fair or just. Disagree "These recommendations amount to ""re-inventing the wheel"". Public Health Programs have been in place for decades, however in recent years, these programs have been gutted of funding, personnel and other necessary resources, rendering them vitually non-existent." Agree Agree It appears as though there will be a monumental effort to protect private sector interests in any proposals. Agree Agree "Cuurently Medicare insures only the uninsurable (the disabled and the elderly. If Medicare insured and collected premiums from good as well as bad healths risks, it would be more financially sound. Currently the gov't assumes responsibility for all the ""bad risks"" and the private sector gets to ""cherry pick"" from the ""good risks"". This is illogical and is an unfair advantage for the private sector insurance companies. Ted Kennedy's proposal to extend Medicare to all Americans makes sense." I could not get more expensive insurance and care anywhere in the world; however the insurance co. still put restrictions and high co-pays on all medical interventions. The extra money goes toward enriching the insurers. This is a waste of money. 29652 08/04/06 DC Agree "And please eliminate the ""doughnut hole"" of middle-level patientexpenditures - it can cause important health care coverage to be eliminated. " Agree "I served for years on a inter-agency committee that sought a grant to provide local health care resources to special-need kids; we never got the grant, and those needs were either not met at all, or met only by incredibly expensive, out-of-city care." Agree "This is a really important recommendation. Transparency, efficiency and the well-focussed use of best practices could cut down a lot on current poor health care practices. That would free more money to be made available" Agree "My mother had senile dementia for several years before she died, causing my father to go through a VERY large percentage of his remaining assets, in an attempt to help her. It was awful. I neer want that to happen to me, and I want public and private programs to eliminate this kind of drawdown." Agree "* NEITHER of my two children have any healthcare at all, and both are in dangerous professions. (e.g., my son is a carpenter on large projects with plenty of opportunity to fall, be killed or permanently damaged. Both of my kids are hard workers, and fully deserve to have their health care needs met affordably. We are the richest nation in history, and it is outrageous that 30% of Americans, like my kids, have NO health care. It worries my husband and me - both retirees - that we coul.d have to endanger our last years to help our kids out in case of a real health emergency on their part. Do the right thing!" Agree "Financing should come from in part from enacting appropriate laxes on those large corporations that currently pay no taxes at all, and those extremely wealthy persons who are being grossly undertaxed right now. Do not use value-added taxes - they affect the poor disprportionately. New protection is needed and deserved. I am willing to pay my share to help. " "I like this, and want to make sure this idea is not hijacked by those who stand to gain the most by manipulating it." 29653 08/04/06 FL Agree "* Make health care providers and insurers accountable for ""accounting"". So many times a charge is denied due to incorrectly submitted coding or documentation, the unpaid amount (after months and months-sometimes years) is billed to the patient only to find it on their credit report. Provider charges should have a 30 day or less turn around, insurers should be held to the same for payment. All these transactions should also be sent to the consumer for tracking, that way when something is denied for payment or the insurer pays less than they should the consumer or patient can have a quick response and take quick action on a remedy for payment rather than being caught by surprise when they look at thier credit report." No response No response No response No response No response I have too many for this box! 29655 08/04/06 CA Disagree The concepts are admirable. If it means more government interference it is a self defeating recommendation. Financial protection needs to focus on the lower incomer populations. Wealthy Americans will not be impoverished by health care costs. Disagree The last recommendation for strengthing health care infrastructures for those populations and areas that otherwise fall through the cracks is commendable. How will it be funded? The federal government seems to make a fiasco out of programs designed to help those in need. FEMA is an example. Agree "Using existing federally funded programs makes sense. Again, how will these expanded programs be funded? " Agree End of life services will become more important as the population continues to age. People need to be given the choice of dying with dignity. Agree The recommendation needs to focus on those in need rather than all. Agree Your ideas for financing strategies will be fought by all those who have to pay more. People feel entitled to have good health care but they don't want to pay more. I see this with friends and relatives. Businesses will pass on additional costs to consumers. Those who can least afford health care coverage will still be struggling in the day to day cost of living. Sounds like a good way to define the concept of core benefits for health care. The health care problem in our country is complex and there is no quick fix. Because of political fallout both for Republicans and Democrats it will require years of negotiating to make changes to truly help those in need. 29656 08/04/06 FL Agree Agree "Every health service provider should be held to the same standard. No matter how rural, inner city, rich, poor, etc. There should be standing protocols applied in every clinic, hospital, health care setting/any one regardless of race, religion, financial means should have access to timely care in various kinds of emergency situations/ examples ""save brain in strokes"" ""save muscle in heart attacks"" facilitate multi trauma injuries to qualified facilities, etc" Disagree "I have a personal experience where tricare would not approve payment for an MRI for my daughter to R/O brain mass. In turn, I paid out of pocket to have the test done...there was sufficient indication for this test eventhough it is expensive...I don't want them alone to make decisions about who can have what type of test, or health care, etc may be needed. Not having the test would have reduced costs and waste...but at the possible expense of my daughter's life?" Agree agree Agree "* Especially the children...they are the one ""group"" in our country with the lowest incidence of high impact health care costs...have all the care for children free and easy to access for the parents. Have a health clinic in every school across the counrty overseen by a community physician (voluntarily rotate coverage shifts) provide care, or bridge families to other resources needed. Look at the services shriner's do, lion's club, and other such organizations....the united states has the money for this...low to mid income american shouldn't have to worry about buying a pair of eyeglasses for a child to see, having regular dental checkups, seeing a doctor for the normal childhood illnesses, and vaccines, etc. This should be funded through our government at no cost to parents and easily could be." Agree Quick turn around time on reimbursements and billing will solve an immense part of the problem! There is no other business in america that could stay in business if they accounted for finances the way our health care providers and insurance companies do. Hold them to a standard for payment and a standard for billing...standards that are governed by the outside - not rules they make up for themselves. "All health care, dental, women's, children's, mental health, drugs both OTC and presricption if needed all health care" 29657 08/04/06 LA Agree Agree To much government involvement runs the costs up. There needs to be check and balances so the costs of adm. does not sky rocket Agree Agree Agree If everyone helped pay for health care so the cost was shared. There are to many people today that choose to spend their money on other things and then look to free programs. Agree 29661 08/04/06 MN Disagree "We keep trying to fix the health care problem by providing insurance coverage. We need to provide access to health care, not access to insurance." Agree Disagree Using government based programs is not a good source of data. These programs do not provide a representative sample for the entire American population. I believe using these programs as a template for a more universally applied program is subject to large inaccuracies and will require a lot of adjustments in application. Disagree I agree with everything except the community funding. This is merely an attempt to create universal health care one coverage at a time. Agree Agree "Financing for health care needs to include some burden on the person receiving the care. Charity, while helpful, creates an entitlement mentality. We have been doing this for the past 50 years and look at the mess we are in now." 29664 08/04/06 IL Agree "This is an ideal and worthwhile aim. But, we need to focus our efforts to achieve private sector solutions. More public programs lead to inefficiencies and a loss of appreciation for the worth of the service. The underlying issue is that health care services are expensive." Agree "We need to recognize that a one-size-fits all approach is not the solution. Also, having two health care systems for the poor and the privately-financed is not ideal. Ideally, we would have one system that people can access using different financing mechanisms. I don't want second-rate health care for people because they live in a community or they have financial challenges." Disagree "I don't believe that the government is the entity to promote best practicies and reduce fraud and waste. Instead, we need to get government to get out of the way or, to emulate activities in the private sector." Disagree "I don't believe that we can provide the kind of care that a family ""wants"" in the last days. We should provide the care that's needed and appropriate. Appropriate services should be available on the community level." Disagree "I don't believe that a core of health care services can be arrived at that meets the needs of everyone. Moreover, enacting a set of services into law ensures that it will become outdated and that needed evolution of services will be impeded. Witness how long it took to get Medicare to include drug coverage and the ongoing debate about it." Disagree "Financing should be transparent. Sin taxes are not a transparent or appropriate financing source. We have to ensure that there is a link between the service and the cost - the farther these two are apart the less someone thinks about it. As long as we are paying only 11 cents of every dollar for health care out of our own pockets we will consume it until it is no longer worth 11 cents. This is not the way to an effective, consumer-centered system." Establishing the benefit package into law is a one-size-fits all approach that we do not use with other services that we purchase. It also blocks the plan from evolving. "More government is not the answer to health care in the US. Government can facilitate the process and ensure that facilities are available where the market would not reward their placement. We need to unleash the forces of the market and have government fill-in when or where needed. Currently, and in many proposals, government rushes in and forces out market solutions." 29666 08/04/06 OH Agree Basic health care should be an entitlement for all US citizens. Agree Agree "This initiative, among all others, will be a cornerstone to the success of continued efforts to improve the effectivenes of any delivery model." Agree Agree Agree "how much time a transition will take is a key question. Finite guidelines will ensure parties move toward compliance in a timely manner, with penalties for failure. Any solution has to involve compromise, and teeth to ensure compliance" "very good idea, and should save lots as consistency becomes the mainstay " 29669 08/04/06 LA Agree I agree only if it is kept in a free market with professionals to help explain benefit options. You have to keep in mind that America was built on the principles of free markets. You get rid of this aspect and we are no better than Canada or the UK. We can pay for coverage through premiums or taxes. Atleast through premiums we have control over our healthcare. Government should be no where near healthcare. Agree Agree Agree Agree "* This is a grand notion. Healthcare is expensive because we have the best and the brightest handling treatment and research. Do you want to pay less and get less or do you want to have the best healthcare possible? The idea is well written but you comment states that we shouldn't have the option of loosing financial security over health status. So not only are we giving out free care (very bad idea), we are telling people that they do not have to live healthly lifestyles because it will be taken care of regardless of their personal finances. This is America, I think the recommendation looses sight of that very fact. I agree Medicare and Medicaid have their place but they are not structured in an efficient manner for anyone. My comment is: If your house gets torn away in a Tornado, the government should replace it? You are missing the boat." Disagree "This is America! This is not a communist state, we are in a free market. Competition works better than government handouts and an age of entitlement when it comes to healthcare. Universal coverage would demolish our healthcare system. People just want the easy way out but ten years from now when you are paying an additional 20% in taxes to cover these ""free"" costs, it will be ugly." And how will this control costs? Why do we need government to tell us to have a physical? We aren't smart enough to do this on our own? 29672 08/04/06 CA Agree "Sure. However, even the first word ""coverage"" is one that no one can really agree on. " Disagree "Some unification here would be helpful. However, making this a federal government football is a strategy frought with problems. If anything, simply create stronger programs for primary care, which is really where our system is lacking currently. Increase reimbursment, training programs and broaden care delivery among Physicians, PA's, Nurse Practitioners and other professionals. " Disagree "* Consumerisim is already leading the way in making low cost primary care more accessable, flexible and affordable. Just look at the private, low cost, primary care clinics going in at Walmart, Target and other retail outlets. Government programs in this area assume that the government knows what is best for everyone and that best practices are clear and unchanging in the face of new technology. I found that ""best practices"" usually are only a highly watered down set of principles that various groups agree on, and this is a long way from the best practices as they exist in business and manufacturing. ""Best practices"" is a highly risky assumption to make in a field as complex as health care, unless you have very, very clean data. Adopt common reporting and IT standards, as Kaiser Permanente has done, and then you may have the database needed to steer high cost care in specific areas of medical management. Broad generalizations on ""best-practices"" should be made very cautiously. 65% of all existing he" Agree "More work is needed here, including more tax support for insurance and financial mechanisims to support pallative care. Training, standards and a dramatic move away from the medical model is needed here, but politically it will be very difficult to address these problems, since so many are rooting in societal expectations and the dynamics of families dealing with end-stage issues. Again, the specifics on trying to move a society can get dicey. " Disagree "The open questions here are enough to give one pause. What is ""high-quality"" or ""appropriate"" and who decides? Minimal levels of financial protection should be mandated. However, unfortunately the politics behind deciding on the ""whos, whats and wheres"" would probably make anything truly affordable beyond the reach of our government without a significant reordering of our tax policy and our comsumerist, choice-based culture and society at large. " Disagree "* I see lots about additional taxes but nothing on building on existing systems, including the employer based risk spreading mechanisim. Our current system is not ""totally broken"", but it does not well serve some specific populations, some of whom volunatarily chose not to participate. Providing comprehensive blanket care to everyone in a ""one size fits all"" style would not only be undesirable, but deeply offensive to a society that values consumerisim and having lots of choices and freedom in making purchases. Improve and encourage comparison shopping, price transparency, understandable quality data, and IT, and you will transform healthcare in amazing ways that will be far more consistent with the 21st century. " "* Physical, mental AND dental? Already, the bar is being raised to meet political interests and goals. The majority of the population currently does not have dental ""insurance"", and yet most people manage. A dramatic expansion of health costs will be widely rerided if accompanied by higher taxes and less choice. Forcing people into higher taxes to pay for coverage that they do not want will be greeted by a level of cynicisim and derision by people of ALL political persuasions that clearly is not understood by those who don't work with employee populations on benefit issues everyday. No kidding; in the San Francisco area I encounter deeply progressive people who HATE being ""forced"" (or even just asked) to pay for health insurance that they ""don't want"". It is very hard to overstate how strong and universal this feeling is and the degree to which logical but technical explanations about ""expanding coverage"" pale in the face of such heartfelt resistance. Choice really is a deeply held value in our culture. " "* Forced choice, government micromanagement and much higher taxes are all items that raise serious issues with these proposals as they are presented here. These proposals represent the largest intrusion of the Federal government into the lives of everyday working people in 50 years. Most Americans want repair, not an overhaul of the current system, although, they do feel somewhat that there should be cheaper and more accessable primary care. The Group clearly took on too much and set goals far beyond the achievable, financial, politically and most importantly, societially. Americans are terrific shoppers. We should let them shop for care whenever we can and put the mechanisims in place to facilitate that process. " 29674 08/04/06 MA Disagree "I think we should consider an elective national stoploss plan, where the private insurance companies would provide all claims adjudication, and payment of claims, with the stoploss plan providing funding only, (for claims in excess of the stoploss amount, ideally indexed for inflation). " Agree Agree Agree Disagree "If all state mandates were removed, but, carriers were instead allowed to provide a portfolio of plans from the most basic to the most generous, (perhaps classified in tiers, based on anticipated loss ratios) the pricing would allow everyone to have some basic care without resorting to National Health Care. The ""common message"" above seems to me to be very socialistic." Agree 29676 08/04/06 CA Disagree I don't believe that coverage for all Americans will be beneficial for those citizens who can afford health care. This will lower the type of care and service received by everyone. Agree Disagree I don't think the govet has resources to use to implement a public program. Agree Disagree This will lower quality of service and increase simple demand. Not a good idea. Agree "Although I feel bad about citizens who can't afford health care, I don't know what the right recommendation would be. But I don't think that universal health care is the right solution. This brings down the quality of service that all patients will receive." Although this may not be the best way to come up with recommendations for what can be covered under the high-cost protection. Please keep me informed. 29677 08/04/06 MI Agree It is a national disgrace that so many of our citizens are bankrupt by medical costs. Even insurance policies have not protected many hard working Americans from losing everything they have due to high medical costs. Americans should not live in fear of hospital debt. Agree "These community networks MUST insure that EVERY American has equal access to quality and affordable health care, and must be adequately funded by the federal government, without the risk of losing money each time we have a federal or statewide defecit. MONEY SHOULD BE DIVERTED FROM OUR HIGH MILITARY SPENDING to help cover the cost of health care for all Americans. " Agree "A universal electronic medical record must be a priority. Also, the millions of dollars that hospital and HMO CEOs are making must also be addressed. " Agree Agree "This must be the TOP priority of our government, domestic or international. We have for too long had 46 million uninsured persons, and this is a national disgrace. " Agree "* I believe that we need a single payer health care system, because we can no longer have the insurance industry acting as a middle man. All of the administrative paperwork required in our current system adds too many extra dollars that are not going toward patient care. For too long CEOs of hospitals and insurance companies have been making millions of dollars, and the toll of increasing paperwork on a doctor's office increases. Single payer health care is NOT socialized medicine, and is the only sane method to fixing our broken health care system. " These core benefits should be evidence based. This should also include mental health coverage in parity with physical health. "Health care reform needs to be a top priority, as our system is currently in a state of crisis. We need political leaders to step up and be bold for change, and to unite. We cannot let large hospital organizations, insurance companies, and pharmaceutical industries keep us from a universal, single payer system. " 29678 08/04/06 NY Disagree "* I was heartened when the initial Interim Recommendations of the Working Group called for a comprehensive plan that would provide affordable coverage for all. It is therefore a severe disappointment to see the revised Recommendations present as their lead recommendation coverage for only “catastrophic” costs. Without the kind of access to primary and preventive services that a comprehensive system would offer, the health of increasing numbers of our citizens will be endangered. The levels of subsequent high-cost care could well increase. A system that facilitates access to low-cost primary care will reduce the need for the high-cost services that this recommendation addresses. Further, the concept of providing special financial protections for low-income persons suggests that this will be a means-tested system. The Working Group’s own surveys and reports show that community meetings and individual respondents rejected this approach. Everyone should have access to health care without having to fac" Disagree "* Integrated community health networks are an efficient, community-supportive way of providing health care services. However, the emphasis in this recommendation on maintenance and support of the “safety net” seems to assume continuation of the current inequitable system of care in which millions of uninsured and under-insured individuals and families lack access to the mainstream of American medicine. Responses from the public supporting community health centers do not provide a basis for placing responsibility for the care of the most vulnerable exclusively on a separate ""safety net."" We would hope that the Working Group would support proposals, as it did initially, that would help the nation end this inequity and provide health coverage for everyone. " Agree "I strongly support this recommendation. There are many examples in the Medicare program and the Veterans Health Administration program that show how the quality of care can be improved and, equally important, measured so that further improvements can be designed. " Agree "I strongly support this recommendation as well. We are a humane society, and we should show allow our people to be treated humanely throughout their lives, including at the end of life. " Agree "* I applaud this recommendation but, as I have said, am disappointed that it has been relegated to 5th place, and that the goal of achieving access for all Americans by the year 2012 has been abandoned. This should be the governing principle that guides all the elements of a decent health program for this country. I was encouraged that an entity created by the U.S. Government was supporting the concept of universal health care, the principle that everyone in this country should have access to the health care they need without facing financial barriers that would discourage them from seeking care. I strongly urge that this principle be returned to its place of prominence from which all other considerations flow. It is long past time for the United States to move toward this goal, which every other advanced country has already achieved. " Disagree "* I believe there should be a universal system of national health insurance funded publicly that will make health care available to everyone. Public funding is the most equitable as well as most effective way to achieve universal coverage. This country has the financial means to do this; in fact, many studies show that we can do this without spending any more than now. So the extra cost that was assumed in many of the Working Group’s questions would not really be required. The Community Meetings and the on-line survey found overwhelming support for such a national health coverage program with equitable public financing. Twenty-five of 29 community meetings supported “Create a National Health Program” as their favored proposal (Appendix B, p.7). On-line, 72.2% of respondents -- far more than chose any other option -- agreed with the option “Create a national health plan, financed by taxpayers, in which all Americans would get their health insurance.”(Appendix C, p. 6) And the Working Group repor" "* I do not accept the premise underlying this recommendation. Experience with Medicare in this country, and with the health systems of many other countries, has shown that comprehensive benefits can be provided without excessive spending and without creating a two-class system (one for those who can afford only “core” services, and another for those who can afford to buy more). An American system should also provide access to a comprehensive set of services, without bias or exclusion. This concept of “core” services seems to have been an assumption of the Working Group rather than a response to the views expressed in community meetings or by individual respondents, who were never asked whether they supported the idea of limiting coverage to basic or “core” services. In fact, the Working Group reports in “Dialogue with the American People” that “many participants…were also concerned about arbitrary limits on coverage and were not comfortable with bare-bones benefit packages.”(p.2) Moreo" "The Working Group should bite the bullet and call for the kind of publlicly-funded national health insurance program which it knows -- from evidence from 40 years of the Medicare program to the experience of every other country -- could provide affordable care for all Americans. The citizens of this country are supportive of this, as the Working Group's own polls, and many others, show. Let's do it." 29679 08/04/06 OK Disagree "We should not be concerned with providing coverage in this country. We should actually provide health care to those who afford insurance. If we provide coverage, we are spending unnecessary dollars because not everyone needs care all the time. Whereas if we provide the actual health care, we only spend money as it is needed. We could also control costs better. The government should set up more clinics and require recent graduates from medical school to staff them." Agree Disagree The federal government is not the entity to promote efficiency. This would have to be out sourced. Agree No comment Agree "If health care were affordable then health insurance would also be affordable. None of the players (doctors, hospitals, pharmaceutical companies, suppliers etc) wants to accept less than they are getting now. So, to reduce cost we must use less health care. One way to do that is improve health." Disagree It would cost much less to actually deliver the health care than to provide coverage. The government needs to expand the facilities it has to include anyone who can't afford helath care. "Doing this will guarantee that nobody gets what they want. Any package you come up with will be criticized by almost everyone. Hate to be cynical, but that is just the way it is." 29680 08/04/06 CA Agree It is about time that Americans had a good national health plan for everyone. The era for people having to choose between medicine and rent or staying in a job they hate just to receive the health plan offered by a corporation should be over. No response No response No response No response No response 29681 08/04/06 VA No response "* Why is a single-payer system not even mentioned in your document? From an article in People's Weekly World: ""The Working Group’s focus on cost cutting has activists worried that critical issues are not being considered, issues such as the price of services, the need to streamline administration, the excessive salaries of CEOs of hospitals and HMOs, etc. It seems that unwarranted costs for marketing and advertising won’t be measured and that for-profit hospitals and clinics will not be analyzed to see if recent mergers of hospitals lead toward price fixing at excessively high levels. It is hard to imagine that government regulation will be considered as an alternative to the free market price setting that has totally failed. "" " No response "* From an article in People's Weekly World: ""The Working Group’s focus on cost cutting has activists worried that critical issues are not being considered, issues such as the price of services, the need to streamline administration, the excessive salaries of CEOs of hospitals and HMOs, etc. It seems that unwarranted costs for marketing and advertising won’t be measured and that for-profit hospitals and clinics will not be analyzed to see if recent mergers of hospitals lead toward price fixing at excessively high levels. It is hard to imagine that government regulation will be considered as an alternative to the free market price setting that has totally failed. "" " No response "* Why is a single-payer system not even mentioned in your document? From an article in People's Weekly World: ""The Working Group’s focus on cost cutting has activists worried that critical issues are not being considered, issues such as the price of services, the need to streamline administration, the excessive salaries of CEOs of hospitals and HMOs, etc. It seems that unwarranted costs for marketing and advertising won’t be measured and that for-profit hospitals and clinics will not be analyzed to see if recent mergers of hospitals lead toward price fixing at excessively high levels. It is hard to imagine that government regulation will be considered as an alternative to the free market price setting that has totally failed. "" " No response "* From an article in People's Weekly World: ""The Working Group’s focus on cost cutting has activists worried that critical issues are not being considered, issues such as the price of services, the need to streamline administration, the excessive salaries of CEOs of hospitals and HMOs, etc. It seems that unwarranted costs for marketing and advertising won’t be measured and that for-profit hospitals and clinics will not be analyzed to see if recent mergers of hospitals lead toward price fixing at excessively high levels. It is hard to imagine that government regulation will be considered as an alternative to the free market price setting that has totally failed. "" " No response "We need a centralized, single-payer system, with the accompanying reduction in the average income of doctors and reduction in profits of private hospitals, and the like." No response Our system should emulate Canada's or Sweden's. "Your recommendations do not address a single-payer system, or anything other solution that threatens the ststus quo. " 29682 08/04/06 CA Agree "Because there is an ever-growing divide between the well-off, who can afford medical care, and the rest of us, it is essential that low income Americans be protected. If things continue as they have, the vast majority of us will be in that group." Agree "I have seen the Health Center concept in action in Venezuela. This is what works, because the people served can actually get to the sites. " Agree Agree "It is particularly important that end-of-life care be made available in hospitals and hospices - - - but most definitely accessible in the patient's home, as well. " Agree "We are sufficiently wealthy in this country to easily enable a system that serves everyone, no matter their income. There is no reason for any human being to suffer from a lack fo medical attention while there is so much as a penny in our treasury being spent for anything else." Agree "I believe this can be financed with greater (and enforced) corporate income taxes, graduated enrollee contributions, and the like. Fairness demands that the revenue not come from sales tax or any tax that has the greatest impact on the Americans who have the least income." "I would hope that the benefits would be based on scientific medical evidence of efficacy. New Age, mystical, faith-based, and other nonscientific or supernaturally-applied theories or ""practices"" should be the financial responsibility of the ""believers"", not the collective American population. " 29683 08/04/06 VA Agree "* This article from Public Citizen has powerful arguments for why we should have a single-payer system: "" Health Care Reform in the United States: Arguments for a Single Payer System (HRG Publication #1778) Public Citizen’s Health Research Group submitted the following statement to the Citizens’ Health Care Group as part of a two-year federally mandated and funded process that produced <> as well as Interim Recommendations on which they requested comments. We are gratified that the recent efforts at tapping into public opinion reveal significant agreement on key issues in health care: * An overwhelming majority (96.8 percent) of the persons attending the community meetings felt that the health care system is in crisis or constitutes a major problem; * Over 94 percent thought that affordable health care should be part of national public policy; and * When faced with different priorities competing for public spending, respondents ranked “Guaranteeing that all Americans have healt" No response No response No response No response No response We should have a single-payer system. 29684 08/04/06 MI No response "* I would like to see Doctors allowed to take personal tax deductions for services provided for those that don't and can't pay. This would actually created fair exchange for health care offices. If someone can't pay instead of the doc caring for someone out of good will and donating his/her time. The doc could deduct the value of that service. The doc would feel good about it because he can help those who can't afford care and he can take a deduction for doing this. This becomes a win win situation. This could virtually elimate the need for state and federal funded pork barrel health care plans. The current plans suck money out of the producing citizens and through it into a poorly mananged and wasteful spending goverment. In addition, money is wasted on provided jobs to agencies and employees who distribute the money off the backs of those who must fund it. I would also like to see Nationally enforced any willing provider legislation that would allow consumers to make there choice with respect " No response No response No response No response No response 29685 08/04/06 WA Disagree "You cannot repeal the laws of supply and demand. For any system to work, limits have to be set, advertised, and followed to assure that whatever benefits offered have sufficient funds available to pay for them. Given that there are limits as to what we can afford, somebody is going to go broke trying to stay alive." Disagree "Don't you Marxists ever learn. One size fits all, top down command systems were the path to bankruptcy and failure in the Soviet Union. With the knowledge that over 60% of claims can be traced to life style choices, the wise direction is to put in place policies that reward good decisions. Given that we have a market economy, creating financial incentives to cause competition in the market place just makes sense." Disagree "Please spare me the twaddle about TRICARE. After spending more time than I wanted dialing and re-dialing for an appointment; suffering for months awaiting a visit to a specialist; and never knowing which doctor was going to be there, I bought my own plan. " Disagree "Again, your criteria is on demand, ""....accessing the kind of care they want..."" You need to make provision as to what can be afforded. What is the role of long term care insurance in your brave new world?" Agree How about endangering the financial security of the whole nation? Agree "* Phase out group insurance and put in its place individual coverage, giving discounts to those who maintain a healthy life-style/habits. Encourage tax favored health savings accounts so as to minimize financial impact on those whose out of pocket expenses in the past have sunk them financially. People should make provisions on how they handle these expenses a part of their own financial plan. Establish an order of priority of procedures based on what ought to be funded; cost; and protection of public health. Oregon did this some years ago. Then total the funds available from Federal and state appropriations for the indigent. A panel of actuaries draws a line on the list. If it falls below the mark, sorry on you. If it's above, it is taken care of. If people want richer benefits, then they have the option of purchasing their own, which may reach higher up the list by choosing fewer first $$ benefits; higher deductibles; higher out of pocket limits; and/or paying more premiums" See above I have no faith in government one size fits all health insurance having endured it through a career in the Navy and into my retirement. I have less faith that the burden would be spread in such a way that there would be some common sense incentives that make the insurance mechanism work such as classification of risk. 29686 08/04/06 OH Agree Agree Measures must be taken to ensure that these health centers are used as they are intended. Pilot programs would be ideal to sweeping change. Agree These are all great ideas but physicians and hospitals are very proactive on these topics currently. More government regulation is not what is needed. Agree Agree Agree Monetary contributions need to be made by means in addition to taxation. Private dollars must be spent so that there is accountability with more than one central organization. "I agree with these statements, however, health care professionals must drive these efforts. Physicians, nurses, pharmacists, and others that deal with patients every day must have a strong voice in the decisions which are made. " 29688 08/04/06 VA Disagree "Trying to guarantee coverage for all will only lead to an ever-increasing spiral of government-funded and government-regulated health insurance. If you want to make heealth insurance affordable for all, push for deregulation. Push for letting people buy insurance across states, like John Shadegg's bill." Agree Allowing the federal government to coordinate something? Not a good idea. Disagree "* Medicine is as much an art as it is a science. Basing everything on so-called ""evidence-based practice"" will only lead to new burcratic rigidity. Every patient is different, and no bureaucracy can possibly no what treatment is needed for every patient in every situation. A better reform would be changing those govt programs into more consumer-directed ones. Let recipients have a voucher to purchase insurance or use it to pay health-care providers directly so that they can get the health care that meets their own needs." Disagree "Again, you're letting the government and corporate leaders make all the decisions. Patients and their health care providers are best suited to make these decisions. Vouchers are the best way of achieving that." Disagree "Affordable and ""set of health care services"" is a non-sequitur. If polices must provide access to a set number of servicess, then that policy is less affordable than, say, one that only covers catastrophic care. Let individuals decide for themselves how much health insurance they need, and what type of services they want covered. This will let people of limited means be able to afford health insurance." Disagree "* You bet it's going to take more ""financing"" for this! You want to guarantee everyone access, mandate a set level of services for all, and let the federal government coordinate a bunch of these initiatives. Given how the current government programs, Medicare and Medicaid, are already busting budgets, I can't see why you want to take an approach that ultimately means more government. Better to find more innovative ways to use the money that government already spends on health care, much like Florida has done with Medicaid." "Again, a set of ""core benefits"" will only make health insurance less affordable. Let individuals decide for themselves what benefits they want to pay for." "Although I'm sure you are trying your best, these ideas are more of the same heavy-handed government approach that has led to ever-rising costs these last 40 years. I hope it's not too late for you to look at more market-oriented ideas." 29689 08/04/06 MI Disagree Disagree Disagree Agree Disagree Disagree "Our Government does not see to be able to run programs as efficiently as the private sector. It wastes money and fosters an ""I deserve to have it free"" attitude. " Lack of early education is the basic problem. When children are raised to eat poorly and not to brush their teeth why should the entire rest of the world pay for their teeth care. 29690 08/04/06 HI Agree "* I am a working class poor Fed Employee who was strapped with high cost of healthcare last year because policy paid only 80% of a $20,000+ hospital bill for my son. When living in a state with Kaiser Permanente I never experienced any exorbitant medical bills. Now I live in State of Nevada which doesn't have Kaiser the only insurers here have outragous PPO plans unlike HMO's. My son spent 12 days in Kaiser Honolulu last May 95. His consolidated total bill was a little bit over $17,000. My balance is $0. He spent 2 days in Nevada Hospital and unconsolidated bill(s)totaled over $20,000 and I am now trying to work 2 jobs as a single/divorced parent/Disabled American Veteran of 3 wonderful children. I am not well and have not been since end of Desert Storm My other bills are suffering trying to pay off medical expenses from various medical providers. I live paycheck to paycheck. That is not any quality of life. We should have Socialized Medicine like European countries & Canada. No one should have to live witho" Agree "Take the money out of Middle East Wars and put it back into America's Healthcare System. We need affordable Healthcare, not young innocent military personnell being killed over the various bad apples greed of oil, money & power. " Agree Reduce upper level management CEO positions is privatized care & gov't since us little people do most of the work anyways. Reduce Congress pay and put it into Healthcare. Make Congress be subject to Social Security and not the juciy pensions they get. Trickle that Fraud & Waste money back into Healthcare System. Agree Everyone should have access to Hospice care be it either at home or institutionalized. Comfort care for all end stages of terminal illness. Agree Affordable is the key word AFFORDABLE or SOCIALIZED MEDICINE. Agree "I am robbing Peter to pay Paul. I do not have any additional funds to invest after paying normal expenses of mortgage, utilities, Consumer Credit Counseling (consolidation of medical bills from 2 day hospital transfusion/surgery for chronically ill son totalling over $20,000.)I have nothing else. I pay co-pay and biweekly Healthcare insurance which is big chunk of salary." Use European countries such as England or Germany. Also Canada and model our healthcare standards by the mother country standards. SOCIALIZED MEDICINE FOR ALL. SOCIALIZED MEDICINE FOR ALL 29691 08/04/06 FL Agree Agree Agree Agree Agree Agree 29692 08/05/06 NY Agree Agree Agree Agree Agree Agree "Dear movers and shakers, You know full well that city and state governments are taking away people's money and put them in investment for private companies which will make them fatter. You know that Federal Reserve System is there only for ultimate control. If you let go of these two, there will be no more government fiscal problem or crisis and there will be no more need for taxing people. " Decision making process must leave out giant pharmaceutical companies or any other companies affiliated to these companies with financial interest. "U.S. can afford excellent medical care for all of her citizen without increasing tax, without new tax, and without taking away money from anywhere else. And this is known fact. " 29696 08/05/06 SC Agree Agree Agree Agree Agree Early retirees without company benefits should be able to secure adequate health care and not have to worry about pre-existing conditions. It is virtually impossible that you are without a pre-existing condition in your 50's. Agree 29697 08/05/06 GA Agree "I agree, however some level of regulation will be needed to avoid `futile` care costs or services like dialysis, CABG in 85yo patients,etc." Agree Agree Agree Agree Agree For profit health insurers should contribute 10%of gross profits each year to indigent care or return to its policyholders. 29698 08/05/06 CA Disagree * We currently have coverage for low income via Medicaid. We have coverage for elderly by Medicare and it's various parts. Most people have coverage via work or on their own. Many of the ballyhooed 40 mil without insurance are young adults who are invincible (they think). This leaves some who are too rich for Medicaid but not rich enough to buy insurance. They are the ones who could use protection against catastrophic medical costs. All people need to pay something for insurance or they will overutilize. Disagree Again all people must pay something for healthcare. Up until the advent of the Great Society people all people had healthcare access. Most had insurance and it was affordable. There was no rationing of care. There were county hospitals that took all those who could not pay as well as those who could pay but wanted the better care offered. This also provided training for the next generation of physicians which is not in place today. Disagree "* There is not a bigger waste to the American taxpayer than the VA system. It is not needed nor necessary. All vets with service connected disabilities can be cared for cheaper and better by going to private hospitals. This means they would be placed on Medicare and the government would pay for the premium and all meds. This would get rid of a costly shadow medical area. It would also allow much of the pork money that is currently spent to be used for other things. Evidence based practice is also know as cook book medicine. It takes away the art of medicine and goes mainly to the cost, not quality of care. These two are used interchangably by some who want to control costs. The current fraud in medicine is in the medicare arena. One sees little in the non-Medicare arena. One can not and should not put lids on how organizations spend their money. Is a salary of $500 million too much for a CEO? The answer is it depends. What is that individual done to deserve that salary. The same question is tr" Agree This is already in place and used in most if not all places in the country. The problem is the individual who does not want to face the inevitable and plan in advance. The system is there. Disagree "See above comments. Universal coverage does not work. Please look at Canada where there is no equipment, long lines and now their Supreme Court agreeing that their plan does not work. England and the other EU countries have universal coverage but with opt outs. I have worked under the English system and if I did here, what happened there I would rihtly have no patients. " Disagree "* As stated above Universal does not work. The political party that put it in would be loved for one term and never see the light of day again. There must be incentive for the physician to want to see the patient, for the hospital to want to buy the equipment, for the patient to want to to where they will get the best care they can afford with the best equipment available. The best financing of health care is to have the individual pay for the initial amounts and have catastrophic coverage. HSA or MSA's. This puts the financing in the hands of the users of the system." You are stating universal coverage by a different name. It just doesn't work. The group putting this on is obviously on its own agenda. That agenda is not open to other ideas. This will fail on its political face. This shown by the use of Province in the below identifications. 29699 08/05/06 TX No response Agree Agree Disagree "Would need more specific info re: the last - ""At the community level, funding should be.................." Disagree "All Americans DO HAVE ACCESS TO A SET OF CORE HEALTH CARE SERVICES."" The questions are how they are provided and who pays and how!" Agree "1. ""sin taxes"" be care full on the definiation of this. It can open a pandora's box. Some will agree on what is and isn't a ""sin"". Don't think it will work to ID ""sins"". Too many contraversal ""sins"". Some will be excluded that should. It, sins, are too broad. One group would say this illness is a ""sin"" and others will disagree. Can't get unversal approval. Besides who do you tax? The individuals are many times are the most unable to pay! " "National health plans, single payer (the US gov't), is not the solution. Doesn't work well." 29701 08/05/06 CA Agree Every one needs affordable health care. No response No response No response No response No response 29703 08/05/06 MA Agree Agree Agree Agree Agree Agree 29704 08/05/06 FL Agree "Please clearly define ""very high out-of-pocket medical costs for everyone"" as for example in ""coverage above a stated perceptage of income' so the wealthiest are not included." Agree A simple single-payer system is preferable. Agree Try to emphasize preventive care and integrating proven new (or new to Western medicine) types of treatment. Agree "'The kind of care they want for last days"" should mean making clear tretmets can be patients can refuse unwanted treatment and an Oregon-tested type of physician suicide if clearly stated by patient. (Save many millions of $s on patient unwanted treatments.)" Agree Agree 29712 08/06/06 CA Agree "I agree in principal, especially for catastrophic care, but how can it be funded and overseen? I'm glad to see Medicare implement a drug program as one means to prevent catastrophic medical conditionas as well. It is so complicated that I doubt it will be effective. Part of the aging process means increased need for pharmacological medical support. We must do better." Agree "* A current regulatory body is likely already in existance that could provider oversight of a healthcare safety net. Be on guard for the fox protecting the hen house. E.g. Flex spending acount system organizations are not monitored enough and in my opinion it is so inappropriatley administred by entities that the administrators are pocketing funds and the needed relief doesn't exist. An accreditation process is appropriate for qualifying as a Health Center, but before we can accredit network providers, we need to begin by getting them into the new melinium. Many office that serve Medi-cal populations doen't even own computers! Getting connected would be an appropriate way to begin integration and education of poor quality offices. Information resources can be no cost for connected providers. Required reporting on-line could eliminate some labor intensive oversight and thereby expanding effectiveness." Agree "Start by getting all Medi-cal providers on-line. Some don't even have basic, appropriate charting in hard copy form, let alone an electronic medical record." Agree I have seen progress in this area but we have a long way to go. Agree Agree Agree. All systems need accountability built into the system with conscious awareness and prevention of opportunities for massive fraud -particularly through electronic billing. Many non profit organization provide services and /or equipment based on their mission related to a specific disease. We need to identify the core package without eliminating the motivation to continue providing services. Dental services will need to do better than what is provided by Medi-cal. The dental quality is sadly lacking & in the dark ages compared to current health care management by HMOs. Dental care needs to be submitted to accredation also. 29719 08/06/06 OH Agree "From a nurses prespetive, I did not become a nurse to pick and choose which patients I would care for. As of right now within the health care organizations that is exactly what we are doing. If all people were given the chance for health coverage I would be able to care for all patients." Agree All four aspects listed above are extremely important for this initiative to work. Especially within the four is at the national level being repsonsible for advising the federal government. Without this aspect I don't feel as if the plan would work. Also having the federal support helping out the infrastructure at local levels of health care. This is particularly something that I think should be happening more often. Agree "The health education aspect of this recommendation will be extremely important. When this initiative goes into effect, many people will need much education. Health education they have never received before. " Agree "End-of-life services can be very detremental to patients and their families. This aspect of the plan should be looked at very closely. It doesn't matter who you are or how you pay, nobody should have to suffer from chronic illness or disease with the way health care is today. " Agree I agree with the common message that all Americans should have a health care system. In the end this would improve the morbidity and mortatlity rates of this country. Agree "I agree that it will definitely take time for a seamless and smooth transition to support all Americans with some sort of health coverage. Within the thought of a fiancing strategy and sin taxes, I personally have not yet thought intensely on. Anything will be better then the current system we have now. " "Before this initiative goes into effect, all health care services for every individual should be processed. The above core benefit package covers all spectrums. " 29721 08/06/06 CO Agree "* Insurers need to be obligated to pay FULLY for medically necessary care, with this determination made not by them, or someone working for them, but from the unaffiliated physician seeing the patient. Insurers should share the risk between high risk and low risk beneficiaries, so that the costs of health care are distributed, and not siphoned off to maximize the profits of the insurer by sacrificing full and optimal coverage for subscribing beneficiaries. Co-pays and cost-caps need to be elminated. Beneficiaries should ONLY have to pay regular and predictable premiums, and these premiums should NOT be exorbitant, to where the insurer only insures that THEIR risk is minimized. " Agree "Our health system probably won't benefit from being socialized, i.e., run by the government. But it does need to be strictly regulated, with enforceable culpability and stiff and swift fiscal penalties for insurers who deny or delay coverage. " Agree "Fraud and waste in administration will occur only when stringent professional licensing standards are mandated and enforced for all medical care billers and administrators, to ensure a reasonable and respectable level of competency, efficiency and integrity becomes universal in medical billing and informatics. Insurers need to be prohibited by federal law from treating their beneficiaries by default, and without cause, as potential criminals with the intent of defrauding the insurer. " Agree "Quality of life should always be the paramount concern. We all die eventually. Sustaining a life of pain and suffering at all costs, unless specifically requested or provably desired by the patient, is cruel and inhumane. In some cases, addiction to painkillers for sufferers of chronic pain may be a more compassionate course of action than enforcing unnecessary suffering based on some obscene perversion of purported morality. " Agree "Absolutely. Healthcare which places the maximization of profit by the insurer as paramount by sacrificing, denying or delaying care is clearly immoral. It needs to prohibited by law, if we are truly as civilized and evolved a nation as we believe ourselves to be. " Agree "* Provided financial incentives, i.e., tax breaks to ensures who demonstrate a track or providing responsible, efficient and reliable care to their beneficiaries, and levy heavy tax penalties on those insurers who fail to do so, would incentivize better and more standardized coverage throughout our nation. Obviously, performance reporting would have to be mandated for a healthcare insurer to operate in this country, and they would need to be subject to periodic audits by the GAO or some other yet-to-be-determined federal oversight agency to ensure compliance. Insurers would also be required to be licensed to operate in this country, and would be subject to an annual tax which would pay for the cost of this oversight and regulation of their performance. " "* In order to actual maintain health, beneficiaries need to be able to develop a true, ongoing long-term relationship with a single caring primary care physician, who knows each patient's history and unique issues. Again, physicians need to be empowered by the law to trump decisions of insurers. However, that having been said, physicians also need to be prohibited by law of having any relationships with healthcare insurers which may potentially constitute a conflict-of-interest regarding their patient's long-term well-being. Avoiding such conflicts of interest must be an ongoing condition of a physician, or any other healthcare professional, retaining their license to practice medicine, or work within the healthcare community." "* Let's de-industrialize healthcare, and refocus it as an effective, predictable and affordable cost-distributed personal service for the health and well-being of all Americans. Some insurers who have in the past practiced cost-avoidance by finding ways to deny or delay patient care, and deemed it cost-containment, need to have this practice, and all others like it, harshly, swiftly and permanently de-incentivized. Some doctors have had to abandon private practices in which they had good working relationships with their patients, because the healthcare insurers would pay under cost, or pay to slowly, for these physicians to be able to continue to afford the operating overhead of their practices. Yet I have yet to hear of healthcare insurers who have gone out of business, because they couldn't afford to provide continuing care for their beneficiaries. If they exist, I am certain they are far fewer than the physicians and patients who have been harmed by their unnecessary, negligent and in some instances, a" 29722 08/06/06 NY Agree "Any national program should be similar to, or an extension of, traditional Medicare, i.e. that it's administered by federal government agency and no managed care organizations or private insurers are involved. I feel strongly about this because MCO's make HUGE PROFITS by managing plans and spend a great deal on administrative costs while the Medicare administration costs are very low. MCO's and HMO's need to be out of any national program!" Agree Agree "* Evidence-based best practices for mental health services should use the American Psychological Association's definition of this term. Health information technologies and electronic medical records systems must be developted with safeguards for the privacy and confidentiality of doctor-patient records, especially for psychotherapy. People speak to psychologists, clinical social workers and psychiatrists with the expectation that what they say will be kept confidential and not released to third parties without their specific consent. This must be preserved for psychotherapy to be effective." Agree "I believe educating patients and their families in an atmosphere of respect and honesty is the best way to help people make personal decisions which, in many cases, will reduce the amount of money needlessly spent in the last few days or weeks of life." Agree "ABSOLUTELY !!! Health care should be provided to all so that ordinary citizens, the President of the United States, members of Congress, the homeless, etc have the exact same benefits. I would like to see an extension of traditional Medicare as our national healthcare program...no managed care or HMO's involved in any way since they take large administrative costs and profits out of premium dollars." Agree "I agree that financing should be based on fairness, efficiency and shared responsibility. I would need more information to decide if employers should contribute something towards healtcare costs or if financing should just come from personal taxes." "This makes sense and seems comprehensive. How about using ""medical, nursing, dental and mental health professionals' or just professionals rather than providers?" "* Thank you for doing this! I have been impressed with the process and with the meeting I attended in Manhattan. I'ld like th goal to be 2010 not 2014 for universal healthcare I think the traditional Medicare program is a good model except for the new Part D. The administrative costs are low and no profits are taken out of premium dollars. I think it will be difficult but imperative that MCO's, HMO's and private insurance plans NOT be part of any national healthcare program. We cannot afford to have them involved and diverting premium dollars to high administrative costs and large profits. Part D is a good example of what can happen if you do involve MCO's, HMO's and private insurers...it's a mess!!! I am President of the Suffolk County Psychological Associaion in New York. Psychologists in private practice are being reimbursed by MCO's at fees that we charged in the early - mid 1980's. It is difficult, often impossible, to earn a living wage when you have not had a pay raise in 20 years. " 29724 08/06/06 WA Agree Agree Agree Agree Agree Agree 29726 08/06/06 CA Disagree "* No one in America should be impoverished by health care costs or defer needed health care because of the cost. Coverage for all Americans should cover all medical expenses. We can afford this if we eliminate the 30-40% overhead/profit/waste of private insurers by adopting a government-administered, single-payer system that covers all citizens, takes advantage of its massive buying power, and that directs expenditures to maximize health benefits rather than maximizing profits. Note that a majority of respondents favored a national health care program that is ""financed by taxpayers, in which all Americans would get their health insurance."" A single payer plan meets this requirement, and meets it in a way that is financially sound." Agree "Note that a national, single-payer system would be ideally suited to developin and supporting health care infrastructure and the local level. Unlike a private system, a government operated system can focus on populations and localities where improved access is most needed. Relying on private entities will result in more health care for the wealthy, and less for the poor and middle class -- the very trend we see with today's private system." Agree "Again, a national, government-run, single-payer system is ideally suited to implement this suggestion. " Agree Disagree "* I almost agree with this statement. It is weak in that it only applies to core health care services and it would provide financial assistance based on financial need. We already know that needs-based programs are seen by the well-off as a burden. Since the well-off have more political power, needs-based programs provide second-rate services, eventually becoming so inadequate that even their beneficiaries seek something else! We See this happening today with public schools as de-facto segregaction and class isolation leave poor kids in poor schools. In contrast, Social Security, with benefits for all, remains one of government's most successful programs. (Perhaps that is why we see conservatives constantly trying to privatize Social Security, in order to make it more vulnerable.) Limiting coverage to ""core health care services"" will limit its effectiveness. Setting aside the question of what constitutes ""core,"" limiting services would almost certainly lead to the denial of critical medical ser" Disagree * The assertion that new revenues will be required is not necessarily true. U.S. citizens already pay more per person for health care than do other contries providing comparable levels of service. It is not so much a question of finding more revenues as it is a question of finding the appropriate way of raising those revenues. The first place to look for revenue is in the increased efficiency that a single-payer plan affords. Eliminating private health insurers from the loop would reduce the administrative costs from 30% to approximately 2-3% that is spent for administering Medicare. "Respondents expressed a clear preference for a comprehensive benefit package. A committee to define the areas of coverage that is composed of patients, providers, payers and staffed by experts is likely to be weighted against the majority, the patients who ultimately pay for the whole thing! The committee should be composed of citizens from all walks of life. It needs staffing (payed for by the committee) that has expertise in areas of health care, financing, accounting, taxation, etc. " "* The working group should emphasize the need for a government-financed, government-operating, single-payer plan and recommend a specific date for implementation no later than 2012. The working group should study how taxes to support this program should be assessed. The plan for supporting the program should somehow accomplish a transition from the current method in which employers pay health care to a system whereby healthcare support comes out of general revenues. The transition may take a number of years, but needs to result in a fair sharing of the costs an not a ""windfall"" gain for companies who are relieved of their current burden." 29729 08/06/06 NC Disagree "No ""national program"" can provide health care at a cost that the government could afford. On the other hand, some type of basic, minimal plan could be legislated for each individual or employer to provide (similar to state basic disability plans in NY , CA, RI,) sold though the private market and with the privilege of ""buying up"" for more coverage." Disagree Do you honestly believe that the Federal Government could efficiantly do all of these and satisfy the needs of the constituants the hope to serve? Disagree "Once again, while the Federal Government can offer information and do studuies and research, it is the wrong institution for much of this. You suggest that the Federal Government help reduce waste (point 3). What other institution can ever exceed the waste level of many arms of the Federal Government? " Disagree "Much of this is presently available, and although I agree with your concepts, I refuse to accept the thought that the government should be involved." Disagree "You don't seem to understand that each one of us is responsible for maintaining our own health and if we fail in this personal responsibility, we likely will need a safety net of care to help us through whatever may befall us. If we want ""core health care services"" we need to find ways to provide them for ourselves. Those beyond personal ability to provide our own services, should recieve whatever care is needed, but it should not be free unless the patient is solely out of funds with no future ahead." Agree "Since universal coverage you favor will never happen, financing for the various health care opportunities should first, be the responsibility of those who might need the care, and secondly shared among all providers of care who, in turn, make all or part of a living in the health care profession." "I do choose to define a ""basic core benefit"" since those who can, may purchase what they feel is correct for their own situation. Doctors should be trained to give advice and treatment, but the patient who uses a physician is responsible for payment, either personal, Medicare, Medicaid, or insurance to that provider and, just like buying a car, costs should be negotiable between the patient and the provider of care." "You're heading toward extensive Federal Government involvement in the very personal world of health care. The Feds are not known for""clear channel"" efficiancy, so whatever you propose should be wound through the provite sector and perhaps the states. Leave the Feds out of it except to fund research and other health care initiatives. " 29730 08/06/06 WI Disagree "People should be free to choose the coverage they want. those of us that live healthy lifestyles should not have to support those that choose to overeat, not exercise, drink to much or smoke. " Disagree "All you are doing is adding more government into the healthcare system, which has cost, these government agencies will cost the tax payer more money for less benefit. " Disagree "the government cannot even stop medicare and medicaid fraud, I believe the figure is over $30 billion in lost tax payer money due to fraud adn improper administration. Now you think they will sudenly figure it out." Disagree "These programs already exist in most communities, again, you want to throuw more taxpayer money at problems which actually increases the cost of health care. " Disagree "All Amricans already have access to health care. Those that cannot afford it have access to programs like medicaid, although pooly run by the government. I don't need the government rationing health care for myself or my family or making decisions for us." Disagree "Strange you say healthcare is unaffordable, yet people are willing to invest more, but yet say it cost too much?" I don't want some beauracrat choosing my beneift level and telling me what coverages I should habve for myself or my family. "Goernment solutions have not worked in any country to date, it has succeeded in rationing health care and letting the elite and government employees have prioity status. Just because some people don't want to pay for healthcare, doesn't mean our system is broken." 29733 08/06/06 FL Agree Because I think it is a sad day when Americans get get proper health care because of financial situation. Agree Agree Agree A much needed service for many americans Agree Agree 29738 08/07/06 MI Agree Agree "Integrated community health networks is a concept that is not broadly understood, and certainly is not a standardized definition. FQHCs are also foreign to most people. Add a one sentence conceptualization to to rec." Agree "Why not build this around the Chasm Goals, safe, effective, patient-centered, timely, efficient, equitable? " Agree "I'd word it ""...end of life services such as hospice and palliative care..."" There's a huge gap in literacy level between your video and the recs. " Disagree "* This is a slogan, not a policy. ""Affordable health care"" is a goal that creates income for a large sector of the economy. It is now driven to high-tech frontiers that offer much less promise than prevention, chroonic disease management, and new perspectives on end of life. Without excusing the system's inefficiency, the stronger engine for cost growth is technology, the creation of marginally useful procedures and drugs. Could you leave the financing at the level of rec one, and frame a policy goal that says one role of government is to identify and evaluate ways to assure the health of all Americans, and to stimulate application of new approaches to health when evidence supports them? " Disagree "There is no evidence that efficiency is declining. Therefor, cost increases must be driven solely by technology. Correcting inefficiency simply defers facing the core problem--we have a ""fix-it"" addiction. Only when we recognize the importance of prevention and the inevitability of death will we overcome our addiction." "* It's been tried before, and it didn't work then. It leads to haggling over the margin, should Viagra and birth control pills be benefits or not. Take the high road: 1. Cover catastrophic, defined by percent of family income. 2. Emphasize prevention, particularlly life-style diseases. 3. Build in ""P4P"", on quality, efficiency, and patient satisfaction. 4. Establish health as the goal for the national program, and let people who can afford it buy the marginally useful stuff, through private insurance, out-of-pocket, payroll deduction, whatever. " "The first four are great, five and six are fatal errors. " 29739 08/07/06 LA Disagree "it sounds good, but there is no way to support our current access to health care without breaking the country. we would have to give up something. ie, access, technology, something." Disagree "again, it sounds good, but will cost tons of money with very little of it actually those that need it." Disagree "The federal govt. has already instituted ""price controls"" in the form of medicare & medicaid. These programs have caused price shifting to the insured & uninsured. Only a competitive environment will help bring down cost. Also a limit on Medical Mal Practice suits." Disagree Disagree "* All Americans do have ""access"" now to health care. Affordability is really the issue. Take a look at what drives the costs such as; 1. R & D for new meds, new devices to improve our lives 2. Americans living longer at any cost, in nationalized health care countries, they would die waiting on treatment 3. Surgery done to babies in the wombs, that in other nationalized health care countries would simply die. 4. Lawsuits that cause two things; a. physicians to practice ""preventive medicine"" b. higher E & O insurance cost. " Disagree "It sounds good, but really hides the fact that it will bankrupt our country to provide the same benefits for everyone. Take a look at Medicare right now. it is set to be in the whole by the year 2020. We will have to make changes in that and Social Security without adding another government sponsored program. The employees and employers are already spending amounts greater than their mortgages to finance their health care cost." Your core set will wind up being a Cadillac plan that is unsustainable. "I applaud your efforts at trying to find a solution, but it sounds more like a panacea approach." 29740 08/07/06 FL Agree Agree Agree Agree Agree Agree "The FDA needs to be more expidicious with newer therapies, treatments, and medical devices. Pharmaceuticals need to be cracked down on...exorbanant costs until their contract expires then the generic is MUCH cheeper." 29741 08/07/06 ME Disagree "Most medical plans provide coverage up to $3 million. That is more than adequate for the vast majority of health problems. Additionally, guaranteeing protection would provide incentive for healthy Americans to NOT buy medical insurance, which would only make the problem worse." Disagree "Community health networks are by definition local, and the federal governement does not tax on a local level. This would result in some either some regions receiving money they don't need, or paying into a system for which they are not receiving benefits." Agree "I agree with this on a qualified basis. I think that electronic records and more information are good things. However, the population being examined is not representative of the general population, so any information gathered would need to be evaluated carefully." Agree "I agree that increased hospice and end-of-life services would be beneficial for patients, and may also drive down costs hospitals incur from prolonging the lives of terminally ill patients. I think caution should be used in establishing how much money would be devoted to this by the federal government." Disagree "Guaranteeing access to affordable healthcare is socialist, and has not worked in other countries, such as Canada." Disagree "The best way to finance improved health care is to make Americans smarter consumers, and give them mechanisms that allow them to make informed choices. This would create market pressure that would force health care providers to create affordable health care across a wide spectrum of economic levels." "A ""one size fits all"" approach does not make any sense. Individuals must have the choice to select as much or as little health care as they want." 29743 08/07/06 MI Agree Agree Agree "* The most important of your recommendations along with the ""Support Integrated Community Health Networks"" recommendation. Quality and efficiency improvement are what is needed in America's health care system to drive down cost. I live between two major competing health care systems that are about 10 miles apart. I think both of them believe that improving efficiency and quality means building more state of the art facilities and buying more equipment. They are competing against each so much we are going to have two of everything when one should be enough for our population. I think more focus needs to be placed on getting competing hospitals to use each other for certain services instead of having them spend our health care dollars on brick and mortar. " Agree Agree Agree "I agree with all of your recommendations. This committee did a great job of identifying the problems in America's health care system. Next year, my health care premium is going to increase by another 10%. It is hard to swollow those kinds of increases when you know the Health Care industry is inefficient and has poor overall quality of care compared to other countries. " 29744 08/07/06 WI Disagree "this is merely a disguised form of national health care. The problem is not insurance, the problem is the cost of health care and the high usage we have." Agree Agree Agree Agree Agree "Unfortunately, I see the word tax or taxes far too often - which leads me to believe this is just another guise to created a national health care insurance. Again it does not attack the problem of cost." "* I really don't see anything here that attacks the root problem. The cost of health care is the result of three things: 1)a monopoly (health care) operating in a capitalistic society. Either we find a method of introducing competition into the equation or we turn it into a regulated industry. 2)an uncontroled appetite of an American society for the most up-to-date care and technology - immediately. 3) a society that wants - but doesn't want to pay for it. Our prioities are all messed up. We place fun and entertainment money ahead of necessity money and expect our govenment to bail us out - but, for heaven's sake, don't impose or raise taxes. " 29745 08/07/06 NC Agree Who will pay for these programs? Higher taxes are not the answer. Agree It is important to create a group that represents all health care fields. J. Triano does not represent the voice of Chiropractors. His best practice guidelines are too limiting and will have a negative impact on Chiropractic. Disagree "I disagree because of the people choseen to create a ""best practices"" booklet. I do not want Dr. Triano representing Chiropractic because he is narrow minded." Disagree Agree "Again, who is going to pay for this?" Agree I think the health savings accounts are the most effective way to ensure americans. Health savings accounts puts the responsibility of the individual's health back to the individual. Health savings accounts 29746 08/07/06 IN Disagree "* I agree with the idea that americans should not be impoverished by health care costs. However, reading the interim recommendations reveals no mention of personal responsibility. There are too many people that eat fast food every day, don't eat fruits or vegetables because they ""taste bad"", and don't exercise because they don't want to miss their favorite TV program. When these people get sick, their recovery is prolonged due to their lifestyle choices. No changes in providing increased ""healthcare"" or health insurance is going to change that. I applaud the efforts being promoted hear in trying to improve the health of our nation and decrease the financial costs of the entire system, but I think that this is the wrong approach because it isn't attacking the root of the problem. Yes, there are instances in which accidents happen to people that live as healthfully as possible and, in those cases, they do not deserve to be financially burdened by very high medical expenses. That's not my point here." Disagree "These are all good, but I foresee these programs being paid by tax dollars. I don't like that. We must find a way to financially reward good health rather than financially burdening poor health. (Doctors only make money when someone is ""sick"" - we need to change this mindset so that doctors are more interested in making money off people that are well and work hard to keep them that way)." Agree "Patient/health education by itself will not do the trick. For example, ask your average smoker if smoking is bad for their health and they will tell you that they know... To know and not to do is to not really know at all. We must take it a step further and somehow hold people accountable for their own health." Agree "This isn't a big issue to me, but definitely moving in the right direction of allowing people to determine their own care (people taking responsibility for their own care again)." Disagree "* Here's my fear - core services are defined to prevent catastrophic health costs to any individual and everyone has health insurance. A poor person with government subsidies believes that he/she now has FULL health insurance. They go to the doctor for a little ache/pain that is resolved with pain killers. They have just spent at least $150 for an exam and medications. Under the current system, they wouldn't have gone to the doctor, they would've just taken over the counter medication. Regardless of how the system is set up, everyone must know what is covered and what is not. I think most people take action first and then ask questions later - that's another reason why they are surprised by the high cost of care and run up huge bills. The government rewards high health costs with tax breaks (itemize your deductions on federal income tax). I propose tax breaks for those that actively stay healthy... One other comment here - this recommendation implies that basic services will be covered here " Disagree "Keep the ""core"" benefits covering only the high cost services and the financial burden on society for this type of coverage for all americans will not require much financing. High cost shouldbe defined as at least 1 years income. If their income fluctuated over the last several years, perhaps a 5 year trailing average should be used." "Mental and dental health should not be included. We are trying to prevent catastophic expenses here, not provide healthcare for every citizen." "Keep working on this. Personal responsibility must be preserved or enhanced. Do not make this into a program where anyone with a cold will have those costs covered in the ""core"" benefits." 29748 08/07/06 OK Disagree "Personal responsibility must be embraced. If a service is seen as a right, it is abused and will eventually fail. Must be exposed to free-market system or significant waste will ensue. Private and charitable organizations will pick up the slack to take care of poor. " No response Agree But doubt it ever possible. Need free-market forces. Agree Disagree Need to encourage personal responsibility. Charitable organizations will take care of impoverished. Shoddy governmental programs end up ineffective and inefficient. No response 29750 08/07/06 KS Disagree What about current Medicaid programs? Do they not currently provide FULL benefits for #3 above? Why create another beauracy to duplicate an already available program? Disagree "Again, as above........there are plenty of regional, state and fed programs. Why do we just now have to identify them. Look in yellow/white pages of phone book. Stop wasting more monies to duplicate existing efforts." Disagree "* These notions only continue the same theme. For example, why do we need to ask these programs to ""develop and implement strategies to improve quality and efficiency"". Why are they not doing so already? Also, note that the VA system cannot bill medicare for services but can bill private pay. The VA system and their budget is being asked to care for but not be able to bill for Medicare eligible recepients. Thie is not fair for these individuals to pay medicare premiums all their lives but not be treated fairly. This puts a strain on the VA system at the very time it is already busting from the demand for services." Disagree Just WHO is being denied these services today? They are ALL paid for by current public and private payers today. Who dreams this agenda up? Why is the same theme of duplicating current systems being pursued? Disagree "* OK---how do you impose and police such a recommended system? Where in the Constitution are all Americans promised health care? While it may appeal to some to mandate participation in such a system, it continues the same tune to re-create and duplicate many current systems already in place. How would the new system be financed? This is NOT the way to develop a comprenhensive system of affordable healthcare. For example, why cannot individuals deduct health care premiums on an above the line format for the purchase of individual coverage? This one minor change can impact the stated objective and NOT create something new." Disagree "* Aha.......here is the point of the entire questionnaire with the strong hint in the first line. ""New Revenue"".....this will shift the responsibilty from the private sector to the public sector. What evidence or model do we have in the public sector that gives any assurance of effiency in there over the private sector. Admittedly, the private sector is struggling to pay the increased cost of health care but how would the public sector manage this with any degree of efficency? This new revenue generation would not more effiently deal with the aging population who demands more and more services." "Where are the incentives for the private sector? What would encourage INDIVIDUALS to take the initiative to do these things? Why do I need some governmental program to encourage me to take care of my health? If the government will do this.....what is next? Food, clothing, shelter, transportation? Do I smell socialism? What a slippery slope!" * Programs to encourage the private sector are what is needed. We have a system that insulates consumers from their bad decisions. Programs need to incentivize the individual and private sector to do what it does best. We do NOT need another federal system to inhibit the market place to do its magic. Seems to work in every area of consumerism. Why not here? I mentioned the tax consequences of individual coverage. What about the same as it relates to Long Term Care coverage and its purchase? Why cannot the individual deduct these premiums from his taxable income to encourage this purchase? Think about this small change that would remove many from the public sector when/if nursing home bills become due. hmmmmmmm.....small change but potentially a big impact. Be more creative...look beyond the government to provide goods and services..........get PRIVATE think tank process moving in this area before the looming crisis kicks in!!!! 29751 08/07/06 CA Disagree "More centralized redistribution thru government intervention is most of the problem already. Market solutions will make use of the pockets of waste and ineffective spending. I think the governments place is to provide a safety net far below for the truly indigent and creativity and charity will come from able citizens. To mandate more resources cover Americans is too broad and is costly and shifts poverty. Ineffective spending must stop, by letting folks keep their hard earned resources." Disagree "The federal government should limit it's involvement to cutting taxes and decreasing mandates to facilitate consumers getting what they need, want and can afford." Disagree The Federal government in implementing these actions would further disenfranchise consumers from healthcare options. The Fed must provide tax releif and freedoms to mobilize private solutions. Disagree "These changes are best made by consumers and their doctors. Government paid ""evidence based science"" is costly. Doctors and consumers can create the most effective system." Disagree "By setting forth this as public policy, you would have to be able to mandate resources and behavior. This in a promise cloaked in benevolence that cannot be kept. It will undercut those those freedoms that bring forth creative solutions and charity." Disagree "This safety net already exists in theory. The MRMIP program has had an extended wait because of lack of state funding or state mandated rationing. The shared responsibility would help, but this is policy form and that should be left to insurance companies." No core benefits. "There is great power in questions to steer thinking in the direction the questioner wants. The American people, owning more businesses and seeing the cost of government intervention. The well educated Americans who will contribut to our country with innovation and new ideas are not going to appreciate this system of centralized redistribution, it lacks the necessary market influences that will make health care effective and affordable." 29753 08/07/06 IN Agree "Mandating coverage could be difficult, but should be available to all Americans who need it." Agree I particularly like the expansion of FQHC. It should also be expanded to specialty services outside of the community health networks and it needs to include dental services. Agree "Many areas of this recommendation should be expected now, but if not then should be required of these providers, especially the pricing and education for patients without insurance to see what the costs of tests, labs, etc are before undergoing the procedures." Agree No comment Agree I have heard many women say that due to lack of insurance and finances they have not had a PAP smear or Breast exam in years. When illnesses associated with these tests are left untreated the cost is so much greater then early intervention. Agree Universal health insurance has been seen as inefficent and ineffective in Canada. A different form of coverage needs to be studied and see what works best. We are democracy that shoudl allow people to choose and some may choose no health care. This issue needs to be studied. "This recommendation can go a long way in assisting patients to becoming a healthier individual, and maintaining that wellness state." "I think all eyes are on Massachsetts and we should watch and learn from their efforts what works best and what doesn't work at all. As each state deals with the issue of growing uninsured and underinsured we should be willing to share successful programs and ones that were unsuccessful too. I am not convinced there is a ""perfect"" solution but improvement over the current situation is necessary." 29754 08/07/06 GA Agree "I agree that all citizens should be required to have coverage, just like auto insurance. I do not agree that the federal government should oversee it. We know how they oversee Social Security and the IRS, a bunch of incompetent mad dogs. " Disagree "Federal mandates just scare me. If there was a mandate which passed the responsibility to the state level would be acceptable. However, we need to stop giving benefits to non-citizens and give benefits to those who are legal, but require some responsibility on each individual's part. If you can determine a way to do those things so be it." Agree With the caveat that the federal government cannot administer these programs uniformly and doesn't even need to try. It should be done on the state level. Agree Agree "The key word here is Americans (citizens), and people should have to take some personal responsibility. People who smoke, drink to excess, eat themselves into goodyear blimp size need some responsibility for their conditions that go with these lifestyle choices. Some employers are requiring ees to participate in programs relating to these problems or pay higher premiums. Maybe this would have an impact. I do not wish to continue to pay for these kinds of lifestyle choices. " Agree "Only available to legal citizens, and requirements for responsibility to the individual. We are not a social state." I want some say in what is happending in my country. Close the borders and regain our country. OUr lawmakers need to listen to the citizens. 29755 08/07/06 NC Agree "It is important to provide assistance for those individuals and families who can not pay the premium and deductible for health insurance. Subsidies would have to be in place. My concern is, ""Where would this money come from?"" Increased taxes? This recommendation sounds much like the new Medicare Part D drug plan, where individuals have to participate or pay a penalty. Would the nation program be similar to insure enough participation by individuals to be financially feasible? " Agree "Please include consumers when establishing the public-private group at the national level for advising the federal government on the nation's health care safety net's performance and funding streams, etc. You need to have comments from real people who are dealing with real health care needs. " Agree "There are other government agencies that are already doing much of what is included in this recommendation. Those agencies are the Administration on Aging and the state Units on Aging/Area Agencies on Aging along with Social Security. These agencies all work with the older, minority, low income, and disabled population. Why aren't they included in this recommendation? They are already doing much of this work on improving quality of care and efficiency. Again, can we follow the Medicare Part D on this?" Agree "Hospice care is already covered by Medicare/Medicaid insurance and most private insurance companies. Education of the medical professionals is the problem. Education should start with the physicians, they need this in medical school and should be a required continuing medical education yearly, and include hospital discharge planners and social workers from all health care agencies. " Agree "Again, the funding is the problem. But aren't we already paying for those not insured by their costs being passed along by the insurance companies, hospitals, health care agencies to those who do have health care insurance and do pay?" Agree I agree with a local state income tax to help pay for health care or personal assessment tax on individuals over 18 who have residence in each state. Or how about thinking out of the box and let's have a National Health Care Lottery? It seems like people don't have a problem paying money into any lottery system. "Again, let's make sure we actually reach those most in need to participate. " 29757 08/07/06 NY No response No response No response No response No response No response "* I both use health care and provide it...To provide for excellence of care, I think you need choice, privacy, and the right of the citizen to choose his/her own clinicians and facilities. To keep costs reasonable but to keep from over-regulating patients and clinicians, I think that making sure treatment is affordable to all, yet that each person pays an amount that makes them use wisely, the only solution is a fixed-dollar reimbursement to the clinician from the insurer, and a sliding-scale co-pay from the patient. This also allows clinicians to be paid according to their skill, training, and experience rather than pay each clinician in a particular field the same. Doing the latter ensures that only the average clinicians are properly paid, frustrating the excellent and over-paying those not yet as skilled as they could be. This ensures mediocrity and drives many highly talented people to avoid the fields. You need a system that supports clinicians who go above and beyond their degrees and take years " 29758 08/07/06 RI Agree see the last box below Agree Agree Agree Agree Agree "We have lost our way. To make any sense out of all of this, we need to refocus on the fundamentals: . keeping healthy people healthy . reducing health risks in the at-risk population . managing chronic disease in the chronically ill population It is all about health !" 29759 08/07/06 CO Agree Agree The advisory group should be limited to public and direct providers only. No other private enterprises such as insurance companies. Agree Agree Again the private payer must be eliminated from the system. 3rd party profit centers take away from the healthcare dollar. Agree I would add that this system must be a publicly operated payer not a for profit insurance based concept. Disagree This must be a a tax based public single payer system. Hospitals must be converted (at some expense to the public) back to not for profit institutions. Service providers should be free enterprise as well as public based and payments regulated fairly to insure that Doctors will continue to want to be Doctors. Current private insurance companies are the problem and should not be allowed to steer the solution. They do not belong on this committee. 29761 08/07/06 ME Disagree "Delivering care has a cost. Wether we as citizens pay for that care through premiums or taxes is irrelevent. We should insure against catastrophic loss. Subsidies acn be made available to those in need, however, we should aviod a system that generates an etitlement mentality." No response Disagree "The federal government should promote transparancy. Let industry develop operational definitions for quality and efficiency. The federal government can additionally promote education for wellness and disease prevention, but let industry support the effort by reducing premium costs for people that put disease preventioIn and wellness to practice with behavior." No response Disagree "This is entirely to vague. First, what is affordable? Define financial assistance? Does ""everyone participates"" mean that everyone should pay some level of premium? What about health status that is a result of poor decisions made by the patient? Where is the incentive and reward for good decision making? It should be public policy that all citizens have access to health care, which they do. Affordability comes from competition and consumer knowledge, not policy." Disagree "Health care should be paid for by the people who consume it. Insurance is available to transfer that risk. The government should always be ready to extend a helping hand to people in need, but we should promote personal responsibility. Funding health care through taxes creates a disconnect between those that provide and receive care. This happened with the introduction of HMO's and is one of the major drivers that escaleted costs to begin with." Each individual should determine the health care coverage they desire based on the premium they are willing to invest. Educate consumers on best care practices that reduce inefficiency and cost. 29762 08/07/06 OH Agree Health care should be a right of citizenship and not connected with employment. Agree Agree Agree Agree Agree "We could take a portion of the ""Homeland Security"" budget which would provide sufficient for universal health care." 29766 08/07/06 FL Agree "I recommend an ""additional plan"" of coverage that persons may sign up for that would help with these types of health care costs. These indidviduals could opt to pay for part of the cost via deductions, and have some government money set aside. But the government shouldn't pick uop the whole tab for it. " Agree Agree Agree Agree Agree 29767 08/07/06 MI Agree "By having health coverage for all americans, we would begin to address inappropriate and episodic care provided by emergency rooms " Agree Agree Agree Agree Agree "One might start with utilizing existing dollars spent on the medically underserved. Specifically, disproportionant share dollors are spent on the acute care side of the business which consume a tremendous amount of resources rather than allocating those same dollars to primary care and prevention." I can't wait to make this happen. Good Luck 29771 08/07/06 OR Disagree "All you have to do is look at the disaster caused by the Medicare Part D RX plan to see that this would never be set up properly. That program is the most complicated, complex plan that could have ever been proposed. National health care is not for a democractic government. We are not a socialized government. Our deficiet is outrageous as it is. Most responsible citizens have health care, either through work or private. " Disagree "When the government gets involved in private/personal matters, it becomes a complicated issue." Disagree We have enough federally funded programs in place right now and can't afford to run those efficiently and to the best use of the citizen. No response Disagree They already have access through the current programs Disagree All you are talking about is increasing taxes for those of us who are responsible and work for a living. We are tired for paying for the deadbeats. see above comments 29775 08/07/06 IN Disagree The Federal Government does not have any business in managing health care. Theor past track record with Medicare is a prome example of why they should not be trusted with the individual's health. Disagree We all ready have multiple levels of health care for the low income. Adding another layer is a waste of money. Putting more people into a government plan will destroy what has made this country great by having an indpendent wih=thout govrenment control health indsutry second to none in the world. Disagree I partially agree. The government needs to reduce the fraud and waste which it's programs have fostered. Disagree Another waste of tax money. The services are already existiing and do not need to be funded. Disagree Americans do have access to core health care services currently through private insurance. We do not need any more control by government into areas they do not need to tread. Disagree No government financing. This is socialized health care and we don't need to fall into the trap of mutual coverage. "Defining who is and who is not by law without regard for individual assessments is rediculous. There are already ""core"" benefit packages in existance and to "";egislate"" another set of values will not be effective. Currently Medicare has such benefits and they are not meeting the needs of the individual client. Since the benefits are ""national mandated"" individual states cannot adjust the benefits to meet specific populations needs within a specific state." "* What amounts to a national health care system goes against the very fabric of our great country. With the baby boomers moving into retirement there are many economic hurtles that cannot be met by forcing the nation into another goverbnment program called ""health care."" The real questions are thus: 1. Who is going to pay for it and how? Will a federal income tax of 40, 45, 50 or higher percent cover it? 2. Is this another program giving the government greater control over who gets what treatment and when? 3. Why does the government get the idea that this system will work when there are many examples of countries with this very system have very poor health care? 4. When and if this misguided program would start is there going to be a federal mandate at what age and condition a sick person must die? 5. Where will the innovation in medicine come from? 6. Is this another eway a politician can assure a future election to continue in public office?" 29780 08/07/06 KY Agree Take the profit making motive out of delivery with a medicare for all solution. Agree "With a singlepayer system, everyone has access to the same services." Agree Medicare for all will simplify the delivery system and make oversight more managable. Agree "If health care is a right and not a commodity, this goal is attainable. " Agree "Finance through taxes of individuals and business. Take out the high coast of administration through private health insurance agencies. Health care should be a right, not a commodity. " Agree Singlepayer -- Medicare for all. "Let the recommendations of the health care analysts guide the core requirements, and fund accordingly. " I support John Conyers Medicare for All HR676. 29783 08/07/06 OR Disagree Protection against very high out-of pocket medical costs should be refined to certain types of illness and treatment. Also protection for low income individuals and families should be on a secondary provider basis after all other reasonable resources are exhausted. Agree no additional comments Agree No additional comments No response No additional comments Agree "defining ""appropriate"" care is most difficult. Will likely be resolved by a concensus view. Therefore, some flexibility in the approach should be anticiapted." Agree This statement is so general and broad. Specific bases on financial support are necessary in order to even begin. Choice for realligning finances in future years must receive general consensus by the users and providers for this system. No additional comments 29787 08/07/06 NV Agree Because we can do this in this country we should feel obligated to do this for all Americans. Agree "Again, because we can provide health care to all we need to feel obliged to do so." Disagree I am concerned that these federal programs will bog down the system because of their previous place in the system. I think new invigorated programs need to be instituted. Agree Hopefully we can give full respect in health care to those who are about to die. Agree "With all due respect, we should be embarrassed as a country if we do not provide health care to all Americans." Agree "* I have thought about this for many years and have run my thoughts by many people from many walks of life. In my opinion we need to create a non-profit insurance system. Where those employed by the system are paid well but all profits are returned to the system for greater benefits for the insured. We can see that our for profit insurance system is bankrupting the medical system, causing skyrocketing premiums and is leaving a huge segment of our great societ both under and uninsured. A non-profit system would maximize our country's ability to give the best insurance to all." We need a nonpartisan group overseeing these important issues. It will be an uphill challenge to make changes when special interest groups and insurance lobbyists are making huge profits by keeping the system status quo. I hope that change can take place through grass roots programs. I fully support needed changes in the health care system especially as it relates to insurance dollars being paid into the system in premiums and paid out of the system in benefits. 29790 08/08/06 NY Agree "This is a crucial component of a healthcare safety net. Currently, The number of individuals who are financially at-risk or impacted by healthcare costs is unacceptable." Agree Agree "Cost control is the key word. The cost of administration in this health care system is extraordinarily burdensome. Technology will help, but we need a system that will reduce administrative waste, such a system is likely to come from a single payer or single billing system." Agree "A vital component that will alleviate painful decisions made by patients, families and physicians." Agree "This is the best way to distribute the risks and costs of healthcare. Health care should be viewed as an important investment for the health and welfare of the country, just like education and defense. " Agree "A better healthcare system in america should NOT cost more! It would be a fundamental mistake to invest more money in a system that is already spending more than any other nation, but provides less. Waste and administrative costs must be reduced, and thereby providing the extra ""revenue"" you seek" "And, additionally the core benefits package must be continuously updated." Bulk purchasing and corporate taxes need to be discussed with regards to the high cost of pharmaceutical and medical device costs. 29794 08/08/06 NC Agree "If this recommendation means universal health care coverage - guaranteed coverage of some type (public or private) with a government-defined minimum set of benefits that include access to a continuum of needed healthcare so as not to compromise one's health, then yes, I agree with this recommendation." Agree "Yeah, this is a great recommendation, but good luck trying to get providers to cooperate with one another in a highly competitive environment wherein providers market the latest high-tech, expensive treatments for people with specialized problems vs. focusing on delivering high quality, accessible, effective and responsive preventive and primary care." Agree Duh - isn't this something the government ought to be doing anyway? This is a very silly recommendation to put in the context of fixing the health care system - as if increased efficiencies have not been sought over the past 10-15 years to control costs. Agree "Yes, I think we need to look at the research data that clearly shows that we are spending a huge wad of cash on care in the final weeks of our lives." Agree "* I don't like the way this question is phrased. Were I to disagree with it, my response implies that I don't want affordable coverage for Americans. The problem with this wording is, what is considered affordable? If government standards for determining who is poor or how much people should get each month in SSI (which puts them well below a poverty threshold that is already artifically low) are used in the context of determining health care affordability, then no, I think as implemented this would be a crummy recommendation." Agree "* OK, so you asked. Bush and his cronies need to rescind their huge tax breaks for the wealthy. It is clear that the neo-con agenda is to starve government to force cut backs in public safety net spending, all at a time when public financing of a health care solution is at its most critical juncture EVER! I also think that we need to spend far less on the War in Iraq - those dollars can be better spent on U.S. residents who are dying every day because they don't get the health care they need. Congress also needs to implement ""pay as you go"" rules, but not without rescinding tax cuts for the wealthy, including the latest estate tax repeal, which was sold to the public as a ""death tax"" and which will benefit very, very, very few very, very, very wealthy Americans. This is not fair and should not go forward when people are literally dying because they can't get the care they need. The corporate income tax, due to a growing number of loop holes, has also decreased as a percentage of total federal revenue o" "Universal health care! I would say single payer, as it would be the most cost efficient solution, but I know that there are too many hands in the pie and too much at stake on wall street. Universal health coverage should be the single most important public policy priority right now!" 29795 08/08/06 NY Agree "This is a critical point, as we have all seen individuals and whole families financially devastated by impossible health care burdens. It is ABSURD and WRONG to ask members of the most powerful nation in history to accept this kind of risk on their own. We HAVE thet resources to enact this kind of reform, we only need those in position to make the law to ACT." Agree This sounds reasonable. I support programs that enourage (through incentives) health-care professionals to spend time in the neediest communities. Agree These are all great steps. Agree "* Improving access to palliative care is EXTREMELY important, and a badly neglected area of health care in the current system. Last days are critically important not only for the patient but for the surviving families, whoh are already facing inevitable grief. We need to reduce the opportunity for adding the grief of poor services, restricted access of the family to the patient that is inevitable when they are institutionalized rather than at home, and reduced opportunities for final conversations with the dying with unnecessary last-ditch medical efforts." Agree "This is number ONE. Skyrocketing health care costs are leaving our working people and our elderly impoverished and at risk. We are spiraling toward third-world status if we do not change the way we fund and deliver health care in this country. This is a basic human right (see the United Nations Declaration of Human Rights!!) and mmust be implemented here, now!" Agree "Independent, fair and scientific: just like all our decisions should be." "Thank you for this opportunity, and please do not fail!" 29796 08/08/06 CA Agree Agree Agree Agree Agree Agree 29797 08/08/06 FL Agree "all natural born citizens should have access at affordable rates. those who have been naturalized should be another group also have availability but not at the cost of group 1. there needs to be an accepted schedule for costs of medical procedures and practices. doctors need to have more freedom in practice, rather than fear of law- suits that results in many unnecessary tests and medications. low-income families should also have access to proper medical care." Agree "regretably it seems good doctors and medical facilities will go where the money leads them. growth of an areas population base will bring more medical personal and facilities, but less developed areas will lack for growth in proper medical attention. perhaps there needs to be an incentive to get medical help to less populated areas." Agree "* sounds great, but can there be any system developed without fraud and waste? if there is money moving into the system, there are people trying to work that system to their benefit rather than its intended goal. there seems to be very little motivation on many government levels to drive the individual participants, employees, providers to move at a pace of independent business. the system needs a profit incentive to drive its goal orientation. it needs teeth to motivate without fear of discriminatory reprecussion." Agree "from experience it seems that hospice does a wonderful job. by allowing professionals and interested volunteers to provide this service, it seems patients receive wonderful care. too often the family is making an emotional choice rather than an objective decision, as would be most appropriate for a given circumstance/reality." Agree * hopefully this will not be abused by any medical practice trying to grow their business with fraudulant billing for services or supplies never rendered. this is prolific today in too many hospitals and medical care facilities. it also seems to be an accepted practice because those with insurance will pay and few review their bills. families should not have to bankrupt themselves for medical expenses. but families should also get appropriate counselling about spending or the expense of prolonging unnecessarily life of the incurable or brain dead individuals. Agree "* if all employers and employees had some contribution to health care it should reduce the overall cost. it however, must be a manageable dollar figure. people in many income brackets can not afford the family premium even with the employer paying 50% of the employee cost. if your plan is to include an increase in income tax, it hits many of the same group that is trying to offer employer plans. everyone should have the opportunity to have an above the line deduction for all medical expenses rather than the current percentage of income standard. be more proactive with hsa type involvement that allows any person to protect there catastrophic exposure and save for smaller bills they can personally handle. be more proactive with long term care opportunities to help avoid the future onslaught of baby boomers in a consumption lifestyle from becoming a drain on medicare and medicaid." "* prescription drugs make up about 35% or more of our medical spending. do patients really need this amount of medication? or is it the power of the lobby groups working for the pharmicary industry or the fear of any lawsuit threatening a doctor who does not prescribe? are we enlongating a quality of life or just a length of existance. i hope there can be found an independent, fair, transparent group to identify and monitor the health care system. currently there are too many self-serving entities each grabbing for a larger slice of the medical dollar." 29798 08/08/06 FL Agree It is beyond debate that a serious or catatrophic illness can financially ruin people. Most financial crises are because of out of control health care costs. Agree There should be no reason why Americans living outside urban areas should be offered second or third world care/options. Agree Agree It is critical to provide the elderly/terminally ill or caregivers the options. For too long high dollars have been spent to keep individuals alive rather than accept that life does and must end. Agree "Healthcare should be a right, not a privilege for those able to afford it." Agree "Medicare should be offered to all Americans and financed as it is now. Premiums may have to vary, but why is Medicare (arguably the largest healthplan in the world) available only to those 65 or older and the disabled?" the core package offered should vary by age and stress preventative care at the earlier age brackets and palliative care for the extremely old and or terminally ill 29801 08/08/06 RI Agree "Health Care is not a luxury, it is a necessity." Agree Implementing the Health Care Safety Net based on accommodating various income levels making it accessible to everyone to have medical coverage would benefit in controlling diseases and a healthier place to live. Agree All the above would help management and education of this program. Agree The last days of a person's life should be carried out with the best possible medical services and caregiving available. Agree Positively. Disagree All the above would be a dream come true. This is a tremendous task to accomplish. I'm sorry that I can't offer any financial suggestions but those inteligent individuals involved in designing such a Health Plan need to keep in mind to avoid making it complicated in order for the public not to become frustrated and discouraged with the choices offered. "The above plan is impressive but financing,longivity and the integrety of its operation is questionable." No. 29803 08/08/06 MI Agree But not for illegals Agree not for illegals Agree no illegals covered Agree not for illegals Agree mot for illegals Agree "I am unpset at illegals in this country getting our benefits. Americans yes, illegals no!!" 29806 08/08/06 GA Disagree "There is no black and white answer. I would agree to a national program if it provided coverage for children, the disabled and the elderly. I think you would find if there is ANY buy-in into the program, low income individuals would not take the coverage. I have seen individuals opt out of private insurance that only costs them $21 twice a month." Disagree I see the potential for abuse. Larger private carriers will pick and choose the better areas and the smaller carriers will get left with more rural and poverty stricken areas. The same goes for the hospitals. How can you make it fair and equitable when larger hospitals and carriers exert so much influence. Disagree "You've got to show me how you are going to reduce fraud and waste. Most of the programs have been involved with some type of fraud, especially on the provider level." Agree "Individuals in the last days of their life should receive all the care and support we can possibly give them. It is, to me, a characteristic of a civilized society." Disagree "This should be for children, the disabled and the elderly. Each state can offer a high risk pool for able bodied working persons who work for a company that does not offer health insurance or for persons who opt to not take the health insurance through the employer." Disagree "This is just re-directing the burden. The small employers cannot bear it. Workers are opting out of health insurance because they feel they can't pay any contribution. Only large businesses can shoulder the burden and they have access to influence. Somewhere down the line, they will ask for a tax break." "THis is not a ""Core"". This is a standard policy." "Provide Health Care for the children, disabled, elderly. Take prevention and education to the workers at the jobsite. Provide support and care for end of life" 29807 08/08/06 PA Agree Disagree "* As the Director of a FQHC I feel that the proposal to eliminate the requirement that 51% of a CHC Board of Directors be users of the organization is a poor idea. I think this proposal runs counter to a process that understands and desires that the delivery of health care be responsive to the needs of its users. I have witnessed on a first hand bases how the needs of various special populations in our client base have been identified by those Board members who are users of our organization. If other community-based health centers are interested in serving the vulnerable populations currently served by FQHC organizations, they should accept this requirement or seeking funding for their mission directly as FQHC have in the past. I would like to see this recommendation removed from your report." Agree Agree Agree Agree 29808 08/08/06 NJ Agree The current private system should be utilized to provide health insurance for as many Americans as possibe. One approach is to require employers to provide health insurance for all employees and require these plans to have a minimum benefit. All other Amrericans without health insurance ( unemployed and below a certian income level) should be able to qualify for a goverment program similar to Medicaid. Agree Agree Agree Disagree Agree 29809 08/08/06 OR Agree "Not providing basic, preventative health care coverage for all means that the working poor have to go to emergency rooms when their health becomes too bad. This is more costly than it would be to provide everyone a basic level of healthcare. We need to provide federal support for the development of integrated community health networks to strengthen the health care infrastructure at the local level, with a focus on populations and localities." Agree Agree Agree Agree "I agree that it is critical to ensure that all Americans have access to a set of core health care services. Financial assistance should be available to those who need it. Not providing basic, preventative health care coverage for all means that the working poor have to go to emergency rooms when their health becomes too bad. This is much more costly than it would be to provide everyone a basic level of healthcare." Agree "I think the emphasis on preventative health careis the most important issue, & then the idea of managing health care issues, long term by working with the patient, instead of Western medicines current emphasis on the dr. knowing the cure, will be a critical attitude shift in attitudes about wellness." 29810 08/08/06 CT Agree "For me, there is not enough detail here to produce disagreement. Recommendations are pretty high level, and in keeping with a principle of the need for a national health program that I subscribe to. When there are more ""teeth"", ie exactly how program would be financed, administered, then I cn make more substantive comment." Agree Agree Agree No response Agree "Currently health coverage is a for profit industry...regulated, yes, but clearly for profit. I would support contribution through income tax like structure, minimum with cap based on salary for a BASIC catastrophic plan and prevention only with more and all other coverage available through buy up options with individual carriers." 29811 08/08/06 IA Agree "* everyone should be able to have same coverage equally whether you are the president, senator, govenor, judge, jury, or child no matter age, race or sex I feel healthcare should be implemented before spaceship exploring what ever happen too taking care of our own first? Illness DOES NOT DISCRIMINATE it affects everyone. The elective surgeries, the makeover abuse of insurance is wrong, I cannot get my needed cares. 2001 I had to file bankruptcy due mainly to healthcare issues now 5 years since and I have not had a physical since there is a problem there. I was in emergency surgery after 8 weeks of driving myself everywhere very very sick Iowa City only hospital to thoroughly investigate sickness that lead to embolism rupturing, 2 weeks later my step-mother died from same thing hers hit heart mine hit colon. I know there are many more serious occassions when someone doesnt have appropriate coverage why so we as the United States of America the land of the free and the home of the brave have to do without? med" Agree Granted there are some sites Mae Davis Clinic for one WONDERFUL action....... Agree "why cut these cut the plastic surgery the abuse types not the needed types, take away the ways and means of jet setters dining in the caribbean for a business proposal and save the Jetsetta's in our society." Agree "agreed to also putting an elderly man in prison for his assistance was wrong also, what about the sex offenders that inflict harm and disease and sometimes murder! " Agree AMEN IF THIS COULD TRULY HAPPEN Agree "AS STATED ABOVE TAKE THE BUDGET CUTS ELSEWHERE NOT FROM HEALTH OR EDUCATION (SPACESHIP) HOW MUCH SPENT IRAQI CLEANUP, HOW MUCH EXPENDITURES WERE THERE FOR MICHAEL JACKSON, O.J SIMPSON, MY 80 SOMETHING GRANDMOTHER WAS RAPED AND HURT SO BAD SHE NEVER REGAINED COMING OUT OF HER COMA." TOTAL AGREEMENT CAN BE DONE "TAKE A POLL HOW WOULD ANYONE IN THE ROOM FEEL IF IT WAS THEIR CHILD THAT NEEDED SURGERY AND A PAIR OF GLASSES TO SAVE THEIR SIGHT, OR THEIR DAD NEEDED TREATMENT FOR BACK INJURY FROM WAR AND THERE WAS JUST NO COVERAGE FOR HIM OR REHABILITIVE CARE TO MANAGE THE PAIN." 29813 08/08/06 NJ Agree "* Dear Sirs and Madams, I thank The Citizens’ Health Care Working Group, which was created by Congress in 2003, for calling upon our nation to develop and implement universal health care by 2012. I applaud the group for allowing meaningful public participation by taking public comments (until September 1, 2006), before finalizing its interim recommendations. I am proud to be able to weigh in on this extremely important matter. Thank you for accepting my comments. I support high quality health care for all. As a disabled individual, with a multiply disabled child, I am keenly aware and troubled by how health costs are soaring in the United States. In addition, 46 million of Americans have no insurance and employers are shifting health coverage burdens to workers constantly. As our leader, President George W. Bush has responded with a proposal for privatized Health Savings Accounts and high-deductible, limited benefit plans that would push us even further in the wrong direction. President Bush’s plan" No response No response No response No response No response 29814 08/08/06 NJ No response No response No response No response No response No response "* Dear Sirs and Madams, I thank The Citizens’ Health Care Working Group, which was created by Congress in 2003, for calling upon our nation to develop and implement universal health care by 2012. I applaud the group for allowing meaningful public participation by taking public comments (until September 1, 2006), before finalizing its interim recommendations. I am proud to be able to weigh in on this extremely important matter. Thank you for accepting my comments. I support high quality health care for all. As a disabled individual, with a multiply disabled child, I am keenly aware and troubled by how health costs are soaring in the United States. In addition, 46 million of Americans have no insurance and employers are shifting health coverage burdens to workers constantly. As our leader, President George W. Bush has responded with a proposal for privatized Health Savings Accounts and high-deductible, limited benefit plans that would push us even further in the wrong direction. President Bush’s plan" 29816 08/08/06 WA Agree "* since taxpayers ultimately pay the healthcare cost of many Americans already, we may as well have a system in place that is fairer both for those that don't have money and for those that do have some money but, would lose everything to pay their healthcare costs. For me, I've worked my entire life since I was a kid. I am going to be eligible for early retirement soon because I have worked so hard. But, how can I possibly afford to retire with the cost of healthcare where it is. I can't retire unless I have some sort of assurances that I won't be wiped out by some illness or the illness of my spouse. As it is now, I must continue to work even though I would like to retire and leave my work and the income provided by my work to someone younger. I will not allow myself to become impoverished after a lifetime of working to save for retirement and ""the good life"" just to realize that I will go to my grave as a pauper because I have illnesses that are normal for Americans my age. " Agree "This all sounds good. It's going to take long term committment from our government to make me feel secure. The way our government changes it's funding priorities, it makes me nervous to believe that politicians will actually provide a stable system that can be relied on for real healthcare." Agree "A system like this using public employees can work. If it is a service based operation managed by committed professionals (not bureacrats, empire builders and resume writers) it has a chance of working. If you place transitory, spoils based appointees in charge of this system you will get poor performance. The senior leadership of this type of operation needs to be accountable not to politicians as they rotate through office but, to the people as they rate the services they receive." Agree Respect for the individual is always important. End of life quality is just as important as any other time. Agree I need to be able to live and pay my bills in spite of having an illness. Agree "As long it is a fair process, I think most Americans will agree to start up and maintenance costs." "This system will need citizen oversight. This seems like a good way to do this business. Again, we need to avoid the possibility of top level managers being beholding to politicians. They need to be responsive and responsible to the public." "I am skeptical that this could happen. I hope it does but, since our priority at this time as a people seems to be killing people in other nations or supporting our ""friends"" that want to kill people in other nations, I have some doubts about our current committment to national healthcare." 29819 08/08/06 CA Disagree "A national program as described above would further insulate health care consumers from the costs of their care, causing costs to rise. It would also take choice away from those Americans who would prefer to spend their money on something other than health care." Disagree "I think government support for health networks will politicize the issue, with ""vulnerable populations"" defined by politicians looking to pander to their constituencies. Additionally, I believe federal support of ""vulnerable populations"" will eliminate much of the incentive for these groups to reduce their vulnerability. (For instance, why should rural communities be subsidized for their choice to live in an area with reduced access to health care facilities?)" Disagree The only way for the government to promote these ideas is by regulation or the threat thereof. These ideas fall into two main categories: reducing cost and improving quality. Businesses in the marketplace naturally strive to excel in these categories; it is generally business insulated from the market by government bureaucracy that provide low-quality service at a high cost. Disagree "Individuals should be able to choose the end-of-life care model that works best for them, rather than be forced to settle for a one-size-fits-all policy. Providing funding for these programs insulates patients from the price of these programs, preventing them from making an accurate cost/benefit analysis." Disagree "* I strongly disagree with the notion that access to health care is a right. People should be free to decide how much or how little health care is worthwhile to them. People should have a right not to purchase health insurance, but should not enjoy government subsidies if they later need medical care. Letting health care be governed by a free market system will reduce costs and allow individuals to buy the exact coverage they want and need. Those few who cannot afford to participate in the market are better served by non-governmental organizations and charities than by the nationwide bureaucracy necessary to ensure ""affordable health care"" for all." Disagree "* Any system that transfers the cost of health care to a third party will prevent patients from being able to accurately assess whether a given procedure or operation is worthwhile. There is an optimal financing mechanism for health care: let individuals determine how much health care they're willing to pay for; let health care providers compete for their customers; let innovation direct how low-income individuals can best be served. If the government is committed to making health care ""affordable"" for all Americans, there is no incentive for health care producers to reduce or control their costs short of government regulation." "There is no objective ""set of core health care service"". Each person has a different idea of what health care is a luxury and what is indispensable. A one-size-fits-all for what would be covered would inevitably contain too much care for some individuals and too little for others. Those who needed less than what was covered would be forced to pay for services they neither wanted nor needed, while those who needed more would be subsidized by everyone else." "* America's most dynamic and innovative industries are those in which the government is not involved. Her most lethargic and unresponsive industries are those in which the government has involved itself under the auspices of protecting producers, consumers, or both. Many of the problems of today's health care system are the result of eliminating the need for patients to make the hard decisions over what care they want and need. Further involving the government in American health care will make it more inflexible, more expensive, more politicized, and less responsive to the needs of patients. Please work to protect individual choice and responsibility by limiting further government involvement in health care." 29820 08/08/06 RI Agree Agree Agree Agree "Too vague. I would not support if it included physician-assisted suicide in ""culturally sensitive end-of-life care models.""" Agree Agree 29821 08/08/06 CT Agree Emphasis on coverage for all americans especially those in the low income levals. Agree I especially support the fourth suggestion concerning focusing health care in areas where quality health care is most needed. Agree "Heaslth education very important. Also, reductiuon in fraud and waste." Agree No response Agree "In general I agree with this recommendation BUT, it is far to long, wordy and repetetive" 29823 08/08/06 MO Agree "* I hope the leaders of this effort realize the benefits of the single payer model as the best vehicle for providing health care for all at an economical cost and a fair and equal method of access. There are 39 countries which have a higher life expectancy than the United states, according to the 2006 edition of ""Pocket World in Figures"" issued by The Economist magazine. The same source says the United States spends more for health care as a percent of GDP (14.6) than any other country. James Hoggard" No response No response No response No response No response 29826 08/08/06 CA Disagree "Agree with everything except the exclusion of those that are not ""Americans."" It should be for all residents." Agree Agree "Build around evidence-based practices and ""provide individualized care for all patients""." Agree Agree Agree Very True. 29827 08/08/06 NM Agree Agree ADEQUATE FUNDING AND INCREASES IN FUNDING AS DEMAND INCREASES. Support the folks who have to do this work. Disagree This sounds like a lot of administrative beauracracy to me. The healthcar system is already top-heavy with quality control agencies and watchdogs. We don't need more. This sort of thing is likely to increase the cost of medical care without inproving access to good care. Agree "Yes, it needs to be OK to die, and the choice to die gracefully and pain free needs to be offered to everyone (yes, we all have to die eventually.)" Disagree "Who defines these ""core services"" and what are they? Is this a sly way to ration healthcare? The poor get a little and the rich get a lot?" Agree "Healthcare is not expensive, compared to other expenses--war, transportation, energy. We need to quit lying to the people that healthcare is too expensive. Healthcare is valuable, but not expensive." "OK, but don't cripple the group by requiring them to keep within an unreasonable budget. " 29830 08/08/06 CA Disagree Disagree Government should not be paying for Health care when people own boats and cars and take vacations every year that cost more than the cost of health insurance. Agree As long as the promotion is through tax incentives to private industry. Disagree People need to be encouraged early to plan for their own support. other countries save far more than Americans do. Disagree People have choices and make choices every day. stay out of our lives. Disagree THis is great if you are a communist. Just stop this crap. 29831 08/08/06 MT Disagree "While it sounds good, it takes away personal responsibility and places it on the backs of neighbors and others in the community. Families are to take care of their own (first) and we've gotten away from this responsibility. It doesn't encourage people to be responsible but to sponge off of their neighbors. There is valid reasons for some people being on hard times, but this system encourages people to be lazy and irresponsible. We need to have safeguards to protect us from leaches." Agree This is great especially if it's done via the internet. Building another big bureaucracy will do nothing but start with good intentions and then sufficate it in it's own bureacratic bull s---. Disagree "I basically agree with the concept, but because of Medicare & Medicaid we have seen a huge increase in fraud, graft and corruption in claims, so I disagree with what is done in practice. It agains gets one away from being responsible and trying to get someone else to pay for my poor choices and mistakes. Private enterprise, if encouraged, can take care of this far better than government could ever dream since government has no incentive to do so and the private sector does." Agree "Jesus said,""Mercy is better than sacrifce"" and to show compassion is very good, but never if it takes away the persons pride, personal responsibility and self esteem. Then it is no longer mercy but corruption." Agree "This, however, is not to come from some government bureaucratic program, but if our government would allow the free enterprise system to work so that our economy could really flourish, then families, churches and communities would have not problem taking care of their own. It's the economy that drives this and the more the government gets involved in the economy, the worse the economy becomes." Agree If our economy is healthy we would have no problem financing health care. 29832 08/09/06 OH Agree Disgraceful that every other Industrialized Nation in the World has some form of National Healthcare for all of it's citizen's and the U.S. being the wealthiest can sit back and allow this to happen! New Corporations are opening in Canada and other countries with healthcare as it is more affordable to do business! SHAME ON OUR GOVERNMENT! Agree CAN NOT MAKE NATIONAL HEALTHCARE AVAILABLE TO ALL FAST ENOUGH! Agree "Use some of the models of the other countries who have successfully made healthcare available to all of the people! Fed up with Special Interest Greed over the welfare of our Nation! SHAME ON OUR GOVERNMENT, ESPECIALLY REPUBLICANS. " Agree Stop putting Special Interest Groups before the well being of the people and our country! Agree Cannot have National Healthcare Fast Enough! Disgraceful each day that goes by. Agree "Again, use models from other countries with successful programs and put aside Special Interest groups." "This cannot happen fast enough, this could improve our entire way of life, the fear of losing health insurance brings stress to many I know and work with every day, many must continue working long beyond their expected retirement to afford healthcare and still fear losing all! Disgraceful!" 29834 08/09/06 OK Agree "It is important to cover ALL Americans and lower costs by getting everyone into the risk pool. I have a friend who was bankrupted by her mother's cancer and who now is without coverage as she succumbs to Alzheimer's. Having said that, I think the most important step listed here is that there must be coverage for ALL Americans. This is, in my mind, a matter of security, productivity and justice." Agree I am on the board of a non-profit providing free medical care for the needy (with no means testing required). I am disturbed by the difficulty the staff seems to have in determining what other services are available in our city and that there is no incentive for them to cooperate to provide better health care across the area and across the populations needing assistance. Disagree "* I disagree with this only because I think it doesn't go far enough to include the private sector. Saying this would control costs ""across the entire health care system"" is not sufficient. I would like to see more information available on ""evidence-based best practices"", electronic medical record systems, reduction of fraud and waste, consumer information and disease prevention/health promotion be promoted and required across the spectrum of public and private health care in this country. But, assuming that the health care system in the U.S. will continue to be a mix of public and private, this recommendation does not go far enough. I am particularly concerned about fraud and waste in the insurance industry itself." Agree no comment on this one. I agree with this recommendation. Agree "I am not sure how this is different from the first part of the first recommendation. If all Americans had affordable health care, wouldn't it go a long way to ensuring that no one in America would suffer financially during illness or due to an accident? I think this should be the primary recommendation, rather than being offered as a lower priority." Agree "* I think that the health care system in this country will continue to be a mix of public and private solutions. In looking at the percentage of our GDP spent on health care in comparison to every other industrialized nation, it seems that we already have enough money in circulation in the health care economy. It is a matter of how these dollars are spent. I would like to see a system that is making better use of our money. The key will be ensuring that all Americans are in the pool, that it is affordable to all, that there are incentives for healty behaviors, and that profits go to improving health care." "I'd like to see a stronger statement about preventive services and some incentives for healthy behaviors (excercise, weight management, smoking cessation, etc.) In the long run, we could save at least some of the cost of end-of-life care by making more emphasis on health behaviors." 29835 08/09/06 KS Agree Agree Agree We need to coordinate the purchase of prescription drugs in an effort to collectively lower the cost of medications. Agree Agree No response 29837 08/09/06 IL Agree "our goverment should understand that a healthy individual is a productive individual, and we all should have the right to health care." Agree "fqhc are wonderful,but the problem is that they are not many the one that do exsist are over crowed,long wait times there should be an insentive for the doctors to work in fqhc and monies to expand the exsisting fqch so they would be able to offer specialty care,labs,xrays so they patient don't need to run to emergency rooms and run up outragoues bills" Agree Agree Agree Agree sure why not in the long run the benifit is for us and our children if we contribute to the presidental campain by one dollar and we get no benifit in that in the long run why could we not contribute a bit more and have all the benifits..... advocate this from the highest mountain with our good health we have a possiblity to reach the moon but now a days prevention is out of our reach and we let things go until sometimes it to late and the cost sometimes leaves us penny less but when you can't afford prevention the sad reality is that we will be doomed for poor health care for our people in our great land of america. 29838 08/09/06 NY Disagree "I do not trust a ""private"" national program to protect AMericans from high out-of-pocket health care costs. A public program is a better idea." Disagree "The general ideas in this recommendation are fine but once again I object to any private group poarticipating. Our experience with HMOs and MCOs has shown clearly that private groups are ""for profit"" and eat up the money needed to provide health care." Agree Disagree I agree with the general comments in this recommendation with the exception of the use of private programs. Agree Agree 29839 08/09/06 MA Agree I believe that any solutioni to provide cov'g for all Americans needs to include the public and private sectors. I am awaiting the outcome of the plan to be implemented in Massachusetts and believe that it may very well work effectively to meet all your recommendations and that IT could serve as a template to accomplish this and other recommendations you've made. Disagree "* I do not believe that the federal gov't is capable of accomplishing this initiative and I do not agree with the concept put forth here. This recommendation will ensure at least a two-tier system of health care for Americans: the have's and the have-not's. I suggest that you consider meeting the needs of ""vulnerable populations"" just as the needs of other populations are met. They do not deserve less and I know from experience with the current gov't programs that this ""vulnerable population"" receives less quality and quantity of ""care"". I read your recommendation as one that will expand the gov'ts role in the provision of health ""services"" that are already too burdensome on taxpayers and ineffective in many cases. There is EXTREME beaurocracy involved in any gov't program or whenever the federal gov't is involved. I say, NO, NO, NO to this recommendation. Additionally, the cost of administering such a program will, I guarantee, cost more than any benefit derived. There is no need for ""intergrated community " Disagree "* The federally-funded health programs currently existing fail to provide ""consumer-usable information about health care services"". Just look at Medicare Part D and I rest my case. It is absurd to think that the federal gov't can ""promote efforts to imporve quality of care and efficiency"". The existing federal programs are not efficient at all. The regulations that would evolve to supposedly ""improve quality of care and efficiency"" would cost excessive amounts to develop and would not be effective. We have seen attempts at the federal level fail time and time again. I, personally, do not want anyone at the federal level to have access to my medical record for any reason and I know that this provision will have anyone and everyone gaining access to ppl's records. The gov't is not at all effective at reducing ""fraud and waste"" in anything." Agree "* I think that the words ""the kind of care they want for last days"" is an imperative in incorporating this recommendation into any final ""plan"". Choice is critical. I agree that dignity in dying is essential and that ppl need to be better informed, and the process simplified, relative to making end of life wishes known in advance of such a situation arising. This is the solution...enable Americans to make these decisions known and inform the public better about the need to do so. This ought not to have to involve an attorney or be done upon admission to a hospital. There needs to be broad access to the necessary documents that can easily be filled out to achieve this recommendation." Agree "While I agree, I am wondering what is and who will detemine what are ""core health care services"". I think that all Americans ought to have equal access to all available health care services, not just ""core health care services""." Disagree "* I will again refer to the Massachusetts system that will be put in place in 2007. I do not agree that increases in income tax ought to be proffered as an option to financing ""universal"" coverage. Also, I do not agree with the ""universal"" coverage as it has been presented in the past and wonder about the reference made to it, here. My suggestion for some means of funding will be viewed as radical. I see it as being sensible and realistic. It will necessitate comprehensive change in gov't policy, however. We must accept that illicit drug use is inevitable. MUCH financing for rehabilitative treatment and treatment for illnesses related to such drug use could be obtained by taxing what are now illegal drugs to the hilt. There would be all the money that now goes to enforcing a totally failed program administered thru the DEA available, specifically, to pay for rehab and treatment programs to a population that will use illicit drugs whether legal or illegal. To fully explain my position so that it is not just t" "* I do not agree with the concept or implementation of any policy that establishes a ""core"" benefit package for all Americans. Reading the means by which such would be developed further entrenches me in my position in opposition of such a policy...it is discriminatory and will be costly due to court challenges, to begin with. I think this is an atrocious proposition and I reinterate that all Americans are entitled to all available treatment for all health related illnesses dependent only on their choice to accept or refuse such treatments." "* I wish to reiterate that I believe the Massachusetts plan has much potential to accomplish all that the commission wishes to accomoplish. It may be as simple as using this model at the federal level, even if it needs some ""tweeking"" once we see how it works/doesn't work. I happen to think it will be fair and work for all residents of Massachusetts and could be the solution model for all you are trying to achieve sans the ""core health services"" which would be included anyway, but would not be a provision directed only to a particular population." 29840 08/09/06 SC Agree Disagree "* The risk of diluting the strength of programs already established and performing well and making significant steps towards further improvement will occur when programs like FQHC's are ""MODIFIED"" to resemble the status quo, losing the community input that is so valuable to the on-going success of the programs. The evidence is demonstrated by the very actions that you take now to reconfigure the conventional practice of medicine in this country. Community input is what keeps one in contact with the real issues that affect the population. " Agree Agree Agree Agree 29841 08/09/06 KY Disagree "I disagree with this completely. Each person must take personal responsibiity for thier actions. I do beleive that access is importnat and I beleive in local organizations helping those that cannot afford coverage. We do not need this kind of legislation, at all...even though it might feel good to say everyone should get free coverage. " No response Disagree "The federal govenerment is not the place to expect or implement these kind of initiatives. Sounds good, feels good, but bad idea. " Disagree This is being done now. Disagree "Forced enrollment is not a good idea. Helping people is a good idea. Your agenda is well intended, but the consequenses have other implications. We do not need another welfare plan. Private sector and local communiites should deal with the issue of those in need, not from the federal level. " No response 29842 08/09/06 CA Agree "It is important that Americans are protected from very high health care costs, but this recommendation is far too vague. It is a worthy goal, but this tells us nothing about the steps to get there. What we should focus on is reducing the overhead costs for private insurance companies such as the paperpushing middlemen and the inflated salaries of the CEOs. By cutting costs at the insurance companies we can actually make the desired coverage affordable." Disagree "* Supporting health networks is important and of course I agree that we should increase the support, but I do not feel this recommendation hits the appropriate point. The goal is not to create more jobs for middle managers to write reports about how the community is functioning and to tell a random boss in Washington about their work; the goal is to improve health care. We should improve health care by making preventive medicine available to every single citizen. Too many people are walking into emergency rooms as their first destination in the medical world, and this must stop. We must allow people to seek and receive preventive treatment in order to cut costs and keep the population healthy." Agree This is a good recommendation but it can only work if funds are provided by the government. We must prioritize properly; money spent on the war in Iraq is wasted money that should be spent on the health care system. There is no reason for Americans to die overseas at great expense when we could easily save Americans living here with little expense. Agree "This is an appropriate recommendation, but I suggest also including the option for euthanasia. Oregon has an excellent policy that could be used as the model for the entire country. It has not been abused and has helped many individuals and their families deal with the intense pain of lethal diseases." Agree "This is the most important statement on this page. All Americans indeed must have affordable health care, and we should do it by promoting efficiency, reducing fraud and insurance company CEO pay, and vastly increasing preventive medicine." Agree "We must cut profits at insurance companies. It is clear that the system right now is not optimal, and it is obvious that insurance companies are taking advantage of the common person. The government must take a far more active role in controlling health care. We must reduce our military spending and transfer that money to health care. The military is incredibly wasteful and the healthcare system would benefit greatly from even a small percent of their budget." There must also be a way to enforce this core package. 29848 08/09/06 OH Disagree "* These statements are not specific enough: we must have a system with comprehensive benefits for all--not a two tiered system. (Except that elective surgery should be covered by those who can afford it.)Universal health care should cover preventive care, acute and chronic health care. It should universal and cover immigrants; their contribution to our society is important; should they not be treated for infectious diseases or other illnesses, we will all suffer with greater costs when their health requires emergency care. We could cover everyone with comprehensive health care and save money if our system were universal, non-employer based and government run, stopping the high administrative costs and profits of HMO's and pharmaceutical companies." Agree A government run program will save on administrative and current high profits of HMO's and pharmaceutical companies. Agree "We need to take health care out of the business arena and see it for what it is--a right and responsibility that this richest of all countries in the world is obligated to provide all of its residents in an efficient, quality, cost-effective manner. We need to enhance the National Health Service Corps for doctors, nurses, social workers, dentists to get loan forgiveness for service to our people, so that they can afford to go into the medical field." Agree There needs to be more options for people--for health care in the home and hospice care for all those in need. This could be supported with training dollars and grants from the federal government. Agree "No two-tiered system but a universal system which provides quality, accessible health care to all in America is what our goal should be." Agree "Though many of us, including me, are willing to pay some more taxes to assure universal health care, this is affordable now if we would not support the high administrative costs of HMO's, pharmaceutical companies now profiting from providing us with health care." "Mental and dental health care are extremely important to the well-being of all of us and should certainly be part of the core package as should preventive, acute, and chronic care." I hope that we can implement this program during my lifetime. I remember testifying for National Health Care in the early l970's before Congressman Vanik's committee. Let's move on this and not just meet and talk. 29849 08/09/06 VA Agree Agree Agree Agree Agree "I'm concerned as to what is meant by ""those in need"" and how it is determined. I would certainly not base it solely on IRS records as unreported income could be quite high in some areas of the country. We must address the determination of need in a rational manner as I've seen too many people be eligible for low college assistance, etc. but have two homes and several cars in a business name. " Agree "Full coverage will not be cheap but I believe it is the responsibility of government and a close study of the German system, public/private may be a good example." "Although I agree with this recommendation we must remember that in the European systems many services, especially surgery, is more selective and for those people over a certain age and without private insurance or financial capability the surgery is not performed." "It's not a free ride and if we want a good and fair system we all, all, all, must pay for it. " 29851 08/09/06 NY No response "* While agreeing with the broad objectives of the recommendation, I draw back from the unexpressed implication that something short of a NATIONAL plan that protects EVERYONE may ultimately get approaced. One aspect of the national plan that has been so far overlooked, I feel, is that besides saving healthcare consumers the MONEY they now spend on myriad middlepersons like insurance companies and medical billing personnel, it would save them the TIME it takes to select carriers and to negotiate carriers' diverse contractual practices, and spare them the STRESS of these tasks and of doing battle at times with insurance carriers and medical billers. Thus, the NATIONAL, UNIFIED system would save healthcare consumers MONEY and TIME, and spare them STRESS. As a human being, I appreciate all three (3) benefits; as a psychologist I especially appreciate the third (3rd)! " No response No response No response No response No response 29854 08/09/06 TX Agree Agree Agree Agree Agree Agree 29856 08/09/06 CO Agree "It's not just the poor who need help paying for health care. Costs have become so high for both insurance and out-of-pocket expenses, that many in the middle class also struggle to pay premiums and expenses due to high deductibles. " Agree Agree "* There's no question that electronic based record keeping will improve efficiency and should reduce costs. Also not every hospital needs to have the most up-to-date and expensive equipment. There could be regional centers that provide lab tests, MRIs, CAT scans etc. Lots of businesses operate on an efficient, centralized supply and distribution system. Somehow this needs to happen with medical providers. Which is why I distrust the private sector to do it. In this instance I think competetion breeds inefficiency and high costs." Agree "Since this group of people use 22% of health care dollars, it is imparative that we as a society deal with this issue both sensitively and realistically. The terminally ill patient's comfort and wishes should be a priority along with an acknowledgement of the limits of medical science. We cannot continue to spend millions of dollars on patients who have a very low chance of recovery, while many other people have little or no access to health care. " Agree It should be a national priority. Agree "It seems to me that fairest, least complicated way to fund an affordable, accessible health care system for everyone is through an income tax deduction or a value-added tax. How about a 5% tax on every soft drink sold in America?" "Above all, a successful health care system should be based on the overall health and wellbeing of society and it's individual members. I don't see that the primary goals of a for-profit health care industry are particularly compatible with the goals of a universally affordable, accessible, high-quality, efficient, compassionate, patient-centered health care delivery system." 29858 08/09/06 FL Agree Agree Agree Agree Agree Agree "Heath care is a basic right. We are paying for ""national health care"" right now, with inflated premiums, we just aren't getting basic, national heath care. We need it." 29859 08/09/06 WA Agree Agree Agree Agree Agree Agree 29860 08/09/06 OR Agree Disagree "* everything sounds good except ""expanding and modifying the Federal Qualified Health Center concept"" Community Health Centers are THE MODEL to emulate!!!!! Because of their community board of directors, they are uniquely positioned to form integrated networks of health carein their communities. They have demonstrated over and over how it's done and other providers have proven to be the exeception rather than the rule. Other providers should be held to this ideal partnership example rather than diluting the effective work of CHCs." Agree Agree Agree Agree 29862 08/09/06 NY Agree "I do think that the patient's physician should be the one to recommend the medical necessity - not a panel, and certainly not pharmaceutical companies. Patients should also have the right to choose their doctors." Agree Agree Agree "It should be a person's choice as to where they want to spend their last days - home, hospital, nursing home, hospice, wherever THEY choose." Agree "The above statement stamds regarding the right to choose your own doctor and that you and your doctor decide what is the best type of treatment, where this treatment should take place, etc. - not some univolved panel or a pharmaceutical company with access to the decision makers through lobbying and the money that goes along with it. " Agree I also believe that eye care should be included. "PLEASE keep health care out of the hands of the lobbyists, pharmaceutical companies, and other big business. Put it back in the hands of the physician and the patient." 29863 08/09/06 TX Agree I think this would best be achieved by a public program with it's main interest in public good over profits Agree "I think the federal government should not interfere with local, public community clinics unless the need arises. They could help with community clinics that request help, but stand back if clinics don't need and/or request federal help. It could function by setting recommendations, but like the saying goes, if it ain't broke, don't fix it. Some regional and state clinics will need less help and guidance than others." Agree "I think we should investigate a single-payer system, where each citizen puts in a certain amount of money- based on age, health, income, etc and receives the care they need." Agree Agree "I agree 100%. It should be considered a right to have high quality, low-cost health care if you are a member of this society. This should be our goal as the leading country in the world." Agree "Take money from the Army, Navy and Department of Defense. Stop spending money in places like Afganistan and Iraq and spend it here. Stop buying million dollar war machines and help all Americans have high-quality healthcare." "* We need to vastly improve our mental healthcare facilities. People who have mental and emotional disorders who are well-off financially can afford private care, those who are poor and have mental problems cannot, and they end up living off the rest of us in one form or another; all too often locked in a jail or prison (which is very costly to taxpayers). We should treat these people as they should be- as patients, not as criminals. It is our fault if we allow them to go through life without proper care and then lock them up if they commit a crime. It would be nice for the federal government to provide for basic dental health, but many things in the dental field are cosmetic, and not required." 29864 08/09/06 WA Agree "Thisprogram shouldbe public, not private." Agree "This is a stopgap, and will not eliminate the waste and suffering of the atomized, insurance company-driven health care system we are burdened with today. That said, it is better than nothing." Agree "I strongly agree with this, WITH the understandng that this is a transitional step towards a single-payer national health insurance program." Agree "As a disabled person, I find the bias toward insittutional care of the present system to be a form of discrimination. I strongly agree with this recommendation," Agree This must be accomplished AS SOON AS POSSIBLE. By 2012 at the latest. Agree "financing must be progressive: ie, based on ability to pay, not on health status." Single-payer health insurance would go far to restore the compativeness of american manufacturing. 29865 08/09/06 FL Agree I believe that the program should be publicly run as gross profiteering has resulted from our current private system. Agree "Same coverage, Everyone... fairest way to go!" Agree Agree Agree All Americans should have the same access to healthcare the Europeans do! We currently pay much more and get much less Agree "Even if my taxes must rise, this is an investment that is worth making!" Major medical is an absolute must! It is time to even the class struggle and save businesses the high costs associated with healthcare. It is cheaper to run a public healthcare system than to run a private one due to gross profiteering by private providers! Try living without health insurance for 3 years and paying 3 emergency room bills in full like I did! Then you'll realize the value of healthcare! 29866 08/09/06 AZ Agree We need to put a lid on how much money the health industry charges. Agree Stop illegal imigrants from using our health care system Agree Agree Agree make the lollygagers like Walmart pay there share! Agree Get er done. 29867 08/09/06 IL Agree "My company (Kroger) is trying to force a insurance change that has a $2000 deductable for each person and then just pay 80% after that. This is a significant reduction in benifits that I as a Lower middle income person cannot afford, plus there is no raise and I have to pay for part of my insurance." Agree Agree Agree Agree "We need to be able to have preventative care as a routine paid for expense, such as Mamograms, colonoscopies, blood tests for Prostrate and other risks paid for every six months, or whenever practical." Agree 29868 08/09/06 UT Disagree "* I do agree with the majority of this recommendation, however, the issue of coverage for all Americans concerns me. I don't think that those who do not contribute, and have a high usage level, should be able to reap those same benefits as those who are in the every day working class, paying premium out there ears. I am also concerned that many of those who are not contributing are those who have all of the benefits of healthcare, however, are either here illegally and, therefore, do not contribute through the correct channels, or those who simply refuse to take responsibility for the cost of their own healthcare." Agree I agree that we need to expand qualified health care into all areas where care is needed. Agree "I do agree with this recommendation. However, I wonder how many people will be affected by this recommendation, if it is done only through the federally-funded health programs." Agree "I agree that with this recommendation, to a point. We also have to look at what is feasible. I agree that it is important to honor the choices made by those with advanced incurable conditions, as well as those of the family. However, these choices have to be within a span of what is reasonable for the specific community. " Disagree "* This is a difficult subject for me, because, yes, ideally, everyone would have the coverage they need, without financial endangerment. But how? This recommendation does not address what channels would be used. Are we talking federally-funded, mandated coverage? Then I say, no thank you. Are we talking only basic services being covered universally? Then, again, I have to say, no thank you. The consumer will become complacent and we will have people without sufficient coverage in the hospitals, not able to pay for the services rendered. The level of care we receive will drop dramatically and we will end up like other countries practicing this theory, without the resources available to make the advancements and give the treatment necessary. " Disagree "* This is a very difficult subject. However, there is a solution. Much of it, I believe, lies in consumer and provider education. How much is wasted in ineffective treatment (oh, let's say 45%)? The consumer has to be willing to give more. If someone wants a service, they have to be willing to pay for it. QHDHP are a great example of this - one has catostrophic coverage, but is responsible for their day-to-day doctor visits and medications. It is a difficult first step, but worth the initial heartburn. " Would this not limit our access to the type of services available now? I am concerned that this type of attitude would not allow for the type of care that many now receive and need. 29869 08/09/06 CA Agree "Disengage health insurance from employment, so all employers can compete on equal basis with countries around the world who have government health insurance. Also, workers out of work like me would be covered. Thank you." Agree I think the federal government should be concerned with health care in the form of administering a nationwide universal system like Medicare for all. Agree "Take away the 30% profit margin, and the high malpractice premiums, and give fewer invasive tests, vaccinations and drugs which only hurt us." Agree Concentrate on home health nursing instead of nursing homes. Agree "Like public education, health care should be available to all, regardless of employment." Agree "Close the corporate and wealthy loop holes, have the people pay their fair share of taxes, and there would not be need for any higher taxes." I think core hospital insurance with use of low-cost clinics is much cheaper than the high premiums we pay. Nonprofit HMOs would also be better than for-profit groups. "If this is the richest country in the world, why don't our rich share with the middle class? Are we also the greediest country in the world? We need to bring back our common values and the common good. Thank you." 29870 08/09/06 NJ Agree "For the plan to work, there must be NO allowance made for any person illegally here in this country: those needing health care found to be illegal must be removed from the healthcare system and shipped to their country of origin, regardless of the extent of illness/injury. This is the only way for our healthcare system to remain solvent, universal or otherwise!" Agree "Healthcare-for-all-Americans is a national security issue: our citizens of all ages must be physically and mentally fit to combat terrorists from all distances, be they 1000 miles away or right on one's doorstep. Those who are fat must be leaner and meaner and all who suffer from degenerative illnesses MUST have drugs necessary to prolong their functional lifespan, because the next time terrorists ataack, it won't be by way of the hard target, but the softer ones among US." Agree "The closer we get to a single-payer system for healthcare, including prescription medication, fewer opportunities for fraud and waste will result. For one thing, we'll all be ""on the same page"" so future fraud will be easy to spot. " Agree "For those of US who have reached the end of life beyond recovery from accepted medical practices, wherever possible, three choices should be given eaqch patient: participation in experimental clinical trials, procedures and drugs that can work to reduce pain, REGARDLESS OF THE EXTENT THEY ARE ABUSED OUTSIDE OF THE MEDICAL SETTING, and/or humane termination with monetary benefits to survivor(s) for not taxing the system through prologation of agony. " Agree "Once again, the participants in affordable healthcare MUST exclusively be American citizens: you're born here, you get a social security number or you were allowed into this country by accepted commercial/government conveyance, you're in. Brought here against your will: patched up and sent back. Illegally here by choice: NOTHING!" Agree "This doesn't go far enough! Corporations that sell food to Americans must be held accountable for the things they put in their products that addict our citizens to bad food and ruin the collective quality-of-life for our society. Those who would fatten US or package what we eat or distribute what we eat under unhealthy conditions are terrorists, and deserve to be executed - their assets seized by the government to pay for the harm wrought upon US all!" "However, it should be made clear to the providers of healthcare AND DRUGS, especially, that they play by the rules of the regulators - not the other way around! Those who run afoul of the rules do so at their physical and financial peril!" "With all this talk about the morality of stem cell research, I offer this modest proposal: All adults requiring medical care should be given whatever information there is on just how the treatments and drugs proposed for them to receive came about. Those who feel it is immoral for them to have such treatments because they find heir origins ""barbaric"" can choose to die by lethal injection! End of story!" 29871 08/09/06 CA No response No response No response Agree Agree "There should be universal, single-payer healthcare for all Americans as is laid out in Conyers' HR 676." No response 29872 08/09/06 CA Agree "Far beyond that, medical care and health coverage should be regarded as national endeavor, with any program being viewed in a comprehensive way, and not as a 'bridge' between those who can afford to pay for their own coverage." No response No response No response Disagree "* All Americans should be guaranteed affordable, quality health care. It should be a law that all American residents have access to health care coverage, regardless of income, age, job status, health. Any real reform cannot be incremental, but must be fundamental. Attempting to shift the costs of health care on to families and individuals by appealing to some ""consumer-driven"" scheme does nothing to really solve the problem. Health care in this country is prohibitively expensive because it has been privatized. We have one of the, if not the, highest per cap spending on health care, and one of the worst records amongst industrialized nations in terms of providing health care to all." Agree "* Financing must be equitable, and must come from all--employers, government and individuals--with each paying a fair share. We need a system-wide mechanism for containing costs rather than shifting them on to families. Public funding mechanisms must be a central part of the financing and cost-containment structure. Use this country's Medicare program--or any country's similar public program--as the model. Public sector programs can and do provide quality care, cost containment, and allow people to choose their providers. The idea that public funded care necessarily limits choice is ridiculous and incorrect. The real causes of waste and high prices must be targeted, and these are related to the role played by private insurance and for-profit medical providers. There is a reason why other countries have far more just and far less expsensive health care available--they have single payer systems in which health care is not held hostage to corporate profit. " "* All American residents should have acdess to a set of core health care services across the continuum of care throughout their lifespan. Cores services must include preventive services, acute services, and patient education. Catastrophic coverage may help save families from financial ruin, but it is not the solution. The only solution is comprehensive medical coverage. Aside from ensuring that people have access to the care that they need, there is financial sense to providing preventive care as a core service: it saves money in the long run if fewer people end up needing acute care." 29873 08/09/06 MT Agree Agree Agree Agree Agree Agree Eliminate the insurance middle-man. We don't need him and it just increases costs. 29874 08/09/06 MO Agree Agree Agree Agree Agree Agree 29875 08/09/06 NY Agree "The difficulty will be identifying what basic medical coverage for all should include. If any and all are included then we cannot afford it. The argument that the wealthy will have access to 'better' care is a fallacial argument for this will always be the case, and it brings us to thequestion of what is basic medical care." Disagree The level of beauracracy this entails along with the complex regulations will make this ripe for fraud and wasteful use of money. Agree The federal programs listed above should be integrated to eliminate the beauracracy inherent to all. One system that manages all of those programs as subsets. The WORST solution would be the creation of just another level of beauracracy above those programs instead of combining them and eliminating much of the management waste. Disagree "* I agree is principle, but the vagueness of the recommendation ie ""expert consensus, and..."" will undoubtedly cause major issues. When a person is being provided service paid for by the taxpayer the choices must be limited or the cost of services and implementation will ultimately fail the system. I support paying for others healthcare, but with that the people receiving the services do not get whatever they want. I want the police to sit out in front of my house everyday and noght but that can't happen. If I want to, I will pay for it out of pocket. That is the price of public services, limited options. " Agree "Yes. A means-tested system instead of an all/nothing would be appropriate. For those who get private insurance then they will always have the option of using that extra insurance or the means-tested government program. The destitute will pay nothing for the service, the wealthy will have a higher co-pay. Those who can afford private insurance will get it instead of paying the high co-pay." Agree "* As stated above it should be means tested as point of sale. All care should be taken to NOT using regular tax money to pay for the services, First and foremost would be to revamp the present programs, VA, medicare etc... to elimiate waste, fraud and beauracracy to fund the national health care intitiative. Second would be to incorporate the means tested co-pays for services to reduce unneeded use of services and to generate some funds to pay for others. LASTLY and only if necessary would be the use of any taxes to pay for the system. There is already lots of money collected through medicare taxes. Use it wisely. Oh, elected and appointed goverment servants should be eligible for the basic means tested program only. Private insurance through BCBS for example should not be footed by the taxpayer. They can purchase that on their own if they wish." "I agree in principle, the problem I foresee is the creation of political appointees as favors. By defining it as non-partisan already admits the infiltration of the democrats and republicans to use it as a political pawn. Any and all means should be employed to remove government employees, especially politicians from participating in the selection of this group. Unfortunately I see this group as the most important facet of the system and easily the most corruptable" "means-tested, means-tested, means-tested. Did I get my point across? Take a look at what Taiwan has created for an idea of where to begin." 29876 08/09/06 KY Agree "I agree, however I would prefer a more comprehensive approach such as Rep Kucinich's Enhanced Medicare For All bill." Agree "Any progress is good so I don't oppose this plan. However, I would prefer to lock out the private sector as much as possible." Agree "I agree, however I would prefer a more comprehensive approach such as Rep Kucinich's Enhanced Medicare For All bill." Agree Agree Agree "Redirect resources currently wasted on the inefficient market-based system, and put the money into Rep Kucinich's Enhanced Medicare For All plan." The benefits must be very generous. 29877 08/09/06 IN Agree Agree Agree Agree Agree Agree "I wanted to save my comments to the last; (because they apply to *all of the recommendations above!) ""Health care"" MUST NOT INCLUDE: 1. ARTIFICIAL Birth Control; 2. Abortion; OR 3. ""Euthanasia""! The last is in quotes because the word literally means ""good death""; when, in fact, it's just ""putting someone out of SOCIETY'S misery""*!) " 29878 08/09/06 PA Agree No response No response No response Agree Look closer at the Canadian and Scandinavian countries. Models for our health care already exist. No response 29879 08/09/06 CA Agree Single payer health care is long overdue! Agree Single payer health care is long overdue! Agree Single payer health care is long overdue! Agree Single payer health care is long overdue! Agree Single payer health care is long overdue! Agree Single payer health care is long overdue! Single payer health care is long overdue! Yes. Single payer health care is long overdue! 29880 08/09/06 CA Agree No response Agree No response Agree I cannot agree more strongly with the need for everyone in America to have health care that is not dependant on ability to pay. Other nations cover evryone with better patient outcomes for half the cost or less. We must also do so. Agree "When advertising budgets and corporate overhead, including excessive excutive salaries, are eliminated the dollars are there for coverage for all." 29881 08/09/06 IL Agree Agree Agree Agree Agree Agree "I am a family physician who provides primary health care to many uninsured, vulnerable, low-income, and poor people living in Chicago. It is way past time to create a real system of accessible, comprehensive health care for ALL people, not just a ""safety net"" to catch those who fall out of health care. We need real change that shows that the U.S. believes in health care as a fundamental right for its people." 29883 08/09/06 OH Agree No response No response No response No response No response Require all levels of medical education to be unrestricted in enrolment. NO MORE CLOSED SHOP FOR DOCTORS! MORE DOCTORS MEANS LOWER PRICED HEALTH CARE. 29884 08/09/06 TX Agree "The fact that we do not have a system as good as Canada's is a national disgrace, and travesty, an embarrassment, and a CRIME AGAINST THE AMERICAN PEOPLE. We now lose Jobs and factories to Canada because we don't have a system like theirs. We are supposed to be this powerful, wealthy nation.......what I see is a nation descending into the third world standard of living." Disagree "This is too complicated. We need a system like Canada's where ALL CITIZENS GET 100% FREE HEALTHCARE paid for by our taxes, which are now going into the pockets of Hallibuton and Exxon." Agree Agree Agree "Not just affordable, but FREE FREEE FREEEEEEE Paid for by TAXES" Agree 29886 08/09/06 AL Agree The pharmaceutical companies and inshurance companies in this country have WAY to much sway over our government. Boot out the lobbyists and get the corruption out of our government so we can start takeing care of the things that really matter. The American people. Agree As long as they cover lower middle class as well. Not just welfare cases and extremes of the spectrum. Give everyone a fair shake or no one. Agree Agree Agree Agree Financeing for public health care should be untouchable by the government or privet industry. To safeguard the system we must keep the powers that be from useing any budget set aside for health care as a surrogate bank for pork barrel projects as has happined with social security. The republicans are mired in religious and corporate corruption and are beyond salvation at this point. We need to rid ourselves of the influince of facist fanatics before we can rebuild this nation. 29887 08/09/06 CA Agree "* As a Union Trustee on a Taft-Hartley Health & Welfare Trust Fund, I know all too well that we cannot continue with the current healthcare system. It's been said that a total meltdown is coming within 7 years, but I believe that is an optimistic outlook, at best. We can and should adopt a Canadian-style model. For the current administration to completely ignore this crisis and instead further line the pockets of the pharmaceutical companies with its Part D fiasco, is just sickening. Let us commit to achieving universal healthcare within the next 4 years. " No response No response No response No response No response 29888 08/09/06 MO Agree Put price controls on drug companies. Plain and simple Agree Agree Agree Agree "Yes, but the wealthy companies in this country should pick up the extra cost. Not the tax payers" Agree Any company in the U.S. making more than 30 million a year should pay into a government health tax. The tax should be percentage based so that the more they make the more they pay. Also companies that move operations to third world countries to avoid paying a living wage should have the tax doubled. 29889 08/09/06 CO Agree "My healthcare needs should be covered no matter who I work for and should cover my needs even if I am between jobs. Other countries do it and it works, why should the US be like a 3rd world nation in this aspect?" Disagree I am a little concerned about the public/private part of this. I am hoping this is not a way for insurance industies to rake in more bucks at public expense. Agree This sounds good. Agree Sounds good Agree I think the nation needs something like this. Agree I would rather have my taxes go to setting up a healthcare system than for war or roads. "Consult with other countries to see how they run their sucessful healthcare systems. Look especially at the Scandinavian countries, France and Canada." 29891 08/09/06 NY Agree Agree "This number will only work if number one (guaranteeing against high costs) is first instated and stood by. People complain that we can't afford national health care in the USA-- but we can (like Europe) if (like Europe) we keep the costs regulated and low. Otherwise, the governemnt cannot and will not be able to afford it." Agree "Yes, efficiency is key. Get rid of all of the ""middle men."" I had socialized health care in Belgium for 5 years: The same doctor who examined me filled out my bill, took my cash and put it in the drawer, and gave me a receipt. No extra people needed for filing, billing, calling about billing, etc. The health care in Belgium was AWESOME. I never had to wait more than 3 days to see any doctor, any time, for any care." Agree Agree Duh. Agree 29894 08/09/06 IA Agree "I believe that financial protection is important but it must go beyond low income Americans. Often, low income families are already covered by state programs while the median income family must carry their entire burden. There must be something to assist when medical tragedy strikes middle income families. The best 80/20 or even 90/10 plan in the world will not adequately protect a median income family from debt and financial ruin when hospitalization becomes necessary." Agree Agree Agree Agree "All Americans should NOT have access to health coverage, they should HAVE health coverage, period." Agree Regulation of the insurance and pharmaceutical industries could lower costs substantially. This is a national crisis. There is no excuse for people going without medication or healthcare while these industries rake in record profits. I agree so long as the members of the group are equal in number to each respective group. Universal health coverage for everyone! 29895 08/09/06 AZ Agree If we are going to allow free trade (NATA) then I believe it should not be allowed that the pharmacuetical companies can restrict where or how we buy our prescriptions. This will cause a supply demand market economy leveling of the playing field. Prescription costs in America are way to high. BIG OIL and BIG pharmacutical companies are the ORGANIZED CRIME of today!!! Agree A network is deffinitly a better plan then say 'a' community hospital or patient center. I believe board doctors should be required to provide a certain amount of services to underqualified and underinsured persons or face tax penalties for not using thier abilities for the betterment of the community. Agree I think it should be taken a step farther and tax breaks should be offered to employees of or providers of survices that rise to exceed and keep standard a high level of efficiency and quality care. I believe this could be encentive to be proactive on the street level to make this happen. Disagree "I have had xperience with the system currently in place and it works. We should not invest are time, funding, and energy on making those terminal patients that are on thier last few months when there are persons not getting much needed care to make them able to be a productive citizen because of cost and availability." Agree This should have never been a question it should be a given. Agree The seems like a very vague statement!! A believe in this core benefit package. I do not believe the community should have to finance the care of health issues caused by aperson who has no regard for living a healthy life. To put shorter I do not want to pay for a lung transplant for someone who has smoked thier whole life knowing full well the risk. I work to hard and long for what little money I have to fund the expense caused by poor life choices. "* I amone of the lucky ones I have decent health care coverage. I have visited many doctors in the last 10-15 years that seemed to lack any functional working knowledge. I find so many doctors who are so book smart but have limited reality smarts. They so often just through Prprescriptions at an item because thier book told them to. I do not believe they have a real understanding of science and chemistry or the medical situations they are facing. We should not overfund a society of professionals whose only answer is to hand out the meds the journal tells them to. I believe stricter oversight and certification, maybe more frequent, of the professional medical field is necessary with maybe more tiered acredidation dogma." 29896 08/09/06 NC Agree "* I disagree, in part. I do not think there is any point in pursuing the possibility of acheiving universal coverage through private means (though I understand why doing so may be much more politically expedient.) If the democratic party is going to move forward, it needs to acknowledge that there are areas of our civic life that are NOT best managed by private entities. Our current mess of a health system is at least in part the result of allowing a system that should be driven by higher values to be driven by the rampant desire for profit. Affordable coverage for everyone? Or just the option for health insurance if you happen to have a spare $600+ a month for a family of four to pay for the coverage? With the high cost of health insurance today, it is not just low-income individuals who cannot affort insurance. I have spoken with numerous solidly middle class individuals who call themselves ""insurance poor"". " Agree Disagree "* Not that I disagree with the impulse as such to reduce waste and improve quality and ""efficiency"" of care. Notwithstanding, we are human beings, not ""perfect"", and therefore some degree of ""waste"" and ""inefficiency"" is ALWAYS going to be part of our systems. My concern here is that what seems to happen often when we try to eradicate waste from systems we end up creating a ridiculous number of rules and regulations that thwart the original intent of the system, ie. providing health care to people who need it. " Agree "Again, I disagree in part. We need to also build up the health professionals who work in these types of environment by acknowledging that is some ways end of life care is an art, not a science. " Agree Disagree "* Disagree in part. Again, I would be wary of too many rules and regulations in order to ensure that medical treatment is in line with ""evidence-based science and expert consensus."" How about letting the doctors who are trained to make these decisions, make them? How is it good public policy to have a bunch of untrained hacks or, even worse, trained doctors paid to reduce costs determining whether the medical treatment your doctor recommends is in-line with ""evidence-based science and expert consensus."" How about trusting doctors and patients to make these decisions?" 29898 08/09/06 TX Agree Health care should be universal and available. Agree Agree Agree Agree Agree Other countries have what we would call singer payer or free health care. The wealthiest nation in the world should do no less. 29899 08/09/06 GA Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" Agree "* I am a single parent of one and haven't had any insurance since 1991. I work part time to be able to be with my son because I think that is most important. My issue is that employers should be able to provide insurance to those of us whose hours per week don't add up to the required amount on a consistent basis. I have been with the same company for over a decade (a leading restaurant chain) and the only way we can get insurance (what they offer doesn't cover much..) is during open enrollment, offered once per year, and if we have been working an average of thirty hours or more per week consistently for a year. I earn too much to qualify for medicaid (around 800 per month, and that's including 200 for child support). There are so many other single mothers just like me wondering how we can make ends meet. I worry about what would happen to me if I ever got sick. Please take into consideration my situation, as it applies to so many. Isn't there a statistic that says something to the effect that around 40% of" 29900 08/09/06 IL Disagree i feel that this proposal does not go far enough because we simply needs universal health care thank you. Disagree we need a national network of community health organizations. Disagree create a universal health plan. Agree Agree Agree family health care needs a more comprehensive plan. 29901 08/09/06 FL Agree No response Agree No response Agree "Health care costs, housing costs and energy costs are going up. Everything is going up. Everything, that is, except our wages at the jobs that we work at. We need single-payer universal health care and we need to Congress to support Rep. John Conyers' Universal Health Care Act." Agree 29902 08/09/06 PA Agree This is a basic human right. Agree Agree My only reservation is many of these programs are being driven into the ground by the current administration. Are we talking about biasing programs on the current degraded VA for example or on what the VA was before Bush? Agree Agree "Again, this is a basic human right." Agree Coverage for mental health care is particularly important. 29903 08/09/06 AZ Disagree "I am always suspicious of Federally managed programs. In the past, they have always cost much more than the projected expenditure. Why not encourage maximum participation in health care IRA's? Some form of voluntary private major medicalinsurance could cover high out-of-pocket expenses." Disagree This sounds like a plan for top-down bureaucratic management. Why can't we have a market oriented health care system? Agree I would agree only if the programs were locally controlled and financed. My dissatifaction with my present HMO is that my choices of providers and facilities are strictly limited. Will this program increase my freedom of choice? Agree "Currently, much of Hospice care is financed by private donations. This should be encouraged. If Federal funding is increased, how will this affect the spiritual dimension of Hospice care? Will the church-state separation issue become a divisive factor?" Disagree "This carries the seeds of budget busting expenditures unless every receiver of medical care has to pay at least a nominal sum for services. Financial assistance programs must, of necessity, involve eligibility requirements. One result is that the receivers who are at the margin (don't quite qualify) apply pressure to liberalize the guidelines." Disagree "These are lofty goals, but are they realistic? I will resist any tax increase to finance a new or expanded program." "No private-public group will be independent as long as the Federal Government is paying the bills. Health care services will be administered under Federal ""guidelines"" (which are usually compulsory)." "I believe a free market based health care system would provide the highest quality care at the lowest cost. However, I realize this is never likely to happen in the current political climate." 29904 08/09/06 FL Agree Yes we need healthcare for all so let's keep the prssure on! Agree None Agree Agree Agree Agree 29905 08/09/06 FL Agree Why should only the rich have health care. Agree Agree Agree Agree Amen. Agree "Even if they got rid of Bush,I would Dance in the streets." 29906 08/09/06 CA Agree "However, i do not want these services to include illegal immigrants. People in California are suffering because illegal immigrants do not provide tax and still make use of services provided by tax dollars. The system needs to ensure that the funds provided are used to help citizens of this country first." Disagree I 'm not sure this job should be done at the federal level. Agree No response Agree I believe all _US citizens_ should have access to basic healthcare without cost. Both medical and dental. Agree but a smooth transition cannot be used to stymie or halt this change in the healthcare system. A set of timed stages and goals should be used to measure and ensure continous progress towards universal healthcare at a quick and steady pace. The inclusion of mental health care seems too abusable. Inclusions of mental health care should be minimal if at all. The sooner this gets done the sooner I can be healthy and better informed healthwise. 29907 08/09/06 KY Agree Agree Agree ...and promotion of a healthy lifestyle. Agree Agree Agree "How do you finance health care with ""sin"" tax, which is the very thing you're trying to reduce? " "Closely link has to be promoting a healthy work environment, which should be the responsibility of the employer." 29908 08/09/06 CA Agree Agree Agree Agree Agree Agree 29909 08/09/06 IN Agree "* Health care costs have hit an all-time high. Consequently, a fundamental human right is becoming increasingly unavailable to hard-working Americans and our families. Prescription drug prices have risen to obscene levels. We used to worry about sending our kids to college, and now we have to worry even more about our kids getting sick. Preventive conditions are turning into terminal illnesses because working class and middle-income Americans cannot afford routine health care visits. This national travesty will not be forgiven our elected officials until we see a national health care system. The time for change is now and working Americans are fed up. We are all sick and tired of being sick and tired. Make change, or we will." Agree "* Health care costs have hit an all-time high. Consequently, a fundamental human right is becoming increasingly unavailable to hard-working Americans and our families. Prescription drug prices have risen to obscene levels. We used to worry about sending our kids to college, and now we have to worry even more about our kids getting sick. Preventive conditions are turning into terminal illnesses because working class and middle-income Americans cannot afford routine health care visits. This national travesty will not be forgiven our elected officials until we see a national health care system. The time for change is now and working Americans are fed up. We are all sick and tired of being sick and tired. Make change, or we will." Agree "* Health care costs have hit an all-time high. Consequently, a fundamental human right is becoming increasingly unavailable to hard-working Americans and our families. Prescription drug prices have risen to obscene levels. We used to worry about sending our kids to college, and now we have to worry even more about our kids getting sick. Preventive conditions are turning into terminal illnesses because working class and middle-income Americans cannot afford routine health care visits. This national travesty will not be forgiven our elected officials until we see a national health care system. The time for change is now and working Americans are fed up. We are all sick and tired of being sick and tired. Make change, or we will." Agree "* Health care costs have hit an all-time high. Consequently, a fundamental human right is becoming increasingly unavailable to hard-working Americans and our families. Prescription drug prices have risen to obscene levels. We used to worry about sending our kids to college, and now we have to worry even more about our kids getting sick. Preventive conditions are turning into terminal illnesses because working class and middle-income Americans cannot afford routine health care visits. This national travesty will not be forgiven our elected officials until we see a national health care system. The time for change is now and working Americans are fed up. We are all sick and tired of being sick and tired. Make change, or we will." Agree "* Health care costs have hit an all-time high. Consequently, a fundamental human right is becoming increasingly unavailable to hard-working Americans and our families. Prescription drug prices have risen to obscene levels. We used to worry about sending our kids to college, and now we have to worry even more about our kids getting sick. Preventive conditions are turning into terminal illnesses because working class and middle-income Americans cannot afford routine health care visits. This national travesty will not be forgiven our elected officials until we see a national health care system. The time for change is now and working Americans are fed up. We are all sick and tired of being sick and tired. Make change, or we will." Agree 29910 08/09/06 IN Agree I especially like the last point on fiancial protection for low income families. Speaking for my family it's a burden when I try doing things right and meeting my obligations and loose out in the end. No response No response No response Agree This recommendation echos everything I feel. Thank-you. No response Help us please. 29912 08/09/06 PA Agree Agree Agree Agree Agree Agree 29913 08/09/06 CA Agree Agree Agree Agree Agree Agree 29914 08/09/06 WA Agree "Keep it public, as much as possible, to increase the probability that more peoople will be served, and better served, for a long time." Agree see above Agree see above Agree (and I just began a new job this week as a hospice RN) Agree ablolutely! Agree "(see above). Public funding, though it sometimes seems cumbersome, is not as subject to losses related to corporate greed and changes in the market. We owe it to ourselves in this country to finally address this need. I believe that good health care is a right." "Don't give up until we have a well-funded, guaranteed, universal health coverage." 29916 08/09/06 OR Agree "All Universal/National Health Care proposals should include legislation providing for a regulated system for delivery, research and sales of all services and products related to a basic need. " Agree All comprehensive changes in the adoption of this type of program will require significant overlay of madated standards across the board. Agree Agree Agree Agree Layering of costs to the end user when one realizes that the patient is not the end user is useless. Rethinking the actual basis of who is the end recipient of this type of program is needed before it would eliminate the question of solvency. Look to private and public enterprise as the final beneficiary of the outcome. 29917 08/09/06 TN Agree Most of the health costs are totally over inflated anyway.Prescription drugs are a prime example. Agree Underpriviliged and elderly should be the first stage in a number changes to correct the health care problem. Agree Agree Agree Agree 29918 08/09/06 NC Agree Lets have single payer health insurance with co-pays small enough that bankruptcy is the only option. Agree Agree Save more money-have one program for all Single Payer. Agree Agree Agree Glad to see dental as part of the discussion. 29919 08/09/06 PA Agree oversight committee composed of union members knowledgable about health care Agree Agree Agree Agree Agree most if not all of these issues are dealt with in house bill 976 29920 08/09/06 NY Agree "The rising costs of medical care is based on a combination of insurance companies and their profits, malpractice insurance, private health care insurance,long-term health care,while at the same time both public health care programs are being cut such as Medicare and Medicaid." Agree Community based model healthcare for everyone enables everyone to have access. Agree This is truly only a first step. Until the goal of profit is removed from our healthcare system not much is going to change. I think physicians who agree to be part of the community based health care system should receive excellent renumeration those who don't will go it on their own and subject to substantial taxes on their profits. Agree Another move forward as far as dealing with the end of life process. Agree A single payer healthcare system would ideally bring a tremendous resolution to future expenses. Agree I agree with this perspective completely. Yes especially preventive care takes the view of prevention rather than letting things slide. 29921 08/09/06 FL Agree But high deductible plans will not keep people healthy so that they can prevent and detect serious conditions early. Agree These clinics need coherent funding -- chasing and monitoring dozens of grants is too complicated and costly administratively. Agree "The costs of medicines and supplies is so outrageous because they are controlled by private companies that make huge profits. As long as medical sales representatives make $300,000 a year and demand 100% mark-ups, health care will continue to be unaffordable. " No response Agree Agree Any additional tax burden should be placed on those who can afford it. The main problem with cost is that the government does not have the political will to reign in for-profit corporations. "If you need it for ""life, liberty and the pursuit of happiness"" it should be covered. " We must be careful not to perpetuate the two-tiered system with the rich getting better coverage than the poor. 29922 08/09/06 WA Agree "This has been needed for a long time.The suffering and pain that I have endured and seen in many people who are low income or in poverty is a disgrace.I am healthy person and have survived inspite of no insurance.Aged people, babies, children and health compromised people are at great risk and very much need this. " Agree I agree with this. I work in a Community Center and see many people with out access to health care. Agree I agree with this recommendation.Prevention is the biggest support for good health care.Good Health begins in our own communities. Agree I agree. Health care should begin in pregnancy and go through a life span of an individual regardless of income Agree I agree.Health Care should be accessable and available to all people with out fear of bills piling up that will put severe strain on them. Agree A system that includes all Americans is worth the wait. "Incomplete Health Care contributes to pain, suffering and often death." I am happy to know of these recommendations. 29923 08/10/06 WA Agree "Key here is two variables. First, how high is very high? What treatments and proceedures are excluded. For those with high incomes, a requirement that they obtain coverage or accept a penalty (loss of tax break? Higher deductable?)" Agree Agree "Sounds good in prinicple. Devil is in the details. Does someone really have a ""new"" idea that will ""reduce fraud and waste""? What is it? Who decides what is an ""evidence-based best practice"" and how does this differ from the current legal standard of care? What happens if there is not concensus on what is an ""evidence-based best practice""? " Agree Agree "Not only is this fair, it will make America more competative." Agree "* While additional revenue may be necessary, there is already much money (relatively more money than is spent per capita by several other industrialized nations) already dedicated to health care in America. What is needed is that it be redirected in a more efficent and rationalized way. (Without making a specific recommendation, I suggest the private companies that make their money ""brokering"" health care between consumers and providers add little ""value"" to the health care equation.) That said, a modest tax, paid proportionately by all, seems a fair way of ensuring the goals of universal coverage while potentially capping spraling costs for American industry." "This group should be truely independent, in a manner similar to the Federal Reserve Board. In addition, there will need to be a reasonable mechanism to resolve the list of covered treatment on the one hand, and the amount of money appropriated by Congress on the other." 29924 08/10/06 FL Agree "* There is no ideal solution. There is one thing, however, that needs to be addressed: Health care is a basic need and no luxury. Therefor most insurances should work as not-for-profit companies with tight oversight. Additional insurance can be available for people with extra wishes. The system should be unified from birth to death, i.e. remove all the complications of Medicaid, Medicare, Va, and so on. One system should do it even though the money comes from different sources (government for veterans, workers as part of their contributions, and so on). There should never be the question of who pays. That would make hospital admissions faster and better. The government has to tax employers for illegal immigrants as long as the gvernment does not enforce the laws and employers reap the benefits. For visitors from abroad there should be agreements with all countries to make sure visitors are covered and their home insurers pay. Again: KISS!!!" Agree "Health care is not a good field for business and competition. The capitalistic mantra should be eased and doctors should not be millionaires and nurses barely make a living. Everyone should earn a real living wage and specialists who are good deserve something extra. Medical institutions (like the hospital I work for) should not engage in prestige objects but serve their clients with functional, friendly but humble facilities. Keep cost under control. " Agree "* As humans we are quick to demand the best. But we should also learn to use old established practices that are good and cheap. Medication is to expensive. Prolonging life at any cost is not good practice. You may not believe it but the US banking system is enormously costly because everyone deals with paper cheques. That is medieval and should be replaced with the European system where cheques are history and electronic transfer (no internet, please!!) works beautifully. Patients should hace SmartCards (as in Europe) with their histories and ailments on record. The patient decides, which information will be released at the various places. What is needed, too, is a national, tamperproof ID card system which the ACLU stupidly fights teeth and nails. That way everything from health care to homeland security to common administrative operations would be facilitate, reduce fraud and waste and most importantly: errors of all sorts." Agree Agree Sounds to good to be true! If that will not be realised in the next few years I will move to Europe. Agree * I already commented on that above not knowing the question would be asked seperately. One thing bothers me te way it is now:people sell their home to be able to pay for medicine. That takes dignity away and a rich people should not allow that so that some CEOs cn ake hundreds of millions a year. Health care must not be tied to employment. Still employers should pay part of the cost so that working people have an incentive to work and not rely on welfare. The latter is a big problem costing employers and employees big sums to support the lazy. Unemployed people should eventually be comitted to community service to make up for their lack of payments. The government should line up peoples help like it is being done with jury duty. I gladly commit three days a month (free of charge) to help with this major project in any capacity I can be helpful. * As the USA is a nation of selling and shopping this project has to be sold to the people beyond party lines. It has to be accepted that rich people will growl. They should learn about social behaviour (not socialism) and not give donations to save taxes and further their own social standing. This is not about money aristocracy and recognition. This is about doing something good for everyone and make the nation proud of overcoming old cliches and move to a level that can serve as a role model for other nations. 29925 08/10/06 AL Agree I agree 100%. It's a shame that we supposedly live in the greatest country in the world and we are facing a health care crisis like we are facing. Agree Agree Agree Agree "Maybe if the leaders of America gave a shit, this would happen." Agree 29926 08/10/06 OR No response No response No response No response No response Agree "* For several years I have asked my representatives in Washington to push for a univeral health plan, Canadian style, without insurance companies or pharmacy corporations makeing decisions regarding patient's care or needs....it must be a one-tier program to prevent discrimination....alternative and Asian medicine must also be respected.I feel that if the profit motive were eliminated from insurance corporations etc. we could finance this program through taxes recovered from special exceptions made to those people and corporations whose special interests lobbyists push to feed off of the American people's inability to fight back for their fair health program without millions of dollars to finance their fight...." "I feel that if we canceled all health programs that our government provides for the administration, justice department, congress et al that we would get a suitable health program in a relatively short period." 29927 08/10/06 NC Agree "* The primary reason for Americans to be impoverished by health care costs is lack of insurance or/high insurance costs, and high out of pocket costs. Also people who are sick can lose their jobs and then they are stuck having to pay for their health care costs when they have cash flow problems. A universal health care program with a single payer - the US Government - modeled after the VA and Medicare systems (with the government able to negotiate the prices for prescription drugs) would work well. Those wo models provide better care at a lower cost than most private health care plans provide. It would solve the problem covering all Americans and provide protection against high out of pocket costs because all Americans would be elligible for it." Disagree "* public/private seems to be too focused on the current system of using public funds to help private medical businesses make a profit at the expense of health care accesss to lower income people. It ignores the fact that the VA and Medicare systems provide better quality health care at a lower cost simply because the medical insurance and pharmaceutical companies would not be as profitable. This places the wants of those two industries over the health care needs of poor, working and middle class Americans. " Agree "using the Medicare and VA systems is the best way to improve quality or care and efficiency, and to also improve access. " Agree "having family members who went through hospice at the end of their lives, but they had access to lots of money to pay for this - either through family assets or union-paid health insurance upon retirement, so it wasn't really a problem for them. But for me and my other family members, such end-of-life care would bankrupt them because it isn't paid for by their insurance." Agree "I don't like the part of the statement - everyone participates. It shoudl read that ""...everyone should be elligible,..."" - because when people participate - it sort of leaves open the possibility that people might have to pay to play, and they might have to pay more than they can afford." Agree "Efficiency can be improved by moving to having a single-payer plan for both medical care and prescription drug coverage. Taxes will have to pay for these costs and transitional costs as well, Taxes should not be dumped on working and middle class people through payroll taxes or personal imcome taxes - but other taxes like corporate taxes and taxes on upper level incomes should be reinstated to cover these costs. " vision care needs to be incorporated with this also 29928 08/10/06 MI Agree every one in the great usa should beable to go to bed at night and not worry about health care Agree lets get started count me in Agree lets get it done Agree lets start Agree lets start now Agree i want to be part of this lets start now i want to be part of this 29930 08/10/06 OH Agree Agree Agree Agree Agree Agree "a set amount such as 60.00 a year for each citizen to be paid monthly, quarterly or a direct deduct when filing taxes be required." "A program of this magnitude cannot work without a professional groupthat makes up a vast crossection of the health care industry serving as the steering committee forging policy and recommendations on a true, viable National Health Care plan." 29931 08/10/06 MI Agree Agree Agree Agree Agree Agree 29932 08/10/06 MO Agree "Having studied this issue for the past several year, I believe we need a single-payer health plan on the style of Canada, but we also need to fund it, like the Australians by a straight 5% (hypothetical) tax on income, with exceptions for the impoverished and non-working due to age or disablement." Agree "* Rural areas are the hardest hit for lack of health care, but mostly because of the poorly distributed resources of health care. Cities for instance have tons of MRI equipment, that rural hospitals can't afford. Also we need to open up and adequately fund our teaching facilities to train more American doctors. We often train foriegners to become doctors, who instead of returning to their home countries, choose to stay here and practice here. This is unfair to the U.S. citizen that helps fund their education in place of our own citizens and it is unfair to the country of origin of these foreign doctors. They also lose the chance to upgrade their medical personnel." Agree Information technology can streamline the actual costs of healthcare and eliminate a lot of administrative costs which have no benefit to the patient. Agree Agree In the richest country in the world no one should have to choose between life and bankruptcy. Agree "For what we spend now, we could cover every U.S. citizen without increases in funding, we just need to eliminate administration costs, fund more preventative care, and by doing so prevent the extreme costs that ER's incur through preventable early treatment and education." Hold the AMA accountable for policing their ranks. If malpractice insurance costs are being driven up by lawsuits then those doctors that repeatedly generate these suits through their incompetence should be stripped of their licenses. The AMA rarely does this. If they don't clean up their act then gov't should do it for them. We should be training more doctors and not limiting the number of med students when there are clearly shortages in rural areas. 29933 08/10/06 NE No response Agree Agree Agree Agree Agree "FINALY A HEALTH CARE REMEDY TO PREVENT THE WORKING MEN AND WOMEN OF THIS GREAT COUNTRY FROM FINANCIAL RUIN DUE TO RIDICULOUS COST OF MEDICAL CARE AND THE HIGH COST OF DYING. THANK YOU FOR YOUR EFFORTS ON THIS SERIOUS ISSUE, TOGETHER WE CAN MAKE THIS WORK FOR OUR FAMILIES AND THE FUTURE" 29934 08/10/06 PA Agree Agree Agree Agree Agree "* all americans should be gauranteed affordable heath coverage as well as quality health care. This should be public policy,established by law. It should be regaurdless of income level, health status, age, or job status. Incrumental change should not be acceptable. High deuctable plans and health savings accounts only shift the cost of health care to families under the guise of ""consumer driven health care"" schemes. Often they exclude needed services and ultimately do little to deal with the real causes of escallating health care costs." Agree "We need a system that provides affordable and equitable coverage where everyone pays their fair share, employers,government and individuals. Implement a system to contain costs. The medicare program could be used as a model on how the public sectr ccan insure all Americans keep costs managable and allow people to get health care from the provider of thier choosing" 29935 08/10/06 NY Agree "I believe that a government-run program providing affordable, cradle-to-grave universal health care is a human right that should be available to all citizens and immigrants in the United States." Agree Agree Agree "Every effort should be made to allow individuals and families to choose the type of care they desire in the last days, where it involves moving into a nursing home or staying at home." Agree "As a matter of public policy, the government should guarantee that everyone--citizens and immigrants--have affordable and comprehensive health care." Agree "The govenment-run health care system should be financed primarily through a tax on employers. A national system should provide affordable and equitable coverage. The financing could be modeled after the Social Security and Medicare systems, but employers should bear most of the responsibility for funding if that is done." "It is vital that we have an affordable and comprehensive national health care system with coverage for physical, mental and dental problems." 29936 08/10/06 NJ Agree "I'm self-employed, and my monthly healthcare insurance cost is the most onerous financial burden I bear except for my mortgage...and it eats up almost the same percentage of my monthly income. That doesn't even include all the out-of-pocket medical expenses I incur, which are also outrageous. And I don't even have to pay FAMILY coverage, as my daughter is covered by her father. Some relief would be much welcomed." Agree As long as such centers are adequately staffed. None of us needs to be sitting in crowded clinics for hours. Agree Agree Agree Amen. Agree "Yes, especially including dental. Good teeth care should NOT be a luxury." This can't come fast enough. Thank you for sharing the information so succinctly and thoroughly. 29937 08/10/06 AL Agree "It's very simple, everyone ought to have the opportunity and privilege to seek medical attention for whatever reason no matter what there financial situation is." Agree "I believe it's time for the federal government to step up and take an initiative to help the citizens of this country, like Canada has to help everyone have some type of health care." Agree Agree Agree Agree 29939 08/10/06 PA Agree No response "Before rendering an opinion, I would want to hear a lot more from the medical community concerning their views on this. The explanation above is loaded with buereaucratic jargon, but not a lot of substance." Agree Agree Agree Agree I am not a financial expert and cannot comment effectively on this. "I believe it is extremely important for scientific evidence to be acknowledged and adhered to as policy, not allowing it to be undermined by anyone's political agenda, i.e. the current outrageous stem cell research debacle. " 29941 08/10/06 MI Agree "* In a time when we are losing new businesses to Canada because of the high cost of health care programs, we have to know a change is necessary. Basic coverage for everyone would help both the individual and the big business. We hold a belief that the government can never run something cost-effectively, but it can't be that hard to do a better job than what is going on right now, and numerous studies have conclusively proven Canadians receive better medical care for less money. If basic medical coverage was provided by the government, they could force the prices for everything down, from prescriptions to procedures. Yes, taxes for everyone would go up, but businesses would be paying about the same, or possibly less in taxes for medical than they pay to an insurance company now. Right now businesses choose to have more part-time employees just to get out of paying medical for them. That is wrong. These people are forced to go uninsured because of the cost to the business. If medical taxes become based on how " No response No response No response Agree How do we not have this already? No response 29942 08/10/06 PA Agree "* I personly believe that we should take all politicians off of ther special benefits that we pay for including after they retire they receive there full salary, medical benefits and everything they had when they worked. Wew pay for all this and when we retire we have next to nothing given to us. This is why social security is in the shape it's in and thats why we don't get any good medical benefits because they don't have to care about us. If they were getting what we get I would bet this would all change but no one sticks together in this country. This would take a large amount of people to do this. Don't elect the senators and congressman in any more and limit them to just two terms just like the president. Then things would start to change." Agree WE can spend millions over in Iraq then why can't we spend millions for the people. No response No response Agree Theres no reason that people should have to pay high costs for health care in this country. It should be so cheap that everyone should get the best health care. No response 29943 08/10/06 CO Agree All facilities should be managed with the same rules and conditions. All locations should have the same funding and amenities/equipment to service the people. No one place should be made better or worse dependent upon the income of the surrounding people. All staff should treat everyone as a person and not a number. No response "I don't quite understand the above, so I will not agree or disagree." Agree No comments. Agree "I believe this is the most expensive ""medical bill"" that anybody will face in their lifetime, long-term care." Agree Absolutely! Agree Anything that moves us toward something that is affordable for all is better than where it is headed now. "Yes, yes, yes." 29944 08/10/06 MD Agree Corporations should pay a special tax so that all Americans have heatlh insurance Agree Agree "And let the Doctors decide the best course of action, not the HMO or any other agency responsible for providing payment for services. " Agree Agree Agree "Healthcare should be available to all, regardless of financial staus - the money being spent in Iraq could provide publically funded heath care for all - not just those not currently covered. If each corporation based, or doing business in the United States paid a healthcare tax, everyone would have health insurance." 29945 08/10/06 DC Agree It is outrageous that Americans should be forced into bankruptcy by medial bills. Agree My uninsured roommate has gone without much-needed health care because there are not enough community health centers. Agree Medicare should be expanded to cover the uninsured. Agree Agree All Americans should have health care. No response Medicare is by far more efficient at providing health insurance than private insurers. Programs like Medicare should be expanded to insure everyone. 29946 08/10/06 TN Agree Agree Agree Agree Agree Agree 29947 08/10/06 IL Agree Agree Agree Agree Agree Agree 29949 08/10/06 CA Agree Agree Agree Disagree single payor Agree Agree 29951 08/10/06 MD Agree "Now that the bankruptcy laws have been changed to protect the credit card industry, it is critical that we have protection from financial devistation due to astronomical medical bills." Agree Agree Agree Agree Agree "If we were to stop funding the illegal Iraq occupation, we'd have plenty of money to pay for health care for all Americans." 29953 08/10/06 NJ Agree Agree Agree Agree Agree All other advanced civilizations have affordable health care - surely we can too. Agree 29955 08/10/06 VA Agree Not only low income individuals but also those who have no income (until they can become employed again) to have an income and it puzzled me so bad to hear regarding a situation where someone was turned away due to not having any insurance and was completely ignored by staff. Insurance is extremely high and only those with lots of money can afford it. Agree "Why had it taken so long to integrate this recommendation. I have heard complaints from just talking to people in the every day, that the ""quality care"" is slipping and is noticable." Agree "My dad has medicaid and a situation happened where he did not have any money to get his medication and he went without all of his medications for a week or so and when he was rushed in to the doctor and asked what happened, he told him that he did not have money to pay for his medication and his doctor was upset because my dad could have encountered serious problems for missing his meds for such a long period of time. " Agree My heart still goes out to the family whose husband made a really bad decision regarding his wife and did not allow her parents to care for her. She was denied water etc and service from staff while in the hospital and died slowly as the days past. Nothing like that should ever be allowed ever again!!!!!!! Agree "* I agree and I am a single female who is still seeking employment and it hurts to see how the system treats a person when it comes to getting assistance until employment comes again for me. Not only that, having no health insurance on top of that hurts even more. It's like congress or those in charge of making common sense decisions are not doing so because ""they"" are not faced with it and could probably care less as ""they"" go home at the end of the day unmoved. This is not other countries who have no real democracy or leadership that would ""dare"" to make a difference for the ""people"" and hear the concerns." Agree Make it work for everyone. As long as there is no miss diagnoses of treatment. I have friend(s) who recieved wrong treatment and the end result would have been a bad one. Thank you for allowing our opinion(s)to be heard over this website. I think that at times we wonder who will care enough to listen to the concerns of the people and all are impacted by the decisions that will be made rather it is a good decision or a bad decision and the time frame it takes to restruction it to fix the problems that have existed over a period of time (too long). 29956 08/10/06 NJ Agree Agree Agree Agree Agree Agree 29960 08/10/06 WA Agree I would amend this to guarantee access to a defined core set of medical services that everyone is entitled to as mentioned in a later recommendation. Disagree "I think this sets up a two tiered system that will not be universally supported and funded. This looks like Medicaid. A better way would be to replicate Medicare or Social Security that are universally supported and funded because they are open to everyone. Combined with my comments to the first recommendation, the health centers could be charged with providing access to the core services mentioned above to gaurantee access." Agree I would also move to combine these federal programs strategically into one program so they can become seemless and eventually be combined with the FEHB and other state employee programs paid for by taxpayers. Lawmakers should be in the same plan as everyone else! Agree Agree Agree I would use Medicare and Social Security as models and include lawmakers in the same system! "If I could do only one thing, it would be to combine all health insurance programs paid with tax dollars into one standard program that includes lawmakers and all other government employees. Self interest will endure these programs work well and are not tampered with politically. Medicare and Social Security are the best models out there." 29962 08/10/06 IL Agree Agree Agree Agree Agree Agree 29963 08/10/06 TX Agree Yes I believe all Americans should have medical coverage. Agree Agree I agree with all of the above. Agree "I believe that palliative care, hospice care and other end of life services should be made available to all patients and their families in accessing the care they need." Agree I believe that public policy for all Americans should have affordable health care. Agree I agree with all the above comments. I agree with all of the above. I think this is about time something was done for the majority of all the people who can't afford health insurance. 29964 08/10/06 NY Agree We should all be able to have the same health care regardless of our financial status. We should not have to choose between our health and just living. Agree "It sounds good, but it seems most federal programs to be watchdogs, end up costing more than the programs themselves. " Agree It sounds great. I think it is a shame that so many retirees are not able to enjoy their golden years because of the high cost of heath care and prescriptions. Agree Agree Hurray! Agree It seems to me that if everyone participated in a unviersal plan that the cost should be very reasonable. Let this be a not for profit plan. 29965 08/10/06 PA Agree Agree Agree Agree Agree Agree 29967 08/10/06 VA Agree Agree Agree "* RE INTEGRATION AND REDUCTION OF WASTE IN ADMINISTRATION:Medicaid for Hospice nursing home patients was set up for hospices to be the payor and then pass through room and board back to the nursing homes. Hospices don't have access to the patient co pay info, current fiscal year room rates, etc. There is great turnover and lack of continuity amongst nursing home billing staff. This creates an environment in which hospices pay amounts that are incorrect because they are billed incorrectly, nursing homes are delayed their reimbursement, and hospice mgt. folks have to contend with invoices, checking rate info, submitting to DMAS for the pass through money, etc. Evidently this was written into regulation. This regulatory change needs to occur to remove hospice from the room and board rate payment for hospice nursing home patients. let nursing home bill directly for that even for hospice patients BUT MANDATE AND REQUIRE NURSING HOMES TO OFFER HOSPICE SERVICES, AND CHANGE THEIR REGULATIONS TO ALLOW HOSPICES " Agree "* Palliative care is hospice care backed up in time. Most ""palliative care patients"" should be hospice patients, but they cannot be yet because of their treatment choices, or the recommendations from their physicians. Hospices should be reimbursed at higher rates the first week of care and the last few days of care as intensive visits, meds, equipment, etc. are implemented then. Also, Hospices should be able to have Medicare determine some outlier palliative procedures/treatments that are approved for coverage plus covering hospice daily per diems. Example, a patient could have blood transfusions covered and medicare pay that amount, plus pay hospice its per diem, cause hospice is still gonna keep patient out of hospital after the out patient blood clinic procedure thus costing medicare less. There should be consistency amongst what hospices provide. some hospices use ""open access"" to take patients away from smaller hospices that cannot afford to pay for costly palliative treatments. There shoul" Agree Agree "* Sin taxes should be implemented or increased to fund other needed services. Every working American should have at least hospitalization coverage made affordable to them. Private insurance companies should have their profit margins controlled and their practices of case mgt. scrutinized. No adult should receive Medicaid and completely free care unless they contribute to the system in some way. In Bermuda I believe, you can't get government assistance unless you clean the streets, babysit for others, plant gardens, manage the water collection devices, etc. In other words, everyone does their part to get what they need from healthcare. Another controversial concept is birth control and ADC and medicaid. Unmarried women should be told they will not receive additional ADC for multiple illegitimate children. In a clinic, I heard a young woman say she was gonna get pregnant for fourth time because she would get $39 more dollars a month. Mandantory sterilization is very controversial I know, but if somone" 29969 08/10/06 MD No response No response No response No response Agree "It should be public policy, established in law, that all Americans have affordable health care coverage, regardless of their income level, health status, age or job status. Health Care Reform should be fundamental, incremental change is not acceptable. High deductable plans or Health Savings Accounts that exclude needed services will do nothing to deal with the real causes of high costs and is not acceptable." No response "* We need a system that provides affordable and equitable coverage where everyone pays their fair share. A system-wide mechanism for containing costs must be in place, simply shifting costs to families and not dealing with the real causes of waste, high prices and skyrocketing costs is irresponsible. Public funding mechanisms must be a central part of the financing and cost-containment structure. The medicare program offers a model for how the public sector can insure all Americans, keep costs manageable and allow people to get care from the provider of their choice." 29970 08/10/06 MI Agree "* Working in a public funded Community Mental Health clinic, I see first hand the problems that arise due to unequal health care coverage. Watching the change of dual eligible consumers loose their medication coverage through Medicaid and being forced into a Medicare Part D PDP, has been extremely frustrating, expensive in time spent by health care providers and in cost for consumers and tax payers. Having many relatives and friends with Medicare, I have witnessed the struggles they have endured selecting a PDP, figuring out what it covers, finding out medications have been removed from their formulary, quanitity limitations, prior authorizations, and now the DONUT HOLE!!!! Yes, we need Medicare to step up to the plate and develop a system of equal coverage and financial protection for our most needy citizens! " Agree There is much that can be learned from succussful state Medicaid programs and the VA. Agree Agree "Having worked in home health & hospice as a registered nurse - I can testify to the ""beautiful"" deaths I have been priveleged to be a part of. Yes, people deserve to die with the support of family, the medical community, and social community." Agree Here! Here! Agree Knowledge is so important in advocating for everyone to support a financing strategy. Knowledge is often the key to providing preventative life styles and encouraging healthy living choices. 29971 08/10/06 FL Agree Agree Agree Agree Agree Agree "We need a new Congress! Our founding fathers were not resident politicians. They had our country in mind not their own agendas. We have too many selfish and dishonest members. There should be only 2 terms for them, like the president, who is another loser." 29972 08/10/06 CO Agree "I want to see a national health insurance plan that covers all Americans equally, so that no one has to fear high deductibles or out-of-popcket costs." Disagree Expanding the FQHC provisions is another example of costlier ways to cover everyone. We do not need a proliferation of clinics--we do need to cover everyone with a national insurance and give everyone their ultimate choice of where to go to be treated at any clinic or hospital that has the service they need. Agree Agree Agree "The ""core services"" should be roughly equal to what is provided for the members of Congress and other government servants." Agree I believe that the system would work if I took the dollars that I currently pay in premiums to my insurance company and sent them through my tax payment to a quasi-federal agency that managed health care for all Americans. We just need to have everyone do this. Too simple? Just make the core benefits equal to what federal employees currently are given. What's wrong with that? 29974 08/10/06 CA Agree No response Agree Agree Agree Agree "Canada has a pretty good system, which is better than what the US has today, half steps are better than no steps." 29975 08/10/06 CA Agree Agree Agree "I have strong worries about electronic medical records. Privacy issues are very important to me. Furthermore, there have been too many reports of lost and stolen records: CDs, drives, laptops, etc." Agree Agree Agree "I oppose the concept of ""value-added taxation."" It is an idea endorsed by those who would eliminate an income tax. I believe it would fall most heavily on those least able to afford it." "I especially endorse the definition of ""health.""" I strongly support the mechanism and expansion of Medicare. Using Medicare as a basis avoids bureaucratic disasters as evidenced by the Medicare Part D program. 29976 08/10/06 PA Agree Agree Agree Agree Agree No response 29978 08/10/06 IN Agree Agree Agree Agree Agree Agree "*Abortion, *artificial* birth control and euthanasia *are not ""health care""*!" 29981 08/10/06 CA Agree "During the various times I have been without health insurance and was sick I never went for care (even when I really needed to) because I was so financially strapped as it was, I couldn't afford a several hundred dollar doctor bill, ESPECIALLY when the uninsured can usally only go to hospitals and urgent-care facilities (where the costs are always 3 times as much as a private doctor's office). " Agree Agree "My family and I have, in the past, been insured through Medi-Cal, and though always grateful for the coverage, have always found it extremly difficult to find either a) a doctor's office willing to accept my Medi-Cal insurance or b) to find a GOOD doctor at all. Most ""welfare"" doctors are not very good. In the end, it's still a blessing to be insured, but if no good doctor is willing to accept your insurance, than what good is it?" Agree Agree "* This is my biggest problem with our current way of insuring people. My husband and I both work, very hard, full-time and are BARELY above the federal poverty line (we have two children). We just now make $350 too much every month to qualify for state sponsered insurance for our children, but don't make enough to be able to afford a private company's insurance. Therefore, unless one of us is able to get a job with benefits, all of us will become un-insured. When my son was born, we made, again, too much for the Healthy Families Program here in Calfornia and tried insuring him privately with Blue Cross. Not only was our deductable very high, but so was our monthly premiums, and they hardly covered anything necessary, such as check ups and vaccinations. I had to ask my boss to reduce my pay in order for us to qualify for Healthy Familes again due to the extreme costs of the Blue Cross private insurance. " Agree I'm not sure. 29983 08/10/06 NV Agree Also financial protection for medium income individuals and families. I can not afford healthcare but I am not considered low income. No response Just make sure everyone is covered don't waste alot of money identifying those in the most need. That money could be used to provide national health care sooner. Less red tape. More action. No response No response Agree "I agree with this, however it is very important that in refererence to financial assisstance being available, when defining ""those who need it"", this needs to be very broad bacause middle income individuals and families are always left out." Agree "Tax the rich. Oil companys, weapons manufacturers, and coorporations making over a certain amount of profit should help foot the bill. If churches had to pay taxes on their income this would provide enormous revenue. Luxury taxes on high end purchases, or environmentally unfriendly purchases. " Use the Canadian health care system as a model. Find out where their problems are and address those before implementation. 29984 08/10/06 WY Agree "Let's get a program working that covers everyone. This is such a wonderful, rich country! We Americans are not here to make the drug companies richer. Take care of us older Americans in the manner that we deserve. One plan with financial protection for all! " Agree Agree Agree Agree Agree Don't make the average Americans poor by having them enrich the drug companies. We all deserve better care than that. 29985 08/10/06 CA Agree Agree Agree Agree Disagree "FINANCIAL ASSISTANCE SHOULD NOT BE A CERTAIN GROSS INCOME. IT SHOULD BE BASED ON THEIR GROSS INCOME MINUS ALL THE DETS THAT THEY PAYING OUT OF THEIR POCKETS. RIGHT NOW MY GROSS INCOME IS MORE THAN THEY ALOD. BUT IF THEY TOOK IN THE MONEY I HAVE TO SPEND ON BILLS, I WOULD MEAT THEIR GROSS INCOME. " Agree MEDICARE NEEDS TO UP DATE THEIR RECORDS QUICKER THAN THEY DO. tHEY STILL HAVE ME DOWN AS A MEMBER OF AN OLD INSURANCE COMPANY. I DON'T HAVE THAT INSURANCE ANY MORE. I CHANGE INSURANCE WITH IN THE TIME PERIOD THAT THEY ALLOW. 29986 08/10/06 AZ Agree Agree Agree Agree Agree Agree 29987 08/10/06 IA Agree Agree Agree Agree Agree Agree 29988 08/10/06 TX Disagree "What amount is ""Very High""? Too ambigious. I do not want Socialized medicine. Research stops and assisting the aging population is almost non-existant." Disagree "I agree only with the last bullet. We have Medicaid for the low income people, to include Immigrants. " Disagree "The first paragraph is totally legalise and ambigious. I agree with what it will promote but I can't see fedeally-funded health programs achieving this. I believe there is already a policy to promote but it is somewhat dormant, at least it is not in the public's eyes." Disagree "The first bullet again is legalise ""integrate evidence based science, expert consensus and culturally sensitive end-of-life care models"". What is the difference between ""Clinical realities and actual needs""?" Disagree There is already financial assistance to those who really need it. Medicare. I believe that each State contributes to the Medicare program and there are no complaints by the recipients because it is free. There will ALWAYS be complaints from Americans that have to pay anything. We are spoiled yet inmature enough to realize you can get just so much sugar for a nickel. Disagree "All of this sounds idealistic. Creating more business or payroll taxes, income taxes or surcharges will in turn create monetary problems for workers. I believe that if all National Politicians were to be on the Medicare program instead of the program set up for only them, a solution to our medical problems would be resolved. I vote for that. " This speaks loudly of Socialized Medicine of which I am TOTALLY AGAINST. I will continue to vote for suggestions and implementation that puts the National Office Holders in the SAME plan(s) as the people they serve. 29990 08/10/06 NY Agree "It is time to stop lining the pockets of health insurance company CEO's who earn exhorbitant salaries and drug companies that charge ridiculously high prices for prescription medicines, and create a plan, preferrably private, that will provide all Americans with coverage. This plan should focus on preventative care and promote healthy lifestyles which would bring overall healthcare costs down over time. " Agree Agree "To be truly successful, the current level of waste in these federally- funded programs must be reduced and hopefully eliminated." Agree Agree Agree 29991 08/10/06 TX Agree LIsten to your constituents! Agree Agree Agree Agree Agree 29992 08/10/06 CA Agree Agree Agree Agree Agree Agree 29993 08/10/06 CA Agree Agree Agree Agree Agree Agree 29995 08/10/06 MD Agree "The program should be entirely public, like the original Medicare program. Neither employers nor insurance companies should be involved. The federal government should pay doctors, but not employ them. " Disagree "As I noted above, there should be a simple, government-funded program paying private doctors and hospitals, as in Canada. Coverage would be universal and waste would be minimized. " Agree Agree Agree "This should be the primary objective. In addition, we should avoid wasting money by involving employers and insurance companies. " Agree I generally agree with the above statements. "It is important to establish a system that covers all Americans, lets them choose their doctors and hospitals, and wastes no money by involving insurance companies." 29996 08/10/06 NY Disagree Quit playing games and recommend what the American public has been saying for the last 50 years. Recommend a national health care plan run by the government and paid for by tax dollars. Every American is covered for all medically necessary services. . Disagree "What you are proposing is a band-aid approach to a national problem. This is not a workable solution to the problems that exist in this country. If the private sector was so efficient in providing health care, why is it the most expensive system in the world? The market place does not work in health care. " Disagree These are laudable goals but put them in the context of a national system and eliminate all of the governmental programs listed above. Have a single source of health care for all. Disagree "I agree with everything listed above except for the role of the private sector. Health care is not about making money, it is about taking care of people." Disagree "Again, I have to disagree because of the second sentence. I should be covered regardless of my income. Should I be required to pay for services. Yes, through taxes and small co-pays. That is very different from what you are saying. " Agree "* Yes it does take time, but other nations have done quite well when they transitioned to a national system. Have you investigated how all other industrialized nations provide care? I'm not saying to replicate another coutnry, but examine the process from other cultures and learn from them. For example, Poland recently has gone from a state model of health care to a social insurance model. There are some in the country who have been studying the possibility of moving the country to a national health service like the UK. " "I will agree with this even though I do not care for the wording. I realize that in Canada the use of medically necessary has become a problem, but at least they were willing to offer as expansive a program as possible from the beginning. " "I teach a course entitled Comparative Health Care Systems and have written a book , Health Care Systems of the Developed World, on the topic. It is difficult to imagine how we as a society can continue to study a problem and not have the political will to do what is in the best interests of the people who are being hurt by our lack of commitment to their medical well-being. " 29997 08/10/06 PA Agree Agree Agree Agree Agree Agree But we've had such groups before... Who will listen this time? 29999 08/10/06 PA Disagree "* I think the recommendations, above, are too vague. Coverage for what? This is not clear. We cannot expect that every bit of elective health services will or should be covered. Which ones would be covered? If coverage is carte blanche, it would lead to excessive services and higher cost. It would be a gold mine for health providers. What is ""high out-of-pocket"" medical costs? Doctors' fees and prescription medications have been rising steadily and need to be regulated. Many tests, procedures, and medications are unnecessary and there should be oversight on excessive ordering. Instead of letting doctors write orders and prescriptions, they should discuss the benefits, costs, and risks with the patient, who is a partner in the decision ot order or not. More emphasis should be placed on prevention of ill health, but offering these services is not the way to make money. Why not put doctors on salaries like other professionals? This would take away the incentive to over-prescribe. Financial pr" Disagree "There is too much emphasis on federal involvement. This makes a top heavy, bureaucratic system. Most of the planning and execution of a health system shoud be at the grass roots level because localities differ in their health needs and resources. I do agree that there should be a single payer, however." Agree "I agree with most of the recommendations, but do not agree that fraud and waste would be reduced by concentrating administration at the federal level. Programs, such as Medicare and Medicare, are at present too heavily influenced by politics and medicare benefits have been cut too much, while other government expenditures have soared, and have not benefitted the average American." Agree "I agree except that much more attention, training, and prioities should be placed on promoting and maintaining the health of younger people, who then would go into old age in better health." Agree "I agree, but think that the high cost of all elements of medical care, are far too expensive and should be reduced to an affordable level. There is too much ""gouging"" of people who need medical care, as different fron ""health"" care." Disagree See above. "Too vague. Who are the ""experts"" you refer to?" "I have the impression that the writer(s) of the above are not well versed in the entire picture of healt/medical care, and especially not versed in the philosophy of public health versus medical care, or treatment of the sick." 30000 08/10/06 MI Agree * i agree my husband a meijer employee has been off work for 5 months for sholder surgery we now have no health ins. because they onlly allowed 90 days then cobra which is too expensive i also work at meijers and have to health ins. because he carreid me now we have doc. bills and everything is adding up i can't cover him cause i'm part-time status working 40 hours. i think it is ashame that this has to happen i work for meijer and so does he. thats what the union did to us i very dispointed in the way our union works for meijer not us. No response No response No response No response No response 30001 08/10/06 GA Agree "The need is so obvious and strong that it requires no further analysis. If anything, a short term test model ccould be used to demonstrate the efficiencies of this type of program." Agree Agree Agree Agree Agree 30002 08/10/06 CA Agree Public and non-profit health foundation only. Agree Agree Agree Agree "YEs-- A birthright, not a privilege. Unhealthy lifestyle choices are discouraged through negative incentives in the system. Preventative medicine gets more focus, funding." No response Sounds like a two-tier system based on ability to pay. Not a real choice. 30003 08/10/06 NY Agree "You need to practice empathy. You may be shocked to learn that we are college and post graduates, hard workers and have health problems. Unless, something is done, we will lose our house. We live meagerly and cannot afford our health care costs. What you propose benefits those who have no financial challenges. When will you start acting like we are not a third world country, but an intelligent and compassionate country. Not only for the healthy and rich, but for all? " Agree Agree Agree Agree Agree 30004 08/10/06 OH Agree "Even with good retirement health insurance and some perscription coverage, our health care costs have risen almoust 25%. I know other people are not as fortunate. We all need the help this recommendation will provide!!" Agree Ditto!! Agree YES!! Agree Some states have tried to move in this direction and it is a welcomed approach. Agree Far more important than seeing that one's inheritance is protected!! Agree A monumental job but one that is necessary. Very sound policy. "We have tried the ""market"" approached and it has certainly FLUNKED! " 30005 08/10/06 PA Disagree I want a health care program run by the federal government that covers everyone for all health care costs - NOT jsut catastrophic. Medicare D has made it clear what a disaster it is to let insurance companies run the health care system. Disagree "I agree in part, cf. the underserved areas but get commercial insurance out of the picture and see to it that income is not a barrier." Agree This sounds ok Agree but not just increased access - guaranteed access! Agree "Yes, and commercial insurance and drug company control is NOT the way to achieve it!" Agree Get on with it! "Yes, ALL Americans" 30006 08/10/06 KY Agree Agree Agree Agree Agree Agree all stated above is agreed and good. "I am stunned of the waste- financial, social, as well as personal- of those inflicted with mental health problems. How many homeless and imprisoned people would live normal and productive lives had sound psychiatric treatment with the right parmaceuticals been available. And this does not include the vast expense dealing with the multitudes not treated properly and the cost to all of us (esp. the mentally troubled)." 30008 08/10/06 CA No response "The big problem here is--who would disagree with this as a goal--someone is going to have to pay for it, big time. Determination of who pays is the difficult part. Really, this point applies to just about all these recommendations." No response No response "One good thing in this one is it addresses the inefficiencies in our current system, a major cause of out-of-control costs and a relatively easy one to go after because most agree on it. Physicians order too many fancy-expensive tests, record-keeping is like the Middle Ages, bureacracies grow like mildew, etc. I also think the pharmaceuticals are driving it too--as wonderful as all those developments are, they're incredibly expensive and someone ends up paying for it later." No response No response "Is this pointing toward a kind of new nationally funded insurance plan? Remember, certain vulnerable groups such as the elderly are already covered by Medicare and Medicaid; part of the problem is lots of the rest of us are falling through cracks that have become crevices. So, this one's a definite maybe." No response "* One thing cannot be ignored is the ballooning proportion of total GDP comprised by healthcare: pushing 16 percent, will go to something like 20 percent by 2015 I think. What this means is the costs in the so-called health care 'market' are simply out of control; there almost isn't enough wealth left over, unless all those millionaires and billionaires have some sort of religious epiphane, to guarantee every citizen access to any kind of treatment they might desire, such as fancy chemo for colon cancer. This renders the question of how to finance plans to near-irrelevance." "Idea of expert panel representing all people and groups is solid but it's likely insurance industry, pharmaceutical industry, and other dominant groups will fight tooth and nail against plans they don't like, namely real progress, unfortunately. Real problem in this regard is the implementation and dominant groups have sealed off all the exits, so to speak." I'll reiterate what I think are critical keys. (1) uncontrollable costs in the overall industry. (2)special interest groups are now able to block any real meaningful change. (3)determining who will pays for care that is now not being given will be the bottleneck. 30009 08/10/06 FL Disagree "The very rich and poor are cared for. Socialized medicine is NOT the answer. People with ""national"" programs have to wait extremely long periods of time for gallbladder surgery or carpal tunnel surgery which are important but not life-threatening." Disagree "There may be problems with good healthcare in rural areas, perhaps fellowship programs would work. BUT no problems for the ""low income"" they are already on Medicaid." Agree "good luck, coordination will be difficult" Agree Agree The problem is the abuse of the current public healthcare insurances. There is so much abuse by Medicaid patients. They cannot get a sterilization procedure paid for by Medicaid but the government will pay for all the babies they can make delivery and followup healthcare until they are 18 and having their own babies. Medicare abuse seems to be from the providers of healthcare and supplies. Agree sin taxes and a wide array of other investments and taxes as long as spread out evenly is the best approach. "anything totally controlled by the government is dangerous. They are so tainted they can't work for the common good, just the good of their parties (right or wrong)." 30010 08/10/06 OR Agree "Financial protections are needed for all, not just by low income individuals. Americans in the middle class should not be descending to ""low income"" status (e.g., losing their homes, losing the opportunity to send their children to college) due to out-of-pocket medical costs. By providing national health insurance we can spread the costs and lessen the impact on all Americans." Disagree "A single-payer, national health insurance program would directly benefit the American people. Spending millions of dollars to ""establish a public-private group...responsible for advising the federal government"" is a waste of valuable resources. While it might be possible to include private insurers in the process of transition to a public health insurance system, the goal should be a national, nonprofit health insurance system. " Disagree "* My concern is that ""controlling costs"" is not a legitimate issue as long as private insurers are making significant profits through ""efficiency"" aimed at controlling access to service. In addition, this statement does not go far enough to present the role of federally-funded programs. We have seen with the fiasco of Medicare Part D that providing ""information on prices, cost-sharing, quality and efficiency, and benefits..."" is not adequate when people are left to make a ""choice"" as a consumer of private health care programs. A national health care system should be established with on-going, data-based monitoring to ensure that decisions in that system are made in the public interest." Disagree "Private, for-profit programs will never provide the end-of-life service that are needed by patients and their families. These systems make decisions based upon reponse to treatment and prohibiting the use of services by those who will not recover. When patients are dying and naturally declining in their response to treatment, private programs have shown little interest in providing the supports that patients and their families need. " Agree "I agree that ""all Americans"" should hve affordable health care. I believe the most efficient and effective way to accomplish this is through a public, non-profit, national health care system. " Disagree "There are sufficient funds going to the Bush administration's tax cut for the wealthy to provide for a national health care plan. If we simultaneously cut the military spending that is making us less secure every day, we would not have a problem in financing a public system of health care. " "Core health services should be established by a public, nonprofit, national health insurance program using evidence-based information, expert consensus, and broad public input (including input from minority communities and individuals). " "The United States is the only nation in the developed world that does not provide a public, national health insurance program for all citizens (and often for all residents, whether they are citizens or not). The American people are no longer going to tolerate this situation!" 30011 08/10/06 CA Agree "* It should be covered in the US Constitution ( the pursuit and guarantee to life, liberty and happiness) and all three deal with medical care. How can we be the most industrialized, democratic society on Earth and we don't have universal health care. The economics of the health care industry demands it. Working Americans, whether union or not, need it. I believe we outnumber any voting group in this country. So if we can't do this, we only have ourselves to blame. The few have dictated to us, the workers, for far too long. Last I remember, majority rules and it's about time we did." Agree Let the feds pitch in but they should not run it. Agree Agree Agree "Common sense, where has it gone. The dollars we spend now in preventive, birth to death, medicine will save the millions later." Agree agree 30012 08/11/06 IL Agree "Having created separate classes of Medicare-ship was duplicitous by any American standard in or out of Business, and it is STILL upon ALL of our elected officials to reconcile this. " Agree "Effective partnership of Government & Business toward Social Policy is now common and obvious throughout the global marketplace. The success of Norway alone is a sufficient model for us to follow, instead of masking our own squalor (both urban & rural) as ""...the most powerful nation on Earth"" " Disagree "Using the Veteran's Health Administration as a model of performance would be foolish. In fact, this old org is still the most outrageous payroll scheme since the Teamster Pension Funds of the 1960's & 70's. Further funds squandered on VAMCs are funds not invested toward Universal Health Care... truly the only way ALL VETs will finally be treated as equals by previous rank or duration of service." Agree thank you. Agree "Losing one's home for the costs of health care at any level could easily become our ""...rust on the razor"" (maya angelou)" Agree "Disparate, indeed. Providing the under-65 Medicare population the same premium cost opportunities for supplemental insurance as the 65-&-Over population would be a fair & just start. This long-time disparity of our Social Policy in particular smacks of undue enrichment among insurance carriers and has created separate classes of Medicare-ship with unjust intent... if not flat-out ill-will. We ought to be ashamed of ourselves." "Only comprehensive care are of the whole person for the full duration will abate the unanticipated costs and consequences of neglect. ""When you talk about the part or the piece, you must talk about the whole."" -Malcolm X" "Sure... Let Us Pray and Let Us Eat Cake, too. SHEEP SLEEP DEEP but none too long." 30013 08/11/06 MN Disagree "I worry that this would become some large bureaucratic nightmare, my belief is we have to go after the lawyers that sue for babies that do not come into this world normal and just want to line their pockets. We have a great health care system just the way it gets paid is broken." Disagree "when I served in the MN House of Rep. I was under the assumption that people were cared for through Welfare MN Care Medical Assistance. Are we just looking for more government to work some of its ""magic"" and take care of us?" Disagree Agree "I was Chairman of the local Hospice for 7years which was totally volunteer, though when my Mother was dying of Pancreatic Cancer we had to utilize a Hospice from another city because ours could not get reimbursed for drugs ! " Disagree Where in the Constitution does it says this? Disagree "I do not see where the Gov is not taking care of everyone now. My Grandfather got the same care in a Nursing home when he was paying his own way and even after his money ran out and the ""Government"" took care of him." "I really disagree with Government based care. You may say it sounds crazy, but when will the time come when we have to get up in the AM and do exercises to make sure that we stay healthy and the electronic chip in our arm tells Central Control we didn't do it. We need Freedom" 30014 08/11/06 HI Agree Agree Agree Agree Agree Agree 30015 08/11/06 AZ Agree "Time to stop profiteering by pharmaceuticals, insurers and corrupt politicians." Agree Agree Agree Agree Every other industrialized country does this. Every other industrialized country also regulates drug prices. Why don't we? The answer is a shadow of shame across this country. Agree "Stop insurance company CEO's and their ilk from ripping off tens and hundreds of millions of dollars every year. Regulate pharmaceutical prices. Stop political bribery. Reduce the ""defense"" budget to what it ostensibly is (around 25%) instead of what it really is (>40%) and redirect these funds to health care. There are many more steps that could be taken - don't expect me to list them all off the cuff." 30017 08/11/06 NC Agree Agree Agree Agree Agree Agree 30018 08/11/06 NY Agree The U.S. is supposed to be the richest and most advanced country in the world and yet we do not have a national healthcare program as do other countries. It's time we do the same. Agree No response Fraud and waste are two of the major problems in the healthcare system. No response Agree Agree 30019 08/11/06 FL Disagree Low income individuals and families have historically been covered by state Medicaid programs and county indigent programs. The wealthy can afford to pay for care. The middle class is being lost in the proposals. Most will not be able to cover costs proposed nor negotiate as recommended when requiring medical services. Disagree "Once again you are attempting to focus on the segment of the population which has traditionally been covered already by state Medicaid and county programs. Though their services have not always been optimal, they have been present. Middle class individuals and families often have no insurance or are underinsured. They need your focus!" Disagree These systems you are touting are already overburdoned with care. There are so many problems with the government programs listed. Fix those existing problems or focus on another means to supply resources to the population! Agree Disagree "You are treading on thin ice here. The pay scales you are recommending are going to eliminate that health care for some who have it now, by placing them in the position to have to pay monies they do not have available to receive quality healthcare." Disagree "The basic recommendations of shifting responsibility from government to individuals appears to be the theme. The people you are speaking to are not representative of those in my demographic area! We look to the government we pay taxes to for assistance when ill, not for their hand to be out (once again!) after we have paid our due in taxes at every turn. Look into government overspending to find monies for these national programs, not back to the American people!!" "The current work group was supposed to be such a group, yet it surely reflected the opinions of the current administration. How can the American people expect an inpartial group selection here? " "* As a Licensed Clinical Social Worker I feel that I have a finger on the pulse of my demographic area. Though I realize that there is no easy answer, reducing excess spending to those who have not ever paid into our system seems a good place to start. It is a shame that Americans who pay in to a system for a lifetime feel so insecure. Please listem to the recording on the Social Security toll-free line. You are paying in for those collecting today, not for yourself! There is no security for younger Americans through this system. Why plan to overburdon it more???" 30020 08/11/06 MA Agree "The American government, while it is better than other governments, have NEVER listened to the public. Healthcare has now boiled down to ""politics"" instead of what is best for the patient's requiring the use of their healthcare program. There is NO REASON for people in this country to be without healthcare coverage." Agree Agree Agree Agree Agree 30021 08/11/06 MI Agree Start with the drug companies. Oil companies are beer store bandits compared to these experts at grand larceny. Disagree "The federal government is a joke. The bureaucracy will drown in red tape. Legislation is needed to curb the gouging for services and goods, like a $10 band aid or a $7 tylenol pill when hospitalized." Agree Start with the total ban on tobacco products ... watch the lobbyists roll out in numbers! Disagree too rigid Agree As long as you make an effort to do something to support the system ... no free ride! Agree It's all so easy ... wipe out the current IRS Code and implement a FLAT RATE accross the board 20% tax and everyone gets coverage. Elimination of corporate welfare would go a long way! "Installing members who use common sense, not dollar and cents control." "What you have here is the magic looking glass. It is bound to be full of greed, fraud and miles of red tape. The power struggle for control of this program would be no less than titanic. " 30022 08/11/06 IN Agree Agree Agree Agree Agree Agree 30023 08/11/06 NY No response I believe that all Americans are entitled to healthcare. I am willing to be taxed to provide that coverage. Healthcare should be readily available as water and public education. Agree Baring some type of universal healthcare plan I can support this recommendation Agree Agree Agree Agree I believe a percentage of corporate/business taxes personal income taxes and luxury taxses would suffice to pay for universal coverage. Baring universal health coverage I can support this recommendation. 30025 08/11/06 LA Agree Agree Agree Agree Agree "Education piggybacks off of healthcare. If children are born with deficits, special education or special programs may not help them become capable of functioning independently. They therefore may remain dependent on society and government resources. For educational programs to be effective, good healthcare must be present throughout the life span. " Agree Our current healthcare system is influenced by lobbyists and polical agendas. This must stop. Our current system is poorly managed and laden with waste. This must change. 30026 08/11/06 VA Agree We need something. Agree Make it simple Agree Remember make it simple Agree Agree Agree Just do it 30028 08/11/06 VA Agree Agree Agree Agree Agree Agree 30032 08/11/06 CA Disagree NO PRIVATE INSURANCE COMPANIES! Agree NO PUBLIC/PRIVATE GROUP. Disagree Redution of fraud? Don't charge extra for insured patients! Disagree Forget private providers for a FEDERAL PROGRAM! Disagree Think NEW JERSEY! Disagree Think NEW JERSEY! The Bush adminstration doesn't care much for good science. "I suggest when you take another poll, you include ALL opinions! Shifting the rising costs of health care to consumers, then expecting people to 'bargain' for the best medical care, ludicrous. Health care costs are rising. MOST Americans cannot afford to pay private insurance premiums, then pay half of the cost of medical treatment. The Bush plan, per usual, will benefit insurance companies. " 30033 08/11/06 VA No response Disagree "* While I agree and support most of the recommendations by CHCWG, I am quite concerned with the group's recommendation to modify the FQHC concept. The most important attribute of a FQHC is the requirement that 51% of the board of directors be patients in the health center. To some this may not seem like a big or important issue; however, the implications of removing this requirement are huge. Maintaining this requirement ensures that the mission of the organization remains in the hands of those patients who actually use the health center and not controlled by individuals who may other interests such as a hospital administrator whose interest may be to ensure referrals from the health center or an attorney whose clients may benefit from the actions of the health center. That is not to say that there should be board members who have experience and knowledge of business or health care, but the common patient, who may be below 100% of poverty, brings a much needed perspective to the governance of a FQHC. " No response No response No response No response 30034 08/11/06 IL Agree Agree Agree Agree Agree Agree 30036 08/11/06 MA Disagree "* A national program like medicare was the overwhelming choice: I cite the response to your question 12, particular attention to: g. Create a national health plan, financed by taxpayers, in which all Americans would get their health insurance. 50.0% 22.2% 9.2% 6.3% 10.4% 1.9% There are different ways to assure coverage for all Americans. Remembering that we all pay for the cost of health care through insurance premiums, taxes, or consumer prices, how much do you agree or disagree with the following options? Strongly Agree Agree Neutral Disagree Strongly Disagree NA/NR a. Offer uninsured Americans income tax deductions, credits, or other financial assistance to help them purchase private health insurance on their own. 12.8% 28.8% 13.2% 24.4% 17.5% 3.3% b. Expand state government programs for low-income people, such as Medicaid and the State Children’s Health Insurance Program, to provide coverage for more people without health insurance. 24.9% 44.2% 11.5% 10.2% 6.5% 2.7% c. Rely on fre" Agree Agree Agree Agree "* I again call your attention to response g of question 12: g. Create a national health plan, financed by taxpayers, in which all Americans would get their health insurance. 50.0% 22.2% 9.2% 6.3% 10.4% 1.9% Through taxation all Americans will participate according to their means in supporting a single payer system that can pay for health care serices delivery through a privately owned infrastructure. Individuals wishing a very high level of coverage options can choice to purchase a supplimental over and above the quite complete coverage program that would be in the single payer program's basic. Thus choice is assured. Cost is controlled because all Americans are in one risk pool and risk is spread accross all members of the pool. Price negociation is maximized by the market share power of the single payer. Service utilization and universal reporting are facilitaited because all providers are billing and reporting to one master, rather than attempting to accomidate the reporting requirments of many fun" Agree "* I disagree that there is no optimal health care financing mechanism. Optimal does not mean perfect. So let's not conflate these terms and misdirect us from the best possible option. I repeat again: Through taxation we can all finance a single payer system that can pay for health care serices delivery through a privately owned infrastructure. Financing is further consolidated when all the other current federal and state funded programs can thus be combined into this one payment stream. Consider the Ryan White Care Act at 2.3 billion, Maternal and Child Health Funding, Rural Health Funding streams, SAMSA funding streams, and the myriad other discrete treatment funding streams. All these are large and when combined into a single payor of a rich coverage package, then taxation need not be extremely high. Again, all Americans would be in one risk pool and risk would be spread across all members of the pool. Price negociation would be maximized by the market share power of the single payer. Service utiliza" You must not accomidate the irrational trernds now underway as acticulated as Consumer Driven Health CAre. This idea is a product of the current conservative agendas being pushed by John Goodman and other ultra conservatives. That is not what you received as input from your surveys and commmunity dialogues. You must represent all Americans not those who happen to have the current control of our policies. 30037 08/11/06 NY Disagree "This is a series of complicated stop-gap measures which will not protect lower middle class and even middle class families from financial devastation. What is needed is universal coverage similar to the system in Germany, i.e. medicare for all. " Agree Agree Agree Agree "we need a universal system covering all individuals for all services, adequately funded so that health care workers and hospitals are well compensated as national policy so that we do not have long waiting lists and a ""secondary"" private system is not needed." Agree 30040 08/11/06 LA Disagree "If ones personal behavior is related to the health care costs, the person should not be rewarded for being morbidly obese, smoker, dangerous driver, substance abuser, sexually irresponsible etc" No response Agree Agree Disagree "* Again, personal responsibility is the key. I am not in favor of those who make poor choices in their lifestyle having a safety net to catch them. where is the incentive to change if those who can pay for others choices. I am for supporting small buisnesses in providing employee benefits including health insurance. I am in support of expanding the role of Public Health in Preventative Medicine. I am in support of Medicaid and Medicare paying for Preventative Health Care and rewarding healthy behavior. I am in favor of private insurance rewarding healthy behavior. " Disagree "Again, this should be driven by the persons productivity, the support the federal government gives towards buisnesses to offer health insurance, public health to increase healthy behaviors, the individual states promotion of healthy behavior. The government should not be in the buisness of deciding how to spend my money on others health. " 30043 08/11/06 CA Agree This should be a basic right in this country. Agree Agree Agree Agree Very much agree! Agree If all middlemen and current insurance costs are eliminated this should take much of the profit out of the way our system works now and improve the cost to consumers. 30044 08/11/06 GA Agree "Eliminate the ""donut hole""! What fool approved this catastrophic idea? The Part D program benefits no one except insurance companies and pharmaceutical companies and the people are finally getting it. " No response No response No response No response No response "* Our government is for sale to the highest bidder and history will revile George Bush and his Cronies for the damage they have done during their control over this country. Not everyone is stupid enough to believe what he says and will remember what he didn't do FOR the country, as well as what he did do TO the country. Enough! Enough lies! Enough deception! Enough of corruption and greed! Enough of saying one thing and doing another. It's time for some very big changes. IT'S TIME FOR HONOR AND INTEGRITY!" 30045 08/11/06 CA Agree Disgrace that the richest Country in the history of the world does not have Universal Health Care. Particularly when there are 50 million tax paying working people who contribute to Society but who don't have Health Coverage for themselves and their families. Agree "Establish all above with proper Congessional oversight so that at least one branch of Our Government will be accountable to properly serve ""We The People""." Agree "Must be total accountability so that Tax-Payers can realize, and actually benefit from paying taxes. And we will know that at least in this area, Our tax dollars are not being wasted." Agree "Our Citizens in this situation should be guaranteed all the grace and dignity that Our tax dollars can provide them. Is the least that law-abiding, tax paying Citizens deserve after contributing to Our Country their whole life." Agree Nice that we help people in other countries with health and medical programs. Sad that at the same time Our Government neglects our own People. Totally support above. Agree "If Our Government has the Will, a way will be found, along with contributions from tax payers, other sources. Including a tax surcharge on Employers who do not/cannot currently provide health insurance to their employees." Support all per above. "Universal Health Care will go far to establish the true greatness of Our Country. No Country can be deemed ""Great"" when it has Citizens, including Children and Seniors, who are unecessarily sick, and even dieing." 30047 08/11/06 IL Disagree Coverage for all medically necessary care for all residents of the country under a single payer universal access publicly funded program. Disagree "There should be no uninsured Americans and no need for a safety net for medical expenses. Everyone should be covered under the same program, for all medically necessary care." Disagree "The best way to improve efficiency is to have a single system. A single system, as opposed to the fragmented system we have now, also offers the best opportunities to improve quality." Disagree There should be no private payers. Palliative services should be offered under the same system as all other care. Disagree All Americans should have access to all medically necessary care. Disagree No new revenues are needed. We are already spending enough money to provide all medically necessary to everyone. But we are wasting 30% (more if you gove financial value to the time patients spend on billing issues) on private insurers' bureaucracies. All medically necessary care should be covered for everyone. We need a single payer universal access publicly funded system. We are spending all the money we need. We should stop giving this money to insurance companies who add nothing of value in return. 30048 08/11/06 LA Agree We all would benefit from health coverage. Agree This is beneficial to everyone. Agree Efficiency is important in health care. Agree This is a betterment for the community. Agree We would all benefit from this. Agree Financing is important here. All need core benefits. 30051 08/11/06 OH Agree Such a strategic move will ensure affordable health care costs and faciliate corporate competition by removing the cost of employee health care benefits from the cost of business. Agree This can be best achieved through the use of automated IT infrastructure and data mining capabilities. Agree Agree Agree The cost of aggravated injury and exacerbation of chronic illness is greater when care is delayed. Emphasis should be placed on preventative heatlh care services. Agree 30052 08/11/06 OH Agree Agree Disagree The federal government has too many layers to accomplish this goal. It works better w/private sector involvment w/feds providing catastrphic coverage. Agree Disagree "I believe consumer driven choice is a better recommendation. Keeping the vunerable financially and physcially safe is a good thing. I don't believe everyone needs to rely on a safety-net system, or a one-size fits all system." Disagree Financing of health needs to include incentives. From the private sector as an investor and incentives for the individuals needing the care. The individuals need to particpate in a portion of the financing and they also need to be compliant with their health care to control to the extent possible any futher health issues. "Consumer driven programs with the individuals absorbing their own health care costs. In my opinion, a core benefit will encourage utilization and do little to meet the objective a a quality system." 30055 08/11/06 TX Agree "The simple fact is that we already spend more per capita in America than any other industrialized nation and yet still have between 42,000 uninsured. There must be enough money in the system. Perhaps it will take some funding resources to begin to redesign the system, but in the long run the cost benifits of this recommendation can be nothing but an improvement to our economy." Agree "* To the extent that we can we are working to achieve this through the Gateway to Care Collaborative and the Harris County Healthcare Alliance in Houston / Harris County. It is now clear that this can be done. It is also clear, however, that ultimately federal direction will be needed to encourage the Federal funding sources to begin to allow and encourage this rather than continue to create funding streams that make it almost impossible for organizations and providers at the community level to come together rather than compete. The Healthy Communiy Access Program that was funded for several years under HRSA was making this happen in communities all over the country until the funding was terminated. Even though Federal funding has been ended, many of the Collaboratives that were started are continuing to bring systems together. The data from HCAP will provide evidnce of the impact of what this recommendation could achieve." Agree "Quality mandates from the Federal government will not work. However, carefully implemented activities that move the service system in the direction that this recommendation proposes will work and will be appreciated." Agree * People want to stay at home as long as they can. Families want them to stay home as long as possible. Our experience is that it is often the system and the way funding is made available that drive people into long term care settings. With relatively minor changes that foster services that keep people home and provides training and support to Care Givers this can be improved and frankly federal and state funding can be stabalized if not reduced. Gateway to Care is doing this with a very small program focused on providing training to Care Givers and Navigation support to help them find the resources they need to keep their loved ones at home. Agree Ultimately this is the answer and will cost less. The real issue now is the number of middle class people who are losing health insurace because the cost has reached a point that more and more small business and even large businesses are finding it difficult to provide Health Insurance. Agree I certainly agree with this. Core services that focus on primary care rather than emergency room care can and will ultimately be the key to success. "Collaboration at the Federal, State, and the local level will be key to the success." 30056 08/11/06 TN Agree "I know medical savings accounts are stupid! I thought it a great idea until I tried to get one. The same insurance company I am not served by, would charge me $100. a month more for the same coverage that would be eligible for the accounts. What idiot came up with that idea?" No response No response No response No response No response "I suggest you come up with a program that includes all senators, congressmen and other government workers. They should not be better served that the rest of the nation!" 30057 08/11/06 WY Agree We need health coveage that is affordable that provides good quality care. If the current situation continues no one will be able to afford to go to the doctor or hospital. Comapanies already are having to get rid of their health insurance plans for their workers. The first people to lose coverage through their company are the people who are retired and no have no other options. Agree Agree Agree At this very difficult time patients and famiy really need more support from their health care providers. They really need to know what services are avaliable and they need to be able to offord the services. Agree Agree 30058 08/11/06 IL Agree Agree Agree Agree Agree Agree 30061 08/11/06 FL Agree private program only. No government control. It would be a disaster! Agree "watch the amount of control the government takes. Private input is the most important. Government workers should not be making the decisions. If you like the postal system,you will love national health care." Disagree the federal government has made a disaster of the VA System. Enough! Disagree "You left out Long Term Health Coverage. Or, did I miss it! Most people do not have this type of coverage. The American people have been rendered to the state of being ""Insurance Poor"". Have you seen the movie Sowlyent Green? You may want to view this film. I can see the federal government taking a close look at it." Disagree Public policy sounds like National Health Care run by incompetents. Agree be careful with universal coverage so we do not get into a rationing system as they have in Great Britain. No new taxes! No universal coverage run by the government. "mental health care is crucial. It currently is rationed by insurance companies. This should not be allowed. Mental illness is no different from a physical illness, and could be even more dibilitating-an example is depression. There are others. My concern is that whatever program is instituted is not a rationing program. This could happen very easily. The other fear is euthanasia. I can see this coming into play in a national health system. " "Careful with dental health. This will require a great education effort for all persons involved. The dental health of Americans is deplorable. Although,it is nowhere as bad as in the United Kingdom. We have a huge educational project on our hands when it comes to educating people on the value of good dental health." 30063 08/11/06 CO Agree Agree Agree "* Medical errors contribute substantially to rising costs. Increased quality of care not only better serves the public, but also holds down cost. There is also a need to hold medical providers accountable for the care they give, and not just in the courts. One housing developer said, ""If the roof I build leaks, I have to repair it and I don't get paid a second time. If my hospital gives me the wrong meds and I have to be treated again, my insurance company pays for all of it. Where's the incentive to do a quality job?""" Agree "The greatest proportion of our individual health care costs come at the end of our lives. Heroic, invasive and extreme measures to prolong life at very advanced ages are often not what a patient wants. They need alternatives." Agree I strongly agree. Agree "All stakeholders must invest - public (government), private (insurance and employers) and individuals. " "The process must be defined by law, but the specific benefit package must be more fluidly defined, with input from all stakeholders and with the ability to change as society and medicine changes." "We must get started now. This is a long-term committment, and the longer we wait the more difficult the resolution will be." 30064 08/11/06 IL Agree "Universal healthcare should be every american's right. Many of us cannot afford the very high cost of healthcare. We pay high preiums, with a high deductable and still cannot make ends meet!" Agree "Even middle class americans need a safety net, for those high deductibles and out of pocket expenses. " Agree Agree "I cannot make a comment. The system as is, does not work. " Agree It is getting to the point where I cannot pay my insurance preiums. My husband died & did not leave me very well off. Agree Bring our troops home from Iraq and afghanistan. The money not spent there could pay for a universal system here. "Health care is the sum of all the parts. The person's wellbeing is this sum of physical and psychological together. and, a person needs teeth to chew food to sustain life!" 30065 08/11/06 CA Agree Almost every other industrialized democracy has a public health care system; those which are private are heavily subsidized for the poor and achieve 100% coverage. It's imperative. Agree Agree Agree Agree Agree "It is simply immoral that we do not provide health care for all people within the United States. Those who claim to support family values must, in the end, come on board or be seen as hypocrites." 30066 08/11/06 CA Agree Agree Agree Agree Agree Agree 30067 08/11/06 LA Agree Universal healthcare in America is long overdue. Access to health care is a matter of human rights and human dignity. Agree No response Agree Agree Agree 30068 08/11/06 CA Disagree "Guarantee financial predictability against high health care costs for everyone, working or not working, disabled and non disabled. Fund Medicare for all with proven social insurance principles." Disagree "Guarantee financial predictability against high health care costs for everyone, working or not working, disabled and non disabled. Fund one Medicare for all program, with choice in providers, with proven social insurance principles and general revenues. We have workable solutions in place today, expand them, don't create separate health care for poor people, you then help create more poor people." Agree "Health care for all is the right, social insurance finance principles are the core values and way to get to sustain the right to seamless access to health care." Agree Agree "You should consider your charge to create the vision and charge others with finding the methodologies. That's how we built the Golden Gate Bridge, got to the moon, and created Medicare in the first place. Expand what works for to all Americans." Disagree "This is not a forum for hight cost health care, it's a forum for access to health care for all. What is so dense here? ""high-cost protection and core benefits"" is not what I heard was the need in the Sacramento CA forum I attended. " "Keep the discussion safe and open. This is NOT about catastrophic health care, it's about the catastrophy that 46 million Americans have no health care." 30069 08/11/06 CO Agree Agree Agree Agree Agree Agree Profits to private insurance companies seem to me to be excessive in our current model. 30071 08/11/06 IL Agree "yes, thism is long overdue. americans need good health care. brian" Agree Agree Agree Agree Agree 30072 08/11/06 WA No response See comments below No response No response No response No response No response "My husband and I believe you haven't been listening to what people have been telling you. Many have told you, and we also believe that there should be a federal health care program for everyone. It's as simple as that. Medicare, we believe, would do a fine job, as it has done in the past." 30073 08/11/06 WI Agree Agree Agree "I believe the health information technologies and ERMS should also take into consideration other types of health care providers, such as Nurse Practitioners when implementing these services. NP's already provide excellent health care and excel in health promotion and prevention." Agree Agree Agree I like the Sin tax idea. Improving the quality and efficiency of health care such as systems like the VA will help decrease costs. I am glad to see mental health included. There is a huge need for mental health services too. 30076 08/12/06 OR Agree There is a CRITICAL need here Disagree "* I DO NOT AGREE with ""expanding and modifying the FQHC concept to include other community-based health centers and practices serving vulnerable populations."" A crucial component of being a Federally Qualified Health Center is requiring this health care center to be GOVERNED BY A BOARD COMPRISED OF A MAJORITY OF PATIENTS WHO RECEIVE CARE AT THEIR HEALTH CENTER. I speak from experience as a patient representative on my FQHC board: without the governance of the health center being directed by patients actually served by the health center, the priority focus on using resources to better meet local patient population needs could easily be diverted by the persuasively “urgent” demands of other interests. Every governing board must sift through the conflicting, at times covert, multifarious interests besetting its decision-making processes. Our board practice includes holding each decision and opportunity up against two criteria: our mission statement, and the requirements of being a FQHC. The mission statemen" Disagree "* I disagree with this recommendation. I believe that other entities providing services to vulnerable populations should operate separately and be funded differently from existing federally funded programs like the Veterans Health Administration, medicare/medicaid, and community health centers. There must be a far more effective, fair, streamlined payment system created than any of these programs provide; the current paperwork requirements and the long waits for reimbursement from these agencies (often 9-12 months) escalate the costs of doing medical business to such a degree that it is not financially feasible without those costs being offset by much higher costs to private patients. Making an unwieldy, ineffective umbrella bigger, doesn't protect anybody. We need something totally different, where there isn't a financial benefit to denying specialty consultation and diagnostic evaluation like there is in the current medicaid system, and capitation contracts. What we have isn't working, so don't make it" Agree "* A significant problem is the alarmingly low-level payments currently made (often less than 1/3 the actual cost of providing good care for these patients) to those providing long-term and adult foster care service for medicaid patients. Conscientious providers cannot afford to receive less money than it actually costs them in materials and labor to give good care. The private pay prices have to be raised significantly to subsidize this deficit or the facility quickly becomes financially insolvent. As a result of this financial inequity, there are comparatively few places for aging medicaid patients. The facilities accepting medicaid patients can only afford to give the level of care that they are paid to give; therefore aging medicaid patients are routinely subjected to seriously substandard care. " Agree "* This may be public policy, but what we want is actual public practice of this policy that does not penalize providers. I believe that providers of care in underserved places should have subsidized medical malpractice insurance coverage, so that specialists, such as OB-GYNs can afford to practice in rural areas. Financial institutions need to establish extremely low-interest long term loans for people incurring catastrophic medical bills. This could be patterned after the federal financial aid educational loan programs that are supported by income from people paying off their loans. We need to reform our current legal system and insurance system that defeats these goals. Every facet of American business needs to contribute a small percentage of the profits generated in order to achieve this goal. We need to look into Denmark and Switzerland's methods of dealing with these things." Disagree "* Obviously we need multiple income streams to fund this huge goal. The bottom line must be that a small portion of funding should come from those businesses that profit in any way from this healthcare system: -Insurance providers should contribute 0.1% of all medical provider's malpractice insurance premiums; this money would come with a concomitant reduction in the risk held by insurance companies by more reasonable limitations on malpractice awards and making the liability time clock run from time of actual service, rather than permitting indefinitely extended liability under the rule of discovery. -Tax 1% of all attorneys' compensation that comes from a split of the settlement award received so attorneys give something back to the system that feeds them. -Pharmaceutical companies and their distributors should contribute a small ""reverse royalty"" on each prescription sold, with this royalty dedicated to providing prescription drug coverage; a reasonable reduction in their product liability exp" "* Let's aim for the end result we want for America. A nation benefits from a healthy, educated citizenry; therefore, we need to look at the components that create a healthy populace. Let's also incent healthy living--by providing some kind of a tax break for citizens who take care of themselves well and therefore don't need to utilize the system much. Vision care must not be overlooked in this process, because kids can't learn if they can't see, and people who see well function better, have fewer accidents, etc. Most people would rather function than malinger, so let's not forget to ask if this patient can move and live free enough of chronic pain to love and work. If the answer is no, then it is essential that we not overlook the benefits provided by physical therapy, sports medicine, rehabilitation training, and alternative medicine such as naturopathic and chiropractic care. Covered services must not be limited by the prejudices engendered by professional partisanship. Let's look the world over for treatm" "* I believe that core health services should include treatment that make it possible for a person to retain or regain function as a productive, working member of society, rather continuing to be disabled because core benefits don't pay for treatment, or your capitation based provider financially benefits from denying you a specialist's consultation and treatment. We need to eliminate these built-in disincentives to helping people regain health and function. If a person is still active in their 80's and needs cataract surgery, rather than considering him ""too old"" a candidate for surgery, we should consider whether a restoration of sight may enable him to live independently for some future years thus reducing the overall time he would be dependent on other costly forms of care. We should consider that over time, the costs of some types of laser eye surgery offset the ongoing costs of prescription glasses and contacts. We should think about what costs are to society as a whole in lost productivity and crea" 30077 08/12/06 OH No response No response No response No response Agree "* We talk about coverage for all Americans. What about Americans that suffer mental illnesses or autism ? Right now their insurance costs are much higher. Insurance for a 55 year old with high blood pressure is cheaper than for a 39 year old with an obsessive compulsive disorder who takes meds as directed, only needs minimal counseling and has never been hospitalized. This discrimination must end. Also insurance companies must be required to cover autism. Families with autistic children pay 50-100k per year out of pocket because insurance companies refuse to even recognize autism as a legit. medical condition. " No response 30078 08/12/06 WA Agree We should have single payor type of insurance. Agree We need single payor insurance. Agree This would be close to single payor and that is good. Agree Agree Agree we need to be free of the current health insurance and pharmaceutical companies and their GREED. 30079 08/12/06 TN No response No response No response No response Agree "I think all americans should have healh care and insurance, regardless of income and insurability by today's standards. Premiums should be determined by income and asking higherincome clients to help the lower. The quality and hospitality of all hospitals and doctors' offices should not be affected by a person's income or insurabiliy." No response 30081 08/12/06 NV Disagree What do you consider very high out of pocket medical costs. I also believe that we should provide medical care for legal persons in this country. The illegal people should not get medicare and freebies. Disagree "* Again, we need to support all legal persons in this country. If we were not paying for the millions of illegal immigrants medical care, we would not have the high costs that we now incur. Also, when you have a CEO of a company making millions of dollars a year and the company is telling the employees that health care costs have gone up so high that they can not afford to give the employees health benefits; I have a real issue. Also, we need to keep our work in the united states or noone is going to be able to have healthcare. The other issues in our country such as outsourcing, letting companies make billions and then say they can not afford health care for their employees is affecting our healthcare. Why not fine these companies that are using illegal immigrants for employees and make the billionaire companies pay there share. The richer get richer and the middle man works and gets no where. " Disagree "Where is the money going to come from to fund these federally funded programs???? Our countries deficit is so large now, what is the government going to trade for the money for the health program??? As it is now most doctors will not even see a patient if they have medicare." Disagree "If the healthcare for end of life is anything like our nursing homes are now, you might as well just have no care and die a sooner death. The people running our nursing homes now should be inprisoned for what they do to our seniors. " Agree "I do agree that all legal americans should have access to a good health care policy. However, what you decide as core services and what I think is core services may vary widely. Every legal american should have access to the health care that they need, whether it be core or not. " Disagree "I can not agree when you are giving a wide spectrum of how this will be financed. If it were not for the middle and lower class workers these large corporations and millionaires would not have their millions and billions. They need to give back to society part of what society has given them. Something should be set up that says if a companies profit is above a set amount, lets say 1 million dollars then that company should be required to pay health care benefits for it's employees. " "* The fact is that we are paying for health care of illegal immigrants in this country and when our own seniors have to decide between health care and groceries, this becomes totally unacceptable. The new medicare plan is a joke unless the senior can afford to pay an extra 100-200 a month and even then they have no optical coverage. So are we supposed to tell our seniors it's ok you don't need to read or see. My mother worked at the same place for 31 years and never had any health insurance. The company she worked for showed good profits but nothing was ever given back to the employees in the form of benefits. America's employers have become so greedy that they just do not care about the workers any longer. American employers used to be proud that they had good benefits and care for their employees. Now they don't need to care because they can send the work overseas (outsource)and make even more money by paying no benefits and low wages. Why can they do this because our government doesn't stop them. " 30082 08/12/06 FL Agree "Although I agree with the spirit of these recommendations I think it is extremely important that it be provided by a single payer as the Veterans Administration is and medicare is with the exception of the drug plan which is a fiasco.It is important that the government have the ability to negotiate for the best prices.The plan should also be extended to include all care not just catastrophic coverage, which is very limimted in scope." Agree The private health payers should not be included in these recommendations Agree Agree The private health payers should not be part of these recommendations Agree The core health services should be public not private and the private payers should not be allowed to compete as was done with the medicare drug plan.The govt should be allowed to negotiate for best prices. Agree The goal should be for the tax system to pay for the core package rather than the private system. 30083 08/12/06 GA Disagree THE U.S. NEEDS A NATIONAL HEALTHCARE SYSTEM LIKE CANADA OR E.U. COUNTRIES. ANYTHING LESS WILL BE CONTINUING TO SUPPORT THE HEALTH CARE INDUSTRIES THE RAPE THE PUBLIC. Disagree WE WANT A SINGLE TAX PAYER SUPPORTED NATIONAL HEALTH CARE SYSTEM Disagree SINGLE PAYER NATIONAL HEALTH CARE! Disagree READ MY LIPS: single payer national health care Disagree "NO, Not ""core health care services"". All Americans will have access to all health care services paid for by taxes. " Disagree "SINGLE PAYER, IE TAXES PAYS FOR ALL HEALTH CARE. " "ALL HEALTH CARE. NOT ""CORE BENEFITS"". QUIT TRYING TO PRETEND THE HEALTHCARE SYSTEM SHOULD ONLY HANDLE SPECIFIC THINGS. " "THE U.S. NEEDS A TAX PAYER SUPPORTED SINGLE HEALTHCARE SYSTEM LIKE CANADA, DENMARK, UK, FRANCE. " 30084 08/12/06 IN Disagree "The prescription Part D plan is greatly flawed. We should have all prescriptions as seniors going directly through Medicare with Medicare having the ability to bargain drug rates nationally. We are simply making the insurance companies and drug companies rich at our expense. It was poorly conceived. For my family of two seniors, living on Social Security and a very modest pension it would be devastating to have the high deductible recommended. It is not realistic for modest income retirees." No response No response No response No response No response 30086 08/12/06 NM Agree We are the only industral nation who don't take care of their citizens health care. We need to get in the 21st century. Agree About time! Agree Agree Agree About time! But don't just give a big chunk of money to the drug caomanies like you did with Medicare Plan D! Agree 30087 08/12/06 MO Agree "* Coverage must be comprehensive. No HSA's for the well-off and second-rate health centers for the working class. Coverage can mean high deductible or only basic coverage. What does 'very high' mean? For me, I must now share in 30% of the cost of regular tests like a colonoscopy. That's at least $500 for that single procedure. My mother died from colon cancer so this is a must for me, yet as a single working mother with a child in college, this is very stressful. If I put off the test until I can afford it, the consequences could literally be fatal. Honest, working people should not be put in this position. When people with good insurance and high salaries are making all the decisions, common terms like coverage and affordable are corrupted." Agree Agree Disagree We must come to terms with end-of-life issues. Agree Agree "* There is currently enough money in the system. We must remove a substantial amount of the 'market force' and profit motive, cap drug prices, stop the marketing of prescription medications, and re-direct that money to R&D. As the Rand Corp. researchers told us more than 10 years ago, ""health care is NOT a normal good, and cannot be treated as such. The only elasticity in the demand for health care is in the primary and preventative areas. All other demand is driven by providers"", so remove the incentives that encourage Drs. to over-prescribe treatments and tests and remove the financial incentives that drive the pharmaceutical industry to become drug pushers to increase profits. Address the extreme administrative overhead in the insurance industry. Not every facet of our daily lives should be made into an opportunity to maximize profits. We know what to do - are we just too greedy to do it?" Please do the right thing. 30088 08/12/06 IL Agree Agree Agree Agree "We all know that each of us must die; there's no way around that and at the very end passing from this life should be made as painless, in every way, as possible. Not only for the dying but for the remaining family. There should be a continuing relationship with the family to ease grief." Agree "There is no excuse appropriate to leave any person without health care and financial help. This, the richest nation in the world, should spend the trillions of dollars on preserving the health of its people and stop with the war in the Middle East. We should be the caretaker of world health. We then would be respected." Agree "All the people must participate in paying for a national system. It should NOT be administered by insurance companies or pharmaceutical companies or any company related to the health industry. It should be modeled on the Social Security System. However, no one should be allowed to borrow from it for any reason. Social Security was financially stable until borrowing and never paying back started. UNDER NO CIRCUMSTANCES SHOULD ANYONE BE ALLOWED TO BORROW FROM THIS NATIONAL HEALTH GROUP." 30090 08/12/06 CA Disagree "The majority of respondents favored a national health program, which is “financed by taxpayers, in which all Americans would get their health insurance.” This implies a program which is public, not private. A program financed by taxes would not require premiums, co-pays, and deductibles for financing and therefore out-of-pocket costs could be minimal. This makes “financial protection for low-income individuals” unnecessary. " Agree Disagree "The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to administration, advertising and profit and replacing them with a single payer like Medicare with only 2-3% spent on administration." Agree Agree Disagree "The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to administration, advertising and profit and replacing them with a single payer like Medicare with only 2-3% spent on administration." "Comment: There was a clear preference among respondents for a fully comprehensive benefit package. A core benefit package should cover all treatments deemed medically necessary by an individual’s health care providers to address physical, mental and dental health." "Final Comment: The Working Group should recommend a specific date for implementation of a national health program, for example 2012." 30091 08/12/06 NY Disagree "* Healthcare is a human right and should be treated as such. It is not a privilege reserved for those who can purchase it like a commodity. Protection against catastrophic expenses is useless in terms of our collective public health. People with high deductible policy, delays seeking needed non-emergency care and refrain from using preventive care. in the end they wind up with more rxprnsive conditions. As long as we allow the health insurance industry to profit from sickness and siphon off 25 cents of every health care dollar, we will never control our collective sky rocketing health costs and bring in the 45 million uinsured americans into the system. We have in this country a wonderful, equitable, democratic system of universal healthcare. It is callled MEDICARE and it is universal for people over 65. Let us expand it to everybody. By including the young and the healthy, we will save enough money to cover everyone for all needed care." No response No response No response No response No response 30093 08/12/06 MI Agree Coverage should be limited to citizens only. Agree Advising groups should be research based as opposed to special interest lobbiests. Agree "Great care should be taken to avoid an HMO style structure where medical practioners are placed as gatekeepers to specialized or alternative care that they have little or no training in. ( or worse, an indoctrinated prejudice against)" Agree Agree Agree There needs to be a financial disincentive for those who choose to perpetuate any unhealthy lifestyle that would increase costs to the system on their behalf. "Emphasis must be on preventive measures, early detection and utilization of conservative approaches as primary care. All choices regarding inclusion or exclusion of provider types and services should be made on independantly obtained research . If gatekeepers are to be installed, they should be licensed in and practice the specialty they are to oversee." 30094 08/12/06 MA Disagree "Recommendation is slanted. Current system is more abused than it is broken. Although it sounds reasonable and humane, define very high health costs, without a definition of ""high"" vs. ""reasonable"" cost, you can't determine. ""Americans"", is that USA citizens, illegal aliens, who are the ""Americans"" that you are going to cover? What is ""low-income"", in my state many ""low-income"" recieve benefits and ""services"" that I at a ""middle/high"" income can't afford to provide for my family. " Disagree Another way to pork barrel. Disagree "Ultimately this defines a ""restricted"" care system, with a one-size fits all mentality." Disagree "Again one size is fitting all. The programs currently available tout their ""individualized"" or ""custom-structured"" care planning, but they don't deliver!! This ignores the human nature of the medical, ""care-giving"", and social services professions. That is basically ""We know what you need and that is what you will get"", or if you want a less standard package (and have an advocate) ""We will give you what you want, but we'll set you up for failure, because we know best""" Disagree It should be public policy that all USA citizens have access to health care. It should be public policy that healthcare costs are reasonable and reflect actual value/cost. Disagree "* Since the USA voter will never agree to the 25% to 45% additional or value added taxes required to finance an brand-new ""rationed"" system, a true solution is probably unreachable. Instead we will be forced into a set of hidden taxes, or taxes on the working sector that pay for the benefits of the unworking or limited sector. This will involve another ""National"" trust, like Social Security where money currently paid in supports the money paid out, ponzi scheme, and our politicians feel free to rob or divert as they see fit." "A ""core"" package is also a ""restricted"" package, or a rationed package. No one should wait 6 months for an MRI as they do in Ireland, with it's universal coverage. No one should die, while two divergent experts argue over treatment, and surgery and treatment are delayed while ""evidence-based science, and expert consensus"" are determined." "* Yes, there is all this nonsense about ""independent, fair, transparent and scientific process"", ""evidence based science, expert consensus"", and of course ""fairness and shared responsiblity"". Has anyone heard that ""medicine is as much an art as a science"", or ""when everyone is responsible than no one is"". The majority of American's have health insurance, of those who don't a percentage choose not to avail themselves of health insurance that they must contribute to. Others are eligible for health programs that they don't join. Insurance companies negotiate rates with doctors and hospitals, but also have an ""uninsured rate"" that bears little resemblence to the actual cost ( MY personal hospital bill (for a bout of diviticulitis that had a less than 30 hour stay) was $14K, what the insurance company paid was only $6K, still totally unreasonable, but there has to be at least $8K of padding anyway you look at it). This was a ""for profit"" healthcare org. hospital, they satbilize and transfer the uninsured. I " 30095 08/12/06 FL Agree * Low income get Health care paid for by taxes They know they get bit withoiut working The mid income worker pays for everyone because they work so they can be forced to pay for the low life minorities that have illigitimate babies and also the prison system that get free healthcare for being imprisoned i am sick Having to work so that I get health care while we continue to support the SLUGS what are you doing about that I am an RN underpaid and they wonder why tere is a nursing shrrtage because of the above we do the work and others get the benefit and the glory Agree People are lazy they get something for nothing they will continue to not make better choices to get out of the muck there is free lunch and I am paying for it and really sick of it Agree the seniors dont have enough to buy their medicine they have paid their dues an dthe government is SCREWING them the medicare people are contiually looling for free and contine to reamin disabled because the still get money for saying they are sick The whole system stinks and perpetuates low lifes minority too bad for the working class whites Agree If you have good insurance and funding Doctors will give you all they can to milk the system if not you die sooner Agree It will always be that the poor will continue to not make a better choice for their life so thta the working will pay for them The system should be that IF YOU ARE HEALTHY THEN YOU PAY LESS why should I pay for someone who smokes and overeats they are sick and I have to pay becuse of there stupidity and ignorance Agree The insurance companies DICTATE the health care provided Some clerk or supervisor says whether someone will get a treatment or medicine based on the cost and the amoutn the patient can and will pay I dont know how they sleep at night and are going right to hell and it doesnt happen to their relatives does it? OK Another group that gets paid alot to sit round for the next 10 years and trvael on my dime to pretend to be worling on this Is there really an answer in this lifetime Good luck please publish what I wrote 30096 08/12/06 CA Agree "* My sister in law has worked across the street from the California State Capital at a small food store for 14 yrs. She is there daily at 5am, ready to serve the many state workers their coffee, etc. She observed the crowds for Arnolds inaguration. She has had 3 ""mini"" strokes, sending her the the ER via ambulance each time. They usually admit her a day or so, stabilize her, send her home. Very serious stuff. She has high blood pressure, and diabetes. Usually the ER physicians give her about a 30 day supply of meds. And then that is all. No follow up care, no follow up meds, or any way to get them. So she goes back to work, to help all those lawmakers enjoy their AM coffee. She has no sick benefits or health insurance at her job. She makes $8.80 per hour. So, these trips to the ED are paid for by taxpayers. This is really expensive. Preventative care is much less costly. Preventative care in her case would not only save the taxpayers, but also save her life. I am in the health care field, and this is v" No response No response No response Agree "* My sister in law has worked all her life contibuting to our economy. She deserves as an American citizen to save her life. High blood pressure & diabetes need preventative meds. She works 40 hrs a week for $8.80 per hour. No government help. Taxpayer. why are we watching her die, due to no preventative health care. Or, heaven forbid, she will have a severe stroke (shes already had 3 Mini), which will send her to a nursing home, and have no quality of life left. Or be able to go to work at 5am every day for $8.80 per hour. At that time our government will finally help her, they will have no choice." Agree "If the state and federal government would stop being in denial about what is really going on. See how much of a tab they are picking up when the uninsured get seriously ill. I think it would balance out, and possibly also have an income based co-pay for health coverage." 30097 08/12/06 MN Agree No private form of funding will ever be as cost effective as a public source of funding. I agree that there should be a national insurance policy that covers everyone. I do not support any private funding of this program. No response "I don't know. I think that I don't agree. I would suggest all doctors be private, but would simply be paid with public money. I would ban private payments for any service that is covered under the public plan. But if we still needed public centers I guess that would be okay. " Agree "I would like to see the working Medicare program expanded to cover everyone. I want it to be paid for with progressive income taxes. I want the doctors to be private as they are today, but to be paid through progressive Medicaid income taxes. Then we still have competition for business, but everyone is covered. And, most important we do not have fat cat medical insurance executives skimming money off the top." Agree Agree "This should be paid for with taxes, not employee contrubutions. I do not want financial assistance. I want progressive taxation. Our health care plans should not be limited by where we work. The plan should follow the individual and not end abruptly when employment ends." Disagree "* No. The only fair way to pay for this is through progressive income tax. Why do we need a smooth transition? I have never had a smooth transition. One week I am covered the next week I am not covered. One week I have a job. The next week I have no job. You prepare the paperwork in advance, set a date, and then start taxing everybody and enroll everyone on the same day. On the same day all private insurance plans are either cancelled or altered to only cover what the public plan does not cover. Then you can insist that all private extra insurance companies use the same paper forms. The taxes will go up for those without insurance now, but those people already paying high health premiums will likely see a slight decrease in their share of taxes compared to their health premiums. " Why would you ask those who stand to lose money and their jobs to decide what is to be covered under a national plan? They are likely to try and keep the program expensive. Doctors and citizens should decide. CEOs of medical insurance companies should be banned from participating. It is in the public interest to put them out of their job. They will not go willingly. They will do everything in their power to sabotage a public system so they can continue to make absurd profits. "* I went without insurance for many years, 5 or 6. I always thought I would simply die if I ever got cancer or something else bad. I was willing to pay taxes for medical insurance while employed, but that was not asked of me(other than medicaid tax). And, none of my employers offered insurance. I have a friend who was self employed and had individal insurance. When his wife had complications while delivering their baby his insurance just decided they would not pay. It cost them some $20,000 out of their own pocket. There is really no way to guarentee that any insurance company will honor its agreement with an individual, so even if I could have afforded it I would not have bought a private plan. I then had an ectopic pregnancy and needed emergency surgery. I paid nothing for this surgery as my income was very low at the time. My surgery cost people who buy insurance through their employers extra in higher premiums. My little sister and her kids helped pay for my surgery with higher premiums. She i" 30098 08/12/06 CA Agree "The only way for a highly developed society such as this one to responsibly care for its citizens is by a socially based system in which all risk is shared. A society's health care need should not be a commodity to be traded on the stock exchange. As in all other highly developed societies,we need a government based tax system. " Disagree "I cannot agree with a system that includes ""private""" Agree Disagree The system should be totally publicly funded Disagree "We do not need financil assistance with payment to commercial interests, we need a totally shared risk system " Agree 30099 08/12/06 WI Agree "I agree and believe that the current position in regards to Medical Savings Accounts (MSA) fails to adequately help all. One must have money to put into these accounts. Of course huge numbers of the working poor do not have funds for MSA's. Thus, while MSA's may have some use they tend to fail to help the people who need it the most. Thus any solution must be a genuine solution that addresses the needs of all." No response No response No response Agree "I have not had the time to read this report in full but I do agree with the ideas I have had some time to look at. It is past time that America deals with the large number of uninsured. This should be one of the foremost domestic issues being dealt with. Unfortunatly it seems to sit on the back burnner. Providing some basic, quality health care to all should be standard. " Agree I agree with this reccomendation. I think it is especially important that this nation establish true mental health parity for biologically based mental illnesses. There are far too many individuals or families who face financial devistation because a loved one has a mental illness that is not insured. The brain is an organ of the body and just like any organ problems can occurr. Failing to adequately insure biological based mental illnesses should be an archaic policy of the past. 30100 08/12/06 CA Agree National health is a given in most countries. Ask yourself: do you consider money more important than health? No response No response No response No response No response 30102 08/12/06 OR Disagree "This is not a solution. Something must be done to control costs from the outset. Don't focus on protection against very high costs, but in making those costs more realistic and balanced! The governments power and influence should be used to negotiate lower costs for everyone." Disagree "This would not bring better health care, especially for those most marginalized. Community health networks have a well known reputation for substandard care. We do not need care focused on this or that population - we need UNIVERSAL health care and insurance." Disagree "You've got to be joking - the Medicare/Medicaid systems are NOT good models, neither is the VA! Best practices according to who?? Reduction of fraud and waste - why not include doing something about the unrealistically high fees and costs that doctors and hospitals charge? Why is disease prevention near the bottom of the list? It should be top of the list! " No response Disagree "I notice you don't mention the model used - such as a $30,000 deductible. You're apparently not listening to the American public! What will be the set of core services, and will the quality be any better than we have currently? I don't really think that anyone involved in this group has an interest in more than just promoting the administrations/governments interest in avoiding truly positive change! We DO NOT need consumer driven health care - we DO need UNIVERSAL health care insurance and care!!" Disagree "If you were truly interested in fairness, efficiency and shared responsibility you would be more willing to explore and consider options that exist and are successful in other countries, such as Sweden." "Too narrow a focus. Too easy to appoint members that will ""tow the party line""... Why aren't alternative care/treatments included in any of this???" "You've managed to take what the American public has said and rework it to the benefit of the government and the health care and health insurance industries. What you present here IS NOT what the American people want - but then, you already know that, don't you?" 30105 08/12/06 CA Agree Agree Agree Agree Agree Agree "* I believe financing revenue streams should come from for profit businesses, corporations and the Federal Government and NOT from individuals and families. If taxes are necessary they should be placed on the small percentage of wealthy Americans and not put additionl financial burdens on the working middle class and poor citizens of our country, The growing economic split in our country between the richest Americans, Corporate executives and the rest of us is a shame that should be addressed in the formation of new strategies for Health care coverage in the United States." * Every attempt possible should be made to ensure that Doctors and patients are the ones who determine the appropriate health care core benefits provided by the system. For profit private health care providers should not make choices on which core benefits to offer based on economic and profit motives. Our Health Care System should continue to support research and development in all the sciences that will maintain our leadership and inovation in health care and medical practices for the entire world. Thank You 30106 08/12/06 OH Disagree "Health care is something that should be available, free of charge, to every one in the world, but certainly for all the people in this, the richest country in the history of the world. It is tantamount to being ridiculous for a country, where some individuals can enjoy multimillion dollars of income each year, to be taxed at less than 40%. An increase in tax rates on these incomes would easily pay for universal medical care. " Disagree "Why such a proposal? Why don't we want to have all people, regardless of where they live, or their income, recieve equal care? I find it impossible to believe that so many people in this country consider themselves Christians, yet turn their backs on the unfortunate." Agree Such is for what we should strive. Disagree "The idea here is something I support, but what does ""private"" payers mean? It sounds like an effort to keep the expensive middle funtion, (the HMOs) in the picture." Disagree The issue of financial assistance for health care is--in my opinion--un American. Agree Financing should be done by increasing the tax rates on the obscenely rich in this Country. "I think I agree with this, but I also have questions regarding its meaning." "I just received a letter from Senator Voinavich, stating that he and Senator Bingaman, are pushing a bill--Health Partnership Act(HPA),S.2772 --that turns the problem over to the States, and gives them five years to decide what they want to do. This amazes me. Why was the ""HEALTH CARE THAT WORKS FOR ALL AMERICANS"" even started? Another waste of my money, and why would anyone want to have such variances in health care provided to people--which would happen?" 30107 08/12/06 TX Disagree "I don't really think you listened to the peoples opinions. If there is taxpayer supported insurance coverage, who will pay that part for children, disabled people and those people who don't work or contribute to society." Disagree I think it is about time people start taking care of themselves and not depend on the government to take care of them. Agree "I think this might be viable if fraud, graft and political pork can be eliminated." Agree There certainly needs to be training of health professionals especially in communication with patients. Hospice care and end-of-life services are wonderful but can this be done by public services? Agree I do agree that all Americans should have health care services but would this burden once again fall on the middle class which is almost disappearing. Disagree If everyone were able to carry their fair share of financing this type program that would be great but I am quite doubtful he could be done. I think we have too many committees now who are rewarded for support of political candidates. Health care for all Americans is a noble cause and I do hope something can be done fairly. 30108 08/12/06 CA Disagree "Most of us in Los Angeles favored a national health program, ""financed by taxpayers, in which all Americans would get their health insurance."" That means a public, not private, program, financed by taxes, not premiums, co-pays, or deductibles. That also means financial protection for low income indiviuals and families is irrelevant." No response No response No response No response Disagree "The most efficient way to finance health care is to eliminate private health inusrers, which allows 30% of health care costs to go wastefully to administration, advertising,and profit. We thought that Medicare's single-payer system with only 2-3% spent on administration is the one we should use." "The majority of us wanted a fully comprehensive benefit package, covering all treatments judged medically necessary by the individual's health care provider, not and administrator, and offering physical, mental and dental services." We agreed that The Working Group should recommend a specific date for implementation of a national health program. 30109 08/12/06 CA No response "I think we need to keep Goverment out of the Health care. We simply can not afford health care the way Gov. spends on anything it controls. We would still have to fund health care, it would just be masked as something else." No response No response No response No response No response 30110 08/12/06 KS Agree "America cannot afford residents with poor health. Poor health impacts the economy, the job pool, and social services." Agree "Some public/private health partnerships are working very well. Some innovative health services are working well. These need to be publicized widely in communities, beyond the narrow health care organizations. In addition, states with antiquated medical and dental practice acts need to be challenged to modernize." Agree Agree "Americans need to have right to die services, ones that assists them to terminate their lives when they wish. American policy against suicide is barbaric. It forces narrow religious values on people who hold different perspectives about life and dealth." Agree Agree "My trust of our federal government -- administrative, legislative and judicial -- is quite low. This community-involved process is interesting, but nothing of substance will come of it." 30111 08/12/06 MA Disagree The national program must be public not private. Check out the Labor Party plan. That plan is foolproof. Private means CEOs and gouging! Disagree Stop stalling. Universal healthcare for all is possible now. Check out Labor Party plan and get going! Agree This is basically what we're after. But Labor Party plan is best of all and easy to understand. Disagree Stop stalling! Single Payer coverage is long overdue. Labor Party plan is the answer. Agree Disagree The Labor Party plan covers this beautifully. Check it out. The Labor Party plan takes care of all of this. Check it out. Single Payer Health coverage is essential to this country. The Labor Party has the answer. Check it out and let us go forward. 30112 08/12/06 MN Agree It is a sad state of affairs when the richest nation in the world does not provide a basic human right to its citizens. Agree Agree Agree Agree "Everyone has a duty to pay into the system, and everyone has a right to high quality health care." Agree 30113 08/12/06 TN Agree "If necessary put an extra tax on all Americans. As many as we have, one more won't hurt." Agree "More taxpayer money, but needed!" Agree Agree Agree Way over due! Agree Health or health care tax! Most people wouldn't invest on their own. There's always something needed at amoments notice and only those with above aveerage salaries would invest. 30115 08/12/06 TX Agree "* It is time that health care becomes a citizen right rather than a product available to those who can afford it. How can we claim to be ""pro life"" or a life-affirming society if we do not assure care for all lives and genuine access apart from an income level that allows one to pay the current price for such care? Few who cannot afford healthcare are choosing to be impoverished, and with the growing economic divide between the wealthiest and the majority, the spectre of unaffordability of healthcare keeps rising up through the ""middle classes.""" Agree "I wonder if the key might be to move away from the ""healthcare industry"" mindset, with its strong links and significant undergirding of Wall Street, to a focus on CARE for the health of the body politic as a cultural value and national priority? I agree that public/private collaboration and focus on evidence-based practice and efficient service delivery divorced from the profit motive constitute a legitimate basis for governmental involvement in the healthcare system. " Agree "* The ability of government programs to gather/integrate/digest/evaluate masses of information about evidence-based practice--and to commission research to further enhance evidence regarding best practices--and to leverage lowest cost access to treatments and technologies makes it a necessary component of a healthcare system for all Americans to involve governmental participation. Government also can set the stage for the professionals in creating a national focus and value on responsible life choices/wellness/routine health maintenance care that will involve more regular utilization of basic healthcare and likely will reduce the frequency of need for ""high end"" health services and the very costly treatments of advanced health problems. Education and prevention have long been known to professionals as important components of a healthcare system but also have long been excluded since the focus has been on treatment and more heroic interventions with serious maladies. If a national system of healthcare is t" Agree "* As much as we like to think it only happens to others, death will confront every one of us. Extremely costly efforts, born of Western ingenuity and research, are marketed as last ditch sources of hope to extend life and it seems normal to choose every means to stay alive rather than to accept that death is inevitable and imminent. Expanded and culturally sensitive services to support the dying and their families to face the end of life with dignity and readiness and supports that minimize devastation for all involved--emotional, financial, physical, spiritual, relational--are components of a good fit of health care for this final stage in the human LIFE cycle. Palliative care and hospice should be prioritized services in a national system of healthcare for all Americans." Agree "* I believe that Americans need to adopt the frame of reference of a social contract that recognizes a responsibility, through government as our collective means to act, to assure the well being of all members of our society. It logically follows from such an orientation that all Americans should have affordable access to health care and that the quality and timeliness of access should not be determined by one's level of income/ability to pay a price for priority treatment. Other countries do provide such a system, generally for less cost than in America, and have good health outcomes. I believe than engendering a sense of caring about the well-being of all, even those who may choose to live by different tenets and lifestyles than I, will set the stage for expecting high quality services to become a norm for our society. I also anticipate that ""rationing"" will be inevitable. As more and more esoteric and costly treatment options are developed, many with very limited long-term benefits on average, it sim" Agree "* April 15 has never been a day of celebration on my annual calendar, and I do not foresee that this will soon change. I will say, however, that I feel far better settling up with the IRS if I believe my money is going to further Good than when it appears to be furthering that which I disapprove. As I previously mentioned, I also believe there needs to be a sense of social contract as a society to care for all who comprise our society. I therefore suggest that we have to acknowledge that no major government initiative can succeed without having appropriate levels of funding and that this is not going to happen without gathering adequate tax income. Windfall tax breaks to the wealthiest among us are an affront to any effort to create a system that can assure a safety net and core health care access with quality for all Americans. Just as the risk pool for large-scale insurance plans means some pay more/others pay less compared to the benefit reaped each year, it is appropriate that the same apply nationa" "I think this recommendation is fundamental/encompasses most of the others and reflects a general value that health care is broad and encompasses many dimensions of life and health--which are inter-related in the overall pursuit of ""health"" or wellness." "* I don't know how to relate it to any specific recommendation or how to state is elegantly. I observe, however, that there is a centripetal force working against the goals of the Working Group and the consensus recommendations. Not all Americans choose to be healthy or to tend to their health, yet they can consume high levels of resources as care providers try to rescue them from themselves or utilize health care resources not in pursuit of health but of ulterior motives. For all of the controversies and intense emotional reactions generated by managed care practices, I suspect there is an ongoing role for professional review of utilization of resources and shaping of policies that not only guard against fraud and waste but also against extension of treatments that are not likely to result in better health (I work in a context of mental health care)." 30116 08/13/06 CO Agree "The one caveat is that in order to provide cost-effective health care for all, private for-profit insurance must be replaced by not-for-profit insurance." No response "A true ""health care safety net"" would be best provided by a single-payer, single-risk-pool health coverage, the most cost-effective health coverage there is." No response "Medicare, Medicaid, Veterans health, workers' compensation and all health programs could be rolled into a single-payer health program that would cut costs for everyone, including taxpayers." Agree "With single-payer insurance, long-term, hospice and home care could all be options, based on an individual's needs. Often now, Medicare and Medicaid will pay for more costly nursing home care, while denying home care that would be less expensive an may be more desirable." No response "All Residents should have access to all needed health care services. This would be possible with a single-payer insurance coverage. The words ""core health care services"" imply limited health coverage, such as many have now." No response "I see no mention here of the need to reassign current health care spending - e.g., the >$300 billion that goes to profit and high administrative/overhead costs. If these funds were rerouted to health care by eliminating for-profit insurances, a progressive tax of individuals and employers would cover all residents at less cost than we now spend to ensure less than 85% of the population." A 2-tiered health care system ultimately costs more than covering all for necessary health care. "A lot of the language in these recommendations sounds very much like a hedge against honestly assessing current high costs of for-profit insurance and creating a truly cost-effective health care system. Instead, it sounds too much like the futile efforts at incremental approaches that have utterly failed. Until there is a willingness to address the true source of high health costs - that is treating health care as a profit center - there will be no real progress made in solving the U.S. health care crisis." 30117 08/13/06 VA Agree Agree Agree Agree Public awareness needs to be raised about these options. The options listed above also need better funding and support. Agree Agree 30118 08/13/06 FL Agree LOOK HOW MUCH MEDICARE HAS GONE UP. WE CAN HARDLY AFFORD IT. IT REALLY IS EXPENSIVE. Agree THE GOVERNMENT SHOULD BE RESPONSIBLE FOR HEALTH INSURANCE. LOOK AT ALL OF OUR MONEY THEY GIVE TO FOREIGN COUNTRIES. Agree THEY RAISE THE PRICE OF MEDICARE EVERY YEAR. Agree THEY SHOULD BE SUPPORTED. Agree YES THAT WOULD BE WONDERFUL IF ALL AMERICANS HAD HEALTH INSURANCE. Agree YES WE SHOULD BE ASSURED OF HEALTH CARE NO MATTER WHAT. YES THE CORE WOULD BE A GOOD THING TO JOIN. 30119 08/13/06 CA Disagree "Not more private for profit coverage; single payer universal coverage, or Medicare for all." Disagree "Again, help for health issues needs to be non-profit, government sponsored, based on ability to pay." Disagree provision of services is the key componenet for every US citizen. Disagree Hospice has both governmental and non-governmental agencies to help w/end of life issues; we need more help toprovide services Agree Financial assistance? why not services will be available to those who need them? Disagree "Medicare is a proven model for universal health care; if we spent the $ now going to sponsor the war in Iraq, we could easily care for all." "No group will be able to make a fair and consensual decision when this group the citizens health care working group doesn't listen to citizens, or respond to what they need." "You seem a token group, one more useless committee, more wasted time, in solving health problems" 30120 08/13/06 CT Disagree "Focus on catastrophic care misplaced. Major concern is payment of ordinary medicl and drug bills and creatin of a cheaper system,with less benefit to the pharmaceutical and insurance industries. Why not universl Medicare?" Disagree BEnefit to drug and insurnce companies must be excluded in creating this infrastructure and must be spelled out. Agree Disagree "Why not encourage hospice services nd give just palliative care to those with very limited time left, rather than devote extensive and expensive medical attention to this group?" Agree Agree how about tax increases dedicated to support a new system of health care? 30121 08/13/06 IL Agree it needs to be public. first off they need to limit the % of profit companies can make. if it is over a certain amount it is immoral & goes back to the people they exploited. workers should not be bankrupted by medical costs. Agree we need federal laws & standards so people in the medical fields wont travel to states where the laws suit them best. but medical care must be administered locally because they are best able to determine what is needed. Agree a start would be to allow all groups to negotiate for benefits. we need a single payer system to lower administrative costs among other reasons when everthing is said & done. Agree it should be public. Agree free health care for all. it should be based on need. not ability to pay. Agree "we need universal coverage for all, a single payers system. big business & the rich should pay for it. 1 because big business benefits from the workers being health. 2 they dont pay their fair share of taxes because all their wealth is ill gotten. by not paying the workers what their worth & overcharging the consumer who are one & the same their profit is gained." preventive care should be instituted first. a stitch in time saves nine. second alternatives for emergency room visits for non emergency situations should be instituted based on need not ability to pay. because people who cant afford medical treatment go to emergency rooms for treatment. this is more expensive for the tax payer & the patient doesnt receive follow up care. eventually a single payer system for all must be instituted. the capital system has failed! 30123 08/13/06 FL Agree medicare should be expanded to cover ALL americans No response No response No response No response No response 30124 08/13/06 CO Agree Agree My concern is how that federal department is selected. We don't need another Mike Brown from FEMA. We need Congressional oversight on any appointments here. Agree Agree Agree This is the heart of it. Agree "Maximize public spending for public benefit. Don't go the route of ""privatization"" which is Republicanese for putting public money in private pockets. E.g., the Dept of Defense, the Dept. of Homeland Security, etc." Does this include vision? hearing aids? I'm so glad to see mental health included. 30128 08/13/06 MI Agree "This is an essential component of any rational health care system. The fact is that too many people are forced to declare bankruptcy because of exposure to high medical bills. Not only does this destroy families, it undermines work productivity and exacerbates existing economic inequalities." Agree "* While I agree strongly with the recommendation, I would like to add three comments for your consideration. First, you should explicitly include free clinics in this recommendation. Not to demean the contributions of FQHCs, but they are not the only player in the local health care safety net. For many uninsured people, free clinics are the only health care venue available. In short, free clinics are integral to the local health care safety net and should be included in the concept of developing integrated health networks. Second, an important aspect of developing integrated community networks is to provide individual patients with the ability to access the local health care delivery system. Some type of health literacy campaign should be a part of this network. That is, the network is a necessary but insufficient strategy. The question to be considered is what do you want the network to achieve. That leads to my third comment. It is easy to specify the need for integrated community network" Agree "I agree, but it's difficult to operationalize under current circumstances. States lack the financial resources to achienve these goals, and the federal government lacks the political will to fund them adequately." Agree "OK, but not high on my list. Hard to disagree that we ought to do this, but the connection to the uninsured is unclear. In my view, it would be better to focus on prevention. I agree, though, that a focus on chronic illness will be very important for uninsured populations, especially given obesity and diabetes rates." Agree "In my view, this should be the first recommendation. Everything follows from a defined commitment to achieve this goal." Agree "* Sounds like you're punting on the key problem of how to pay for the care. I expect that most Americans share the broad goal of access to health care for uninsured populations. Where the consensus falls apart is how to pay for it. Since we live in a time of rampant inidividualism and a fear of any collective social responses or responsibilities, the potential financing strategies are politically taboo. Nevertheless, it will take increased taxes, allocated to health care uses, to achieve the recommendations. Everything else is tinkering at the margins." What this group must do is explain to the American public why there must be some limits and why the limits selected are fair and just. Congratulations on a great effort. I hope your work contributes to expanding access to health care for all Americans. 30129 08/13/06 NM Agree "It's a fantasy to believe that we are not already paying for these problems via insuranced premiums and taxes,lost days of labor, etc. for the inappropriate use of the emergency room for primary care or problems that are not addressed until they are very serious. Coverage for everyone will help to increase preventative medicine which also decreases costs." Agree As above. Agree "I would add some initiatives to help health care providers - most ""fraud"" is a failure to understand or have time to wade through massive books of federal regulations on coding and billing and shouldn't be approached from the current view of guilty/greedy until proven innocent." Agree Agree There should be some element of sliding scale - those who can affford it should contribute at least some of the cost. Agree "* As a physician, I also have to address the additional cost and strain on the system of practicing defensive medicine and malpractice costs. Unfortunately, from the experience of myself and other physicians I know, the majority of ""malpractice"" cases occur when patients have adverse outcomes that are not the result of negligence or poor practice. While patients need to have the right to sue for actual cases of malpractice, this needs to be removed from the arena of lawyers and juries and dealt with (as they do in Europe) by independent panels of MD's who understand the issues at hand and can distinguish between malpractice and adverse outcome. It will never be possible to lower the cost of medicine in the US as long as physicians order unnecessary tests because they fear litigation, or the patient insists or threatens to sue. Imposition of evidence based medicine will only help in those cases where there is good evidence and only when juries are removed from the picture so they can't be swayed by emotio" 30130 08/13/06 NJ Agree "The best way to accomplish this is the eliminate the insurance companies role in health coverage and provide Universal, single-payer, cradle-to-grave coverage for all. The success of Medicare (other than Part D) shows that government does this much more efficiently than the private sector." Disagree "Except for the healthcare providers themselves there should be no role for private enterprise, which means money wasted on profits to the owners, in our healthy care system. This type of thing is what government does best, if it is committed to it and wants to make it work. The goals set forth above are worth pursuing, but the private sector must be booted out!" Agree As long as the private sector (other than the providers themselves) is booted out! There should be no money wasted on providing profits to corporations. Agree Provided that no money results in any corporate profit. Health care money that yields corporate profits is wasted money. Agree "Amen. It should be a Universal, cradle-to-grave, single-payer system, which yields ABSOLUTELY NO PROFITS to any corporation." Agree "* It should be financed through taxes paid by all employers on wages and on all capital gains. The tax will certainly be less than is now being paid by those employers who are providing decent health care coverage to their employees (so the change will reward the good employers) and all employers must be required to pay (employers should not be able to increase their profit by denying health care coverage to their employees). Capital gains payers should also share the cost. Their gains stem from some flesh and blood person's labor, and the coup[on-clippers also require care, they should help pay for it. Universal single-payer coverage will end up costing less (as a percentage of GDP) than we pay now by eliminating a great deal of the administrative costs and by ELIMINATING ALL CORPORATE profit." "There is no need for the US to reinvent the wheel. Most of the industrialized nations have a government-sponsored system that works better in terms of providing health care to all (measured by such things as infant mortality and life-span) than ours presently does. Implementation of a universal, cradle-to-grave, single-payer system is long overdue and should not require years of study." "Corporations, particularly insurance and pharmaceutical companies, have exercised much too much influence in the health care debate. It is time to address the real needs of ordinary people. Eliminate profit from the system, or at least limit it in the case of pharmaceutical companies, and the problem of excessive cost will be solved and we will all be better off." 30131 08/13/06 KS Agree Agree Agree Agree Agree Agree 30132 08/13/06 NJ No response No response No response No response Agree No response 30133 08/13/06 KY Agree I beleive that the government does not monitor and control private insurance companies enough. Disagree "I fear anything the federal government is leading at this point in time. I have little faith in its ability to reach a goal, and fear the money would be wasted away politically never accomplishing a thing. " Disagree Agree No response "I neither agree nor disagree. My frustration stems from the abuses of cash income earners not paying taxes or claiming income, yet receiving free healthcare. " Agree "Uncertain, but I believe moving more to a higher sales tax or a federal value added tax would be best. This way it is based on spending and cash that illegals and cash earners make will go towards it, as well as legitimately earned dollars. A decrease in income tax to offset it is necessary. " 30134 08/13/06 NY Agree Disagree "This has ""bureaucracy"" written all over it. God help us!" Disagree "There may be some useful ideas in this recommendation, but the very notion of an integrated health care system sends a shiver up my spine (are we next to speak of integrated health care system/patient relationships instead of doctor/patient relationships?, and I wouldn't trust a government solution unless it was built squarely on something that already works, eg medicare when congress doesn't interfere with it." Agree Agree Agree "Everyone could be covered with money to spare by streamlining the administrative burden on doctors and by administering benefits though medicare, eliminating all insurance company overhead and profit." 30135 08/13/06 NJ Agree Agree Agree Agree Agree Agree "What we need is federally-administered, single-payer health care that provides for all Americans. The rest of the civilized word does this and there's no reason (aside from corporate interests) why this country shouldn't." More medical professionals than ever before are in favor of a single-payer national health care system administered by the federal government. "This is a step in the right direction, but we still have a long way to go, and it will be a struggle that will make the fight for Social Security and the fight for Medicare look like tea parties." 30138 08/13/06 FL Agree Agree Agree Agree Agree Agree "America needs to redefine it's priorities so that it can have less guns and more butter. We need to promote, through government action, more effective and productive health care. More investment in the administration of health care at all levels is needed as well as a compassionate policies that recognize the great disparities in health care access." 30141 08/13/06 FL Agree Agree Agree Agree Agree Agree 30142 08/13/06 WI Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to devel" Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recom" Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recom" Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recommend" Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recom" Disagree "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recom" "* Over the last year, the members of the Citizens’ Health Care Working Group—a group of 15 health care experts—have traveled around the country seeking the American people’s view on health care. In June, the Working Group drafted six recommendations to Congress and submitted them for public review. Reading those recommendations, it’s clear these experts have not been listening. Overwhelmingly, in the Working Group’s public meetings and online polls, the American people have said they wanted a health care program run by the federal government that covers everyone. We call that Medicare for America. That’s not surprising: polls regularly show that 70 percent of the public support a “single payer” system—the system used by every other industrialized country to provide higher quality health care for its citizens for much less than what the United States spends. But the Working Group recommendations do not reflect that view, even though its mandate from Congress is to develop recom" 30144 08/13/06 IL Disagree "The recommendations are vague, without specific objectives and time-frames, and are a product of yet another 'task-force.' To me, one of the reasons American organizations are less competitive with those in Canada and parts of Europe is because those countries have national health insurance. This decreases costs for organizations by at least 25%! This is doesn't even include the moral rationale for national healthcare." Disagree "Establishing yet another organization to provide checks and balances on a large federal government has not worked in the past, is not working now, and will not work in the future. We need to demonstrate to the mostly Republican opposition to the current safety-nets of Medicare, Medicaid, and Social Security of their moral importance, necessity, and contribution to the national economy. We also need to use the resources we have: -Voting -Respectful, honest lobbying -Educating consumers, etc." Disagree "The idea of government mandates of specific treatments or any similar intrusion in the doctor-patient relationship is troubling. Although best-practice approaches are helpful, would this end the off-label use of medications, for example? Also, if 41 million Americans cannot afford the current level of health care provided improved quality will not help them and making more obstacles for physicians to jump through will not make healthcare more accessible or affordable." Disagree This type of care should definitely not be required to adhere to a managed-care/drg model. The whole idea of this type of care is to at least somewhat deviate from the medical model and do what is best for the individual. Disagree "This has been a mantra for at least 14 years; it has not been put into practice. Further, the current Republican leadership is steadfast in their mission to reduce the level of care currently available to large segments of the country." Disagree "* Requiring healthcare organizations, especially not-for-profits who tend to be quite profitable, to avoid excessive profit and waste is one alternative to contributing more reasons for the cost of healthcare to increase for the average consumer. Slightly increased income taxes would be welcomed by most if this were to take the place of current healthcare costs usually paid for via payroll deduction. This is not to say that the government would be the provider or carrier. Current providers and carriers should still be involved though receive reimbursement or premiums from the government based on a portion of an increased income tax. If an individual's income taxes are increased 5-10% and they didn't have to spend a lot if anything each month for group health insurance when the premiums for group health insurance increase by at least this same 5%-10% rate, would be acceptable for most Americans. Also, as a bonus, people may be more motivated to identify tax credits and deductions like planning for their ret" Yet another task-force that will spend 2 years to arrive at the vague recommendations posited on this website. How about not wasting resources trying to learn what we already know? "National healthcare where a portion of increased taxes are paid via the government to private healthcare organizations to provide healthcare in a similar fashion as now: PPO's etc., is the best option. Whatever people believe about the current Canadian system and those in Europe, it is an objective to strive for, in a short period of time, that can benefit not only individuals but healthcare providers and business organizations." 30146 08/13/06 TN Disagree We need national health care funded similarly to medicare. Private coverage is too variable. Disagree "Again the private system varies, and is not available to poor individuals The Federally Qualified health Center concept would need a huge expansion to take care of the poor in the cities and in rural areas " Disagree Pie in the sky. Disagree How will this be done? all of these recommenday=tion are non-specific Agree Great idea but how will it be implemented Disagree Pie in the sky No specifics What specific ideas are being put forth. these are pretty words but where are the action elements? 30147 08/13/06 FL Disagree "I believe that health care should be free for all Americans, regardless of income. I would hope that we could design a system based on Medicare or on the insurance coverage which Congress gives itself, which provides excellent benefits with very low overhead expenses. By offering preventive care, the extreme costs of emergency care and radical surgeries can be reduced." Agree I would hope that this plan would encourage private practicioners to establish and maintain their own practices in areas where there is currently a lack of coverage. Agree "As you mention in this statement, Medicare IS an efficient system, and I agree with this plan, and think Medicare should be available to ALL Americans, regardless of age or income level." Agree Isn't this type of resource already available through the Hospice movement? Disagree "As long as the President of the United States and the Congress have top-quality health care benefits, no American should have to pay more for comparable benefits than those worthies! I am concerned that the plan as you have stated it could result in many of us having to spend a substantial part of our savings to reach a coverage status." Disagree "Ideally, an income and wealth tax based on a PROGRESSIVE formula seems to be the best way to proceed. Value-Added taxes may also work - they do in Europe - but I don't know a lot about them. " "I do not think that the ""independent non-partisan public-private group should include private health insurance persons. Rather, if our goal is to emulate or expand on Medicare, there is no need for those businessmen and women to speak for us. Otherwise, I agree with the recommendation above." "There is a wealth of resource information available by looking at the countries that have already adopted Universal Health Care programs. Such things as rural and inner-city coverage, financing issues and methods of transition can be studied in detail, and we can choose what appear to be the best of these in our final plans." 30148 08/13/06 TX Agree "* There should be mention of using well educated and trained nurse practitioners, midwives, physican assistants, psychologists, chiropractors, podiatrists, audiologists and other folks in the health care industry who could save the health care system millions of dollars if we would give them full recognition. It would be good not to think that doctors have the whole say-so in the health care arena. If you paid the procedure rather than the practitioner you would also save millions of dollars. You could set a pay schedule for all procedures and whoever is qualified to do that procedure would be paid at the rate that you set. " Agree Agree Agree Make hospice care a top priority for payment vs a high hospital bill. Agree Agree You cannot do universal coverage too soon. * A universal payer system is desperately needed. Pay the procedure not the practitioner and you would save millions of dollars. Doctors are way over-paid and listening to their whining is rediculous. They get too much free. Start charging them for the use of the hospital for surgery and procedures. Stop the fabulous free perks given by the pharmacutical & medical equipment companies to get the doctors to promote their products. Use the money for research and equal advertisement of the new medication and equipment to everyone. My thanks to the members of the committee who drafted these recommendation. Your hardwork is impressive. 30149 08/13/06 IN Agree "OaDDITIONAL HEALTH INSURANCE TAX OF STARTING AT 1% ON INCOME OF $40,000 TO 80,000; THEN 2% FOR 80 TO 120 THOUSAND; AND INCEASE BY ADDITIONAL 1% BY EACH $40,000. THIS IS REASONABLE DUE TO TAX BRAKES FOR RICH. IN THE LAST 40 YEARS TAX RATES ON ULTIMATE RICH HAVE WENT FROM 70% TO 35%. I HAVE BEEN HEALTH CHAIRMAN FOR LAST 15 YEARS AND IN THE FINANCIAL BUSINESS FOR LAST 40 YEARS." Agree IT CAN NOT BE FREE OR IT IS ABUSED; THERE HAS TO BE A CO-PAY BASED ON INCOME . THE COST OF SENIORS CARE COULD BE REDUCED BY 20% BY INSTALLING A CO-PAY. ONCE THEY HAVE COVERAGE; THEY JUST GO TO DOCTOR AT NO EXPENSE. THEY LIFE LONGER WHICH IS A BIGGER DRAIN ON THE ECONOMY AND HELATH CARE. Agree "NEED NEW LEGISLATION TO LIMIT LIABILITY ON DRUG COMPANIES, DOCTORS, AND OTHER PROVIDERS. BY ENACTING THIS US WOULD SAVE ALOT OF MONEY BECAUSE NOT NEAR AS MANY TESTS WOULD BE RUN ON THE ELDERLY. AFTER AGE 82 OR 85 ; HIP & KNEE REPLACEMENT SHOULD ONLY BE OK IF PATIENT PAYS FOR 75% OF THE BILL. WE SPEND A TREMENDOUS AMOUNT ON SENIORS IN THERELAST FEW YEARS OF LIFE AND THE YOUNGER PEOPLE WON'T BE ABLE TO AFFORD THE BILL." Agree I AGREE BUT YOU NEED A CO-PAY SO IT IS NOT ABUSED. PEOPLE DON'T WANT TO PAY FOR NURSING HOMES AND THESE TYPES OF FACILITIES BUT THEY WANT THE CARE. WE SHOULD NOT PAY ENTIRELY FOR THESE SERVICES; AFTER THERE DEATH THERE SHOULD BE A RECOVERY OF COSTS FRO THEIR ESTATES AND WITH A LOOK BACK OF PROPERTY TRANSFER FOR AT LEAST 10 YEAR PERIOD. Agree "* IN ORDER TO DO THIS ALL AMERICANS MUST BE UNDER ONE TYPE OF PLAN INCLUDED ALL POLITICAL LEADERS; EXCEPT THE PRESIDENT AND VICE PRESIDENT. IF THEY RECEIVE A SPECIAL PLAN FROM A COMPANY IT SHOULD BE TAXABLE AS INCOME. IF I AM IN A 35% FEDERAL AND 5% STATE AND LOCAL TAX AND I RECEIVE FREE HEALTH CARE FRO MY COMPANY THAT COST THE COMPANY $6,OOO A YEAR. I WOULD PAY $2400 FOR THAT BENEFIT. IF I COULD PUCHASE IS FOR THE SAME MONEY FOR $500 A MONTH FOR THE PLAN; I HAVE TO MAKE $10,000 IN A 40% TAX TO NET $6,000 TO PAY THE INSURANCE. THE FIRST GROUP STILLS HAS THE ADVANTAGE." Agree CO-PAYS; TAX ON EMPLOYER FREE BENEFIT; AND OTHER MEANS AS STATED PREVIOUSLY. AND ONE SIMPLY FORM THAT RECEIVES PATIENT THUMB PRINT AND PATIENT'S REASON TO SEE DOCTOR. THEN DOCTOR'S CODE AND REASON AND TREATMENT. WHICH COULD BE FAXED TO CENTER COMPUTER AND BENEFIT TO PROVIDER SENT TO THEIR ACCOU SPECIAL TAX WOULD HAVE TO BE COLLECTED LIMIT CERTAIN SERVICES TO THE AGED CITIZENS OVER 85; BECAUSE MOST OF THE SENIOR EXPENSE IS IN THEIR LAST 2 YEARS OF LIFE 30151 08/13/06 FL Agree Agree Agree Agree Agree Agree 30152 08/13/06 VA Agree Disagree "* Most of the Working Group’s Interim Recommendations are good and deserve support. However, its recommendation to “expand and modify the FQHC concept to accommodate” other providers should be removed. FQHCs are community-owned providers of health care, whereas the Working Group’s recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition, justifying it the same way that FQHCs had to – not try to get that support in a back-door fashion by destroying one of the most successful federal health programs anywhere. How and why was such a recommendation developed and included in the Interim Recommendations when it was not addressed in the community meetings? " Agree Agree Agree Agree 30154 08/13/06 AZ Agree "Yes, this is worthwhile and it is doable. " Agree Indian Health Service should be fully funded and the urban Indian health centers should continue to be funded; these services saves money in the long run. Agree I concurr Agree Agree Yes! Agree yes "* Funds for Native American cancer prevention, screening, diagnosis, and follow up care should be increased. Native Americans living on the reservations have little to no resources in this area. Living in a rural area with no transportation is killing many peopole daily. We must not forget the most fragile people (elderly and children). These are all wonderful ideas but how do you acticipate doing them when our health care system currently being defunded and it is not a prority with insurance companices except for the concept of ""the bottom line""? Humanistic, equality care must be the foundation not just how much money companies get. I support the idea of having care for everyone and not just those who have access due to their income, status, education. " 30155 08/13/06 AZ Agree Agree Agree "I believe a big component is disease prevention. To-day Medicare will not pay for many screening tests--but will pay thousands for surgery, drugs etc. This is short sighted." Agree "until providers in nursing homes, assisted care etc are paid a fair wage, this will be a problem area." Agree Agree It is a foregone conclusion in my mind that very soon we will have means testing for Medicare. 30157 08/13/06 CA Agree "The private sector has failed to deliver affordable, quality healthcare to all Americans. It is failing more Americans everyday, every year that passes. It's time to take action!. A universal, single payer healthcare system may have its problems but it will be fairer and more affordable to more people. " Agree The private sector isn't motivated unless there's a profit incentive. That's why government funding and coordination is needed to increase and improve healthcare for all Americans. Agree A single payer system through the government would reduce administrative overhead as well as fraud and waste in healthcare. Agree Agree "This is the basis for moving Americans towards a universal, single payer healthcare system." Agree All Americans should expect to share responsibility and accountability for their healthcare system but it shouldn't be a commodity sold only to the highest bidder. "This is a challenging but essential part of designing a fair, reasonable universal, single payer healthcare system. " "I'm tired of the constant fear and stress induced by our current healthcare system. As a single woman, at age 53, my only option for coverage and access to healthcare is through my overburdened employer. I can't afford to get sick or injured. I worry about my children, parents, other family and friends and even my employer. The irony is, we're all at risk. " 30158 08/13/06 VT Agree Agree Agree Agree Agree Agree 30160 08/13/06 CA Disagree "It provides for a degredation of overall health care. Look at Canada, UK, etc!" Agree Agree Agree Disagree Disagree 30162 08/13/06 WI Agree All Americans should pay for their health care needs on a sliding scale based on their income (earned AND unearned.) No one should have to choose between eating and going to the doctor. Disagree My disagreement stems from my lack of confidence in the federal government to efficiently and effectively manage anything. I believe such controls such stem from the county level with minimal standards established by states and adequate funding sources from all levels of government. Agree No additional comment to the previous statement. Disagree "I'm not sure I understand this recommendation. But I do agree that those nearing end of life should, along with their families, have clear information about all available options and be the final authority in making their own end of life choices." Agree No additional comment. Disagree "A medical services tax on income should be incorporated across ALL income levels, no exemptions, no caps, simply a flat percentage of gross income. Additionally a 1% of profit contribution from all corporations whose annual profits exceed $500,000 should also be considered." I question the need to limit what coverages there will be. All health care NEEDS should be covered. 30163 08/13/06 NY Agree Every American citizen should be entitled to free health care . It should be their right. Agree Agree Agree Disagree What does it mean when you say a set of core health care services? What are benefits that are sufficiently comprehensive? Please clarify. I do agree with high-quality care without endangering individual or family financial security. Agree If the Leaders of this country can come up with millions of dollars to finance a war why is it so difficult to find the monies to support a national health plan for it's citizens. Will unions be allowed to participate in this process? 30164 08/14/06 CO Agree Require 100% participation of all citizens. Require sliding scale of shared cost for basic services insured and recieved based on net worth or other financial criteria. Utilize the talents of the advisors within the private sector to coordinate with the governmental representitives to enhance the potential of a more balanced mix of ideas and methods of implimentation. Agree Do not make this a mandate that is unfunded or underfunded. Included the low cost purchasing power of the medicare system for drugs. Allow for the providers of health care to maintain a reasonable level of compensation so as not to reduce their ability to stay in business and so as not to reduce the overall number of providers available. Agree "Incorporate within this venue an expense charged to those that do smoke, do not activly try to improve their over all health through educational and other offered services to participate in. Allow for expansion of stem cell research and development." Agree Agree "Finance these concepts though the the ""death tax"" or the ""estate tax"" system that has recently been minimized by the Congress and the President." Agree Thank you for allowing my participation in this process. I am honored to have been able to provide my input. Please call upon me again if I may be of service. My professional expertise as a group health and benefit specialist has allowed me to view many aspects of the issue. "Again, thank you for allowing my participation in this process. I am honored to have been able to provide my input. Please call upon me again if I may be of service. My professional expertise as a group health and benefit specialist has allowed me to view many aspects of the issue." I would appreciate the opportunity to be part of the continuing process. 30165 08/14/06 WA Agree "We will have to have some hard national discussions on what we will cover for extremely ill people, e.g. highly expensive new procedures for people who are certain to die without them." Agree I have worked for several decades in community mental health and health centers. I also have been very low-income with a severe chronic illness. In those settings staff is always holding their breath waiting to see what funding cuts will ensue next or what programs will be shut down. It is imperative that there is a consistent funding stream so that staff can focus on their jobs instead of lobbying for funds and so clients can count on consistent care. Disagree "* Two items. First, the biggest waste is that in these systems I have to spend a full 50% or more of my time doing paperwork -- or computer work --to document what I do. This is due to the large amount of money lost to fraud, but it creates its own huge costs. I used to say that I'd be caught up if I could just write about my clients instead of seeing them. Second, ""evidence-based practices"" sound good, but much of the ""evidence"" from research is prejudiced by who the researchers are indebted to or what type of research is granted funding. In mental health, research is done, for example, with people who have only depression (since the analysis is complicated by more than one variable), while in real life, people rarely have ""just depression"". The research results are then mistakenly extrapolated to all clinical situatiions and this is defined as ""evidence-based"". The split between research and real-life practice is a real problem when the research realm defines what is paid for." Agree "I know many hospice staff members. They are hampered by tremendous amounts of paperwork, worsened by cuts in Medicare reimbursement that trimmed their salaries by 10%. The first two items mentioned about are already considered basic standard of nursing and social work care. In King and Pierce Counties in WA State we already have model systems in place. We need funding to pay for social work and other ""soft"" services that are traditionally undervalued. " Agree "* Please do not allow mental health to be cut out. Called the ""cadillac of health care services"" by some, mental health coverage is not negotiable for the large number of people who suffer from severe depression, bipolar disorder, and psychotic disorders. It also saves costs when provided for people soon after a traumatic event. We should also reimburse complementary medical providers. Allopathic care has little to offer someone with my illness, but with this other care I have been able to return to more work." Agree "It is shameful that with an Administration and Congress that supposedly favors free-market policies, the Medicare Part D rules specifically prohibit the federal government from using its considerable buying power to negotiate with pharmaceutical companies for lower costs." "* Thankfully dental health is being included. Clearly our health needs do not stop at our mouths. I've copied my earlier comment about ""evidence-based practice"": ""evidence-based practices"" sound good, but much of the ""evidence"" from research is prejudiced by who the researchers are indebted to or what type of research is granted funding. In mental health, research is done, for example, with people who have only depression (since the analysis is complicated by more than one variable), while in real life, people rarely have ""just depression"". The research results are then mistakenly extrapolated to all clinical situatiions and this is defined as ""evidence-based"". The split between research and real-life practice is a real problem when the research realm defines what is paid for. Hopefully the private-public group will be appointed in such a way that it is non-partisan. Should come up with recommendations of who will appoint. " 30166 08/14/06 MD Disagree "* Your recommendations are not far reaching enough. Most Americans are concerned about having even moderate health care needs addressed, not just catastrophic, higher cost care. You are out of touch with the highest percentage of American citizens and their real needs and concerns. ""Financial protection for low income individuals and families"" means what? What is ""low income"" in your estimation? Do you realize that many Americans living in the 300% poverty level are scraping by now with costs of every day living expenses exceeding their incomes? How would they even begin paying for necessary medical care, let alone any catastrophic care? Which of you have been so desperately ill, seeking help for emergency care....but were able to do some comparison pricing on the lowest cost, highest quality medical provider that you seem to think others can do? As a registered nurse, I can tell you that is absolutely ridiculous. And any logical, thinking human being knows that low cost and high quality do no" Disagree "* This means lots of administrative money and little getting to the ""clinics"" by which you would treat these vulnerable populations.... Baloney. Let's look at some viable national health plans. Let's let the same health care system care for all of our people, to assure us of fairness and humanitarian care. The sad thing is that people who come up with these recommendations are schooled in certain things, but the human equation is missing....you do not know on an emotional, spiritual level what it is like to lack adequate health care, to access care via clinics where those who provide care look down on you as if you are nothing....This is not humane care, and it does impact treatment outcomes. Sometimes beaurocrats need training in looking with the eyes of the heart, not just the logic of the brain. You are attempting to put patches on an old worn out health care system. Our system needs an overhaul. It has become little more than a money making business any more and has lost the healing arts p" Disagree "* This is very wordy and sounds good on the surface....but have any of you done any research on what goes on in Veteran's hospitals? These are all legitimate concerns, but the truth is that these recommendations have not worked before, why would they now? I saw what happened with our local VA hospital...they surely are not a model program to encourage promotion of more like it! I am interested in your idea of consumer usable info about health care services that includes info on prices, cost sharing, quality and efficiency and benefits....would this be for low income people to analyze their care? I will tell you right now, most of them can't afford care, so this would be a practice in the absurd. Their choices are often food or medicine; food or medical care.....rent or medicine; rent/electric/insurance or medical care.....this is reality for a great many of our people, and not only the ones who are classified as poverty level.....your income has to be so ridiculously low to be considered poverty" Disagree "* I say I disagree with this for one reason only. If people are forced into hospice care when they still want to fight to live...when they want the chemo or surgery to allow them additional time, additional hope....they deserve that opportunity...and not to be told they MUST go into hospice. I love hospice. I worked in hospice care for a time as an RN....but it is not something for everyone. It is tough on families sometimes, tough on those who are ill....it is great as a choice, but not as something that is forced on people." Agree "* I agree with this as far as it goes, but it does not go far enough. When the statement is made ""Financial assistance will be available to those who need it""---the guidelines for financial need are way out of scale and need desperately to be up-dated with some sound economic background to base it on. Many families who are in the low middle class or high lower class perhaps....cannot afford necessary care. This is a travesty in a nation as advantaged as ours. People living within what is considered poverty level could not possibly be living on their own....there is no way they could afford to do it....they live with other families...that kind of thing. Those people who have enough income to barely live on their own need help but are not getting it....Why? Because they do not fall below the ""poverty"" lines....so those who are struggling to stand on their own two feet are turned away with no help. So my real concern is at what income level will our government determine that people are able to a" Disagree "* If our government had to be as fiscally responsible as many American citizens must be....we could finance our health care systems. Other governments do...and we are supposed to be the greatest nation on earth.So what is stopping us from treating our citizens like they live in the greatest country on earth? From what I just read, we are expecting our own citizens to be willing to ""make additional financial investments in the service of expanding the protection against the cost of illness and the expansion of access to quality care...."" and our incomes are nothing compared to the federal and state budgets! If we can be expected to make such brave assurances, then why can't our government? ""Shared responsibility""? I think our citizens pay quite a bit in taxes....I think many of us have shouldered our share all of our lives...and the working class has shouldered more than its share most of the time, because they do not get the benefits of the more well to do....life is harder, their works is harder " "* These groups you continually talk about forming sounds like a lot of money, talk, and slow motion to me. That is what this type of thing tends to become. This can be a money drain. This wordiness is also painful. Why not just say health benefits include the human body's care and repair. So much of this seems redundant. I must say, I am pleased to see dental care considered as part of the health care....as hearing should be, too. Again, I say this...anyone can say anything. Our government officials can say anything about health care, about promoting the culture of life in our nation, etc.....but if we really want to know what any one of them REALLY believes....watch what he/she does. Does he put his money and action where his mouth is? Our people deserve health care, so that they can pursue life, liberty and happiness....so they can work, enjoy their families and friends.... and the lack of health care can steal that all away in the blink of an eye.... " 30168 08/14/06 OH Agree Agree Agree Agree Agree Agree 30169 08/14/06 MI Agree Universal health care for every american would be perfered! Take it out of business expense. Maybe raise business tax for all to cover. Agree Agree Agree Agree "Again, every single American should have universal Health Care" No response "Unversal Health Care for everyone, take the burden of the employers. If everyone could go to the doctor when a problem starts it would prevent the serious and expensive illnesses. " 30172 08/14/06 NY Agree Agree Agree Agree Agree Agree 30173 08/14/06 NY Agree Agree Agree Agree Agree Agree "Sin taxes - tobacco, alcohol, etc. can be an excellent source for some of the revenue required to provide basic medical insurance benefits - in addition to some form of required premium, a tax, similar to the Medicare tax without any caps, can also provide additional funds. " "Currently, in the private insurance sector, there are a number of choices to review such as the Mini-Med plans and now the high deductible plans combined with the Health Savings Accounts. There are many dental plan choices available as well, from very affordable reduced fee dental plans through particpating providers to full blown insurance indemnity plans. If agents do their jobs, dental may not be the issue that the government needs to be involved in. Medical care can bankrupt many people - " "Governments (federal and state) by working with private insurers coupled with tax benefits and tax revenue may be able to devise a coordinated basic insurance program which can help address the needs of the majority of the U.S. population. How we handle illegal aliens who receive health care also needs to be addressed, since they are likley to remain under the radar (so to speak)." 30174 08/14/06 VA No response Disagree "* Although I agree in theory with the premise, I do not believe that it is in the best interests to change the FQHC concept to accomodate other community-based health centers that would not require boards to be community users. Modification of this requirement waters down the influence people in the communities have on their own health care. This was not part of the discussion at the meetings and it is a detriment to any improvement. Current FQHC's need the resources to expand to meet the growing needs of the community as ordered by the communities that need additional services." No response No response No response No response 30175 08/14/06 NE Agree I have two children in their 20's who are college students and too old for our health insurance. They cannot afford health insurance so do not have any. I have to just pray that they do not get sick. Agree Agree Agree "People need education on end-of-life care. Sometimes, people need to be left alone to die in peace and not have their life prolonged with pointless medical procedures. For example, dialysis is questionable on a person in their 90's. A person full of cancer and unresponsive does not need a feeding tube. What they do need is pain control and death with dignity." Agree "Yes, I think that health care should be independent from a job, so that it goes with you from job to job or when you are without a job or have a job that doe not offer health insurance. It needs to be affordable, or based on income." Agree I like the idea of having health insurance based on income. It could be taken out of your paycheck like social security is taken out. There should be a minimum level of health care for every person. "I work in a hospital and more and more people cannot afford healthcare. So...they wait until their health issue takes them to ER. By then, it is too late and we spend lots of taxpayer money trying to fix a major problem that would have been cheaper & more fixable at an earlier stage. Plus, we prescribe medications that patients cannot afford and thus do not ever take." 30178 08/14/06 GA Agree "As a nurse, I have seen patients who could have avoided high cost complications to such disease processes as diabetes, heart disease, and cancer, by having regular physical examinations; however, they could not afford these physical exams because their insurance did not cover them, or they had no health insurance. ALL health insurance companies should be required to cover 100% of an annual physical examination. MANY problems could be avoided this way." Agree "It is common knowledge that there are disparities in health care by race and socioeconomic class. However, it has been found that health care dispariites are not found in community health centers. These should be expanded and utilized to their fullest extent." Agree "A relative was recently treated for lung cancer by a physician currently under investigation for incompetence by the State Board of Medical Examiners. It would have been nice to know this prior to her misdiagnosis and treatment, which almost killed her. Once she was in the competent care of another physician, she did well and has an excellent chance of being one of the 15% cured from lung cancer." Agree "As a nurse, I see too often that end-of-life care is overlooked. The attitude seems to be ""they are going to die anyway so what is the point."" This is a stressful time for both the patient and family and needs to be handled with care." Agree "As a cancer survivor, I was lucky and had very good health insurance; however, I was in treatment with others who had no health insurance and really worried about the $12,000 per chemo treatment (up to 8 treatments) along with the very expensive PET scans and bone scans. I also have problems with people having to chose between groceries and medicine." Agree "If all Americans had access to annual physical examinations, I feel a large part of this problem would be solved. My only problem with this is that I don't want to pay for someone to get health care simply because they refuse to work. I don't mean people who are unable to work, but those who just don't want to." "Again, I feel that annual physical exams would be a very beneficial service. By identifying and starting treatment for chronic illnesses early, more expensive complications can often be averted." I would be interested in being a part of the group that defines services for high-cost and core benefits. 30179 08/14/06 WI Agree Agree Agree Agree Agree Agree 30182 08/14/06 MD Agree "* I understand the difficulty in defining who is an ""American"", and being a pragmitist - I know that we cannot afford to provide unlimited healthcare without some sort of control. I think we have our incentives wrong and we waste far too much money for low quality services. I STRONGLY believe that we ""cannot manage what we cannot measure"" - and right now, the way that we record data, exchange data, and analyze data **ON PAPER** is totally inefficient. I think that we need to work towards the Electronic Health Care Record and catch up with banking and other industries that are using digital data and digital management techniques to better manage operations. The waste is embarrassing. We can do better." Agree "We can make better use of nurses and other community health workers than we do. The battles that nursing experienced in regards to the nurse managed ""Minute Clinics"" with the AMA is for less than stellar reasons. I think Medicine needs to understand that you don't need an astronaut to fly a crop duster." Agree "We can look to the VAMC for leadership in what the EHR and other digital technologies can offer us. Sure, there are issues surrounding privacy and confidentiality - but these are solvable." Agree "I think we need to also address long term care. I suppose that you can call LTC ""end-of-life care"" - but this is not necessarily accurate at all times............ We all know that the impact of the aging baby boomers is a crisis waiting to happen. Like our dependence on oil, we will wait until crisis point to start to address it. " Agree "* The issue is of course that we cannot afford to do this without controls somewhere in the pipeline. Our payment system is perverse, we do not pay for quality, and we cannot even measure quality because we are capturing data on paper, making it nearly impossible to analyze. We need to better control and manage what we do, get medicine to understand that we work better as a team instead of bull-headed docs wanting to do everything. I believe that once physiscians understand that some things are better done by nurses (and more appropriate payment can be made for thos e services that nurses can do safely) that maybe we can start to view healthcare as a team sport - and get our expenditures and our waste better under control. This will allow us to do more with less." Agree "* The government needs to ""seed"" but not totally fund, the movement to the EHR. The return on investment must come through reimbursement that is tied to the EHR - we do not want to create a dependence on the Feds for use of technology that most other industries have already realized a positive return on investment for using............. We also need to get the EHR vendor community under control. They are in for market share, which is understandable - but at the expense of broader thinking - it is disasterous. I view many EHR vendors as those with deep pockets and shallow minds." 30184 08/14/06 OH Agree "This is important !! However, the real issue is financial. The report is woefully abstract in dealing with that issue. Until that is resolved, the recommendation is simply rhetoric" Agree "Great idea. However, the healthcare provider world is being forced into competitve situations each day. As with the first recommendation, without specifics, any real movement toward this is years and years away." Agree "Much can be done here, however, the impact is currently, and will be without systemic change, thwarted by the fact that doctors and venture capitalists are invading the system by creating already existing services in community after community in the name of competition. EXCESS CAPACITY in healthcare causes costs to go up, not down. This dynamic is terribly inefficient and costly to American businesses who are already struggling to compete in the world marketplace." Agree "Very important concept. We need a national discussion about end of life, including honest dialogue about the cost of futile care. " Agree "Who could disagree? Without difficult decision-making that will fundamentally restructure how costs occur, this idea has little hope of be achieved. Our current ""system"" is so inherently inflationary that any talk of affordable healthcare seems beyond reach." Agree "* We are at a point in history where I don't think we have the ability to just think about America when discussing financing. The rest of the world has figured out how to compete against us from a manufacturing perspective. We are losing manufacturing jobs at an alarming rate and have been for some time. Healthcare costs are a significant part of the structural inefficiency American manufacturers deal with. If we want to be competitive world wide, we will have to compare our costs against the world. It will not be a ""pretty picture"" when comparing healthcare costs. The only way to truly reduce costs is through some control of capacity, along with requirements for utilization. They must be managed concurrently if any progress is to be had." "This is fundamental and should have been done long ago......however, any mandate must have a funding source. Simply requiring a hospital ER to take ""all comers"" is imprudent. All that does in force additional cost shifting to employers who offer health insurance plans......which causes their costs to increase......" "Healthcare costs are killing American business. Our ""system"" is currently designed to be highly inflationary. That is an enormous problem that is not directly addressed. Until it is, this report, while hopeful, will have little chance of success. " 30185 08/14/06 NY Disagree "* I am against any Government Medical Program. While medical costs are high, it should still be the responsibility of each individual to make sure they have this risk covered. For those who are below an established income level, Insurance Companies should be encouraged to provide basic coverage. For catastrophic illnesses, this is where the Government can help. It is also more difficult to defraud in the case where there is a catastrophic illness. Providing free medical coverage with no financial participation, regardless of how small the contribution, only enables people and some medical practioners to figure out how to defraud the Government." Disagree "* If the Government would get out of the health care situation, it would allow the free market of health care providers to go where the need is - they do not neet Big Daddy telling them. Since the Government became involved in health care, thanks to Sen Clinton, we have had continued increases, less people entering the health care services and the quality of health care has diminished. We have a nurse shortage, a doctor shortage - where does the Government think they are going to establish community centers in areas that need them? How will they get doctors and nurses to go to those areas? The Government's interference has politized the health care industry and removed the humanitarian reasons for individuals to enter the health care field. " Disagree "Again, federally funded programs have become extremely costly to the US taxpaper and increasing the programs will require even more funds and provide other avenues for abuse. The administration of thes programs becomes very costly and does not improve the quality of care at the consumer level - we need more health care professionals and less bureacratic employees to stifle the needs of the consumers." Agree I agree with this but insist that it should be done on a local level with possible help from state funds. The US Government should not be dictating or funding a situation this close to the consumer. Disagree "As previously stated, I do not believe taxpayer money should pay for everyone, ""regardless of their financial resources"" At this time, we have millionaires accessing medical care through Medicare and, where they impoverish themselves, Medicaid. Government assistance should only be given to people under the poverty level. Catastrophic help should be given to people up to the upper middle class income level." Agree "Again - your ""All Americans"" inclusion should be tempered by their income level. I do not agree with additional income taxes, payroll taxes or value-added taxes to finance. Sin taxes and enrollee contributions are a must. Get a line item deduction for long term care insurance - this will help considerably for the future health costs for an aging population. Also allow alternative procedures to be deducted - this will provide individual choices for health care that does not exist at the present time." I agree with this as long as it minimizes Government run programs and permits local communities and states to be involved. "In order to have quality health care, doctors diagnosis and recommendations should not be second guessed by non-medical people in government agencies or insurance companies. Quality care will be provided by those who have the responsibility if allowed and not interfered with by people who do not have direct contact with the patient. The individual patient is know by the physician and their needs and his/her recommendations should come first." 30186 08/14/06 WI Agree Disagree "* Most of the Working Group’s Interim Recommendations are good and deserve support. However, its recommendation to “expand and modify the FQHC concept to accommodate” other providers is wrong-headed and should be removed. FQHCs are community-owned providers of health care, whereas the Working Group’s recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition, justifying it the same way that FQHCs had to – not try to get that support in a back-door fashion by destroying one of the most successful federal health programs anywhere. At the CHCWG meetings earlier in the year, modification of FQHC statutes was not a part of the discussion or recommendations made at those meetings. Why, and how, did such a recommendation get developed and included in the Inte" Agree Agree Agree Agree 30187 08/14/06 NY Agree I am deeply distrubed that medical costs in the US keep spiralling out of control and it is left to employers and citizens to bear the unreasonable bill for something that should be a right just like public education. Agree Agree Agree Agree Agree 30189 08/14/06 NY Agree But we should have a single payer program. Agree Agree Agree Agree "Affordable, but good. " Agree "* We spend more money for less-good health care than do many other countries. Some doctors may be getting rich, but most aren't, and they work hard. They don't have time to give their patients. I'm a psychooogist. Medicaid in NY pays me $36 for a 45-minute session of psychotherapy. State wants to cut out individual psychologists - so they can pay $55 or more to a clinic with a partially-trained mental health worker? The goal seems to be to cut out mental health Rx, though just about every study on the ubject indicates that a huge percentage of dr's visits are actually based on mental health needs. " 30190 08/14/06 VA Agree Agree Agree Agree Agree Agree "We must have a national program. As expenses rise, more and more companies remove health benefits. This is a danger to our entire society. A national healthcare program would also make us more competitive with other markets that have one, as companies will not feel the pressure to outsource to cut costs!" 30192 08/14/06 NJ Agree Agree Agree Agree Agree Agree 30196 08/14/06 CO No response Agree My patients deserve an rx drug coverage run by the federal government and covering every one. Agree Agree Agree "The so-called Working Group needs to listen to what the American people are telling them, and make their recommendations REFLECT THOSE STATED WISHES AND OPINIONS instead of reflecting pre-determined conclusions." Agree "* Part D is a disaster for most poor Americans. Medicaid was covering their prescriptiions very nicely, thank you. Why this change to Part D? ONLY TO CREATE PROFITS FOR THE DRUG COMPANIES/INSURANCE COMPANIES. Private companies need to be booted OUT of the field of health care for all Americans. The FEDERAL GOVERNMENT needs to administer this program. The 'bottom line' MUST BE human beings' health---not corporate profit. The present situation is unconscionable. I'd like to see Senators and Congressmen and their grandparents and families try to cope with a ""doughnut hole"" for THEIR prescription drugs!!!!!!" "* Part D is an insult and a harm to America's poor. The sickest people are being harmed the worse. I am a social worker (MSW, LCSW) for a dialysis unit in Colorado. ALL of my patients have Medicare, and MOST got their rx drugs through Medicaid formerly, with no problems. NOW THERE ARE LOTS OF PROBLEMS. Not just ""start-tup"" problems but problems built in to the structure and policy of Part D. Corporate profit can never be a successful rationale for a public health care program. Part D is SO TRANSPARENTLY and blatantly designed NOT FOR THE HEALTH OF THE VULNERABLE, but for the profit of the corporations involved. Obscene." 30197 08/14/06 CA Agree "Financial protection should cover all Americans regardless of income. Those with higher incomes would have higher ""out-of pocket"" - expenditure." Agree "Use existing public groups (i.e. VA, established community health centers, etc) and ADD a private component to this." Agree Agree Agree This should take highest priority. Agree Insurance industry needs to be approached to particpate. They will certainly oppose any financial health care reform. This recommendation should be implemented first 30200 08/14/06 TX Agree Agree Agree Agree Agree Agree 30201 08/14/06 TN Agree Agree Healthcare remains woefully behind in the IT realm. US citizens need to have portable health records which update regularly to minimize errors and maximize care. Agree "My comments above apply, but we must also stress the need to teach our nursing students and nursing administrators about the proper use of technology and electronic medical record systems." Agree The wishes of those who do not desire heroic or life-sustaining measures should have their wishes respected and have palliative services available to them. Disagree "While I agree with this premise, I would like this structure to include rewarding those Americans who work hard to maintain a healthy lifestyle and those who make a concentrated effort to improve an unhealthy lifestyle." Agree This will likely be the biggest challenge. 30205 08/14/06 TX Disagree Lovely concept but it sounds like ESRD being covered by Medicare - a big surprise to all. Agree It's about time. Agree This is a no-brainer. Agree Good idea. Disagree It's not woeking that well in Canada. Agree Lotsa luck Another great idea - another 'perfect world' concept. All of these will be diminished in reality after going through the extensive policy development & implementation phases. 30206 08/14/06 CA Agree I would like to see education on wellness. I think this would put many large companies out of business since they are all peddling junk food that causes the body dis-ease. Agree "I think the real issue is proper nutrition in low income areas. I have noticed the ice cream truck is usually selling to families in the lower income areas. ""Let food by thy medicine"" Hippocrates" Agree "I would like to see more Eastern medicine incorporated, not sure if that is considered an evidence-based practice or not." Agree "I would be great if we could all have better death-care and more choices around that with holding the services for our loved ones,etc.. without the disgusting practices of embalming and fancy caskets that are going to pollute the environment." Agree "We are all connected, if one suffers, we all suffer even if we are unaware. Quality of life is important for all." Disagree "I am not personally willing to pay for pharmaceutical drugs for others. I have to take responsibility for choices every day, what I eat, drink, my environment in order to give my body what it needs to have optimal health. I am willing to contribute to a system that educates others about good choices and what is good for their bodies, including wellness care." I do not wish to pay for a system that treats with prescription drugs which does not get to the core of what is ailing the body. The rest I can support. 30207 08/14/06 NJ Agree Agree "THERE IS A SERIOUS NEED FOR SCHOOL BACED/ COMMUNITY HEALTH CARE CENTERS TO SERVE STUDENTS/ FAMILIES/ COMMUNITIES- IN MY SCHOOL DITRICT- NEWARK, NJ - THERE IS A large population of undocumented persons who need health services- without fear of LEGAL/ IMMIGRATION REPRECUSSIONS-FEELING SAFE / COMFORTABLE INSTEAD OF WAITING TO NEED TO RECIEVE EMERGENCY ROOM CARE -HOSPITAL- PROVIDING PREVENTION - /ACUTE BEFORE HOSPITALIZATIONS AND SAVING HOSPITALS- -UNCOLLECTED/ REIMBURSED PAYMENT FOR MEDICAL CARE" Agree Agree Agree Agree 30208 08/14/06 IN Agree "This ""Coverage"" should promote wellness and insure basic needs and meds. Elective and pure cosmetic care is not implied in this measure. However, many Americans still need to make very tough decisions even as it relates to what many of us consider as basic care." Agree "Support to organizations could be in a ""pro rata"" basis....meaning the more they assist and put forth in resources/support, the more they can get on reimbersed on other services IE: 10% 15% etc. " Agree "Be careful about ""underserved/uninsured populations""---as you make it sound 'outside of city limits.' I work in an inner city environment and you would think we were in a thrid world country!!!! Special emphasis should be changed to highest need and why limit to medical residents....we all know NURSES do more advocating for the patient than docs. " Agree Toatal agreement. Agree AFFORDABLE is the key word.....I can't afford my own care...the cost is beyond my means...eventhough my employer OFFERS health care coverage. Agree Please look at overall financial statements....many do not take into consideration items such as child support.....giving it OR receiving it and other forms of income and burden. I find it highly unfair that my ex does not have to claim the $1500 I pay every month as income and I cannot claim it as a burden when I apply for assist. Don't forget vision...under medical---I assume. 30209 08/14/06 FL Agree Agree "Include the inclusion, expansion and funding of comprehensive primary care school based health centers (SBHCs) as a part of the safety net." No response Agree Agree Agree 30210 08/14/06 FL Agree A very minor point is a possiblle relationship of this protection with higher savings rates. No response No response No response Agree The Canadian system appears to be the best that I am aware of. Agree The Canadian system appears to be the most economical form of financing that I am aware of. This is a second best solution. 30211 08/14/06 WA Agree "Instead of coverage, I'd say Health for all Americans ; my second choice would be Healthcare. " Agree Agree Agree Many of the services that those nearing the end of life need aren't medical - they need comfort care; social services; spiritual support; pain relief. The care needs to be integrated across systems beyond the healthcare arena. Agree Agree "expanding the medicare model, with its low administrative costs, to every American of any age would be a start.All businesses should pay a set amount for each employee; the state should assume most of the expenses for children and the elderly, or for those unable to work." "* Look to the Oregon model for one way to think about how to determine what is included for everyone, and what isn't. Put more resources into prevention and early intervention for everyone, rather than high-tech, high-cost interventions for a few. EG - make sure that every pregnant woman has access to resources, education, nutrition, and pre-natal care; extend services for at least six months after the birth of the child. This will cut the costs and numbers of babies in the ICU, of child abuse, of infants who don't thrive, etc." 30212 08/14/06 OH Agree Agree Agree Agree Agree Agree 30213 08/14/06 WA Agree Agree Agree Agree Disagree "My concern is that we will buy more than we can afford here. I agree if there are incentives to use resources wisely, and recognition that we need to have some, experimental or maginally useful treatments, on a private purchase basis only." Agree "Limit high cost services, such as transplants, and have private purchase of re-insurance" "Make the core benefit minimal for adults, richer for children. Focus first on community network development Must have abortion option funded." 30215 08/14/06 OR Agree This would also require some changes in infrastructure of medical and dental delivery systems to achieve the cost containment needed for long term sustainability. The coverage should be focused strongly on prevention of disease. Agree "There are two many federal bureacratic structures (Head Start, WIC, FQHC, Medicaid, Public Health departments, TANF programs, just to name a few) that end up duplicating activities, and often have mutually exclusive requirements resulting in many of us unwittingly working against one another, or re-inventing the wheel at different access points." Agree I would reiterate my previous comment about reducing duplicative activities by different federally funded programs. Agree "As an experienced hospice nurse, I wholeheartedly agree." Agree We need to use public schools (and WIC and Head Start) as access points for bringing affordable health care to children. Agree "We need a new focus and energy on proven preventive interventions, and we also need to assure that we use all of the members of our allied health forces. (Particularly in dental where there needs to be more focus on prevention than the surgical model of dental treatment)" "As mentioned before, we need to launch a renewed effort on proven preventive interventions for children's dental health in school settings." 30217 08/14/06 WA Agree Well of course this is what we need! Agree Agree I'd also like to see strong privacy guarantees. Agree Agree Agree "When employers no longer have to pay health care as a benefit, they should be required to participate in helping to pay for a broader program. " 30218 08/14/06 CA Agree Agree Agree Agree Agree Agree 30219 08/14/06 NY Agree Agree Agree Agree Agree "* This recommendation is the most important. After losing health insurance for myself and my wife by leaving a minimum wage job that offered excellent benefits, we were left without health insurance for several months while I pursued a new carreer. We simply could not afford health insurance, even by taking advantage of COBRA, which offered health insurance at the group rate my company had been paying for me. I discovered that my company had actually been paying more for my health insurance each year than they had been paying me employee wages (including very generous stock grants, bonuses, and savings matching). Although I began earning three to five times my previous hourly wage, it took several months before my new carreer path offered financial stability enough to allow health insurance at even the best prices (and that we were only lucky enough to happen upon by qualifying as free-lancers). I do not know what we would have done without that opportunity. Affordable health care is a great necessity " Agree "* Some drug companies are offering assistance to families who need health care. This makes sense since assisting those families will enable them to purchase medicinal products that they need, creating and completing a circle of supply and demand. Let's continue to think along those lines--in order to manufacture a new drug, perhaps manufacturers should be required to designate a part of the income to supporting universal coverage. Accessible health care (treatments, prescriptions, office visits, specialist visits, hospital care) simply means accessible use of our medical companies' products and services, making it simply a valuable investment. When temporarily without health insurace, sometimes prescription drugs come as a donation from one's doctor's office, meaning the company who made it wasn't collecting any money. More accessibility means more profits for involved parties, and a healthier America." 30221 08/14/06 CO Agree "These recommendations can be achieved through a publicly-funded, priavte health care services via a single payer universal health care system. Please work in concert with the Physicians for a National Health Program (PNHP) and the American Nurses Association to do this." Agree "While the Colorado Nurses for Access to Health Care for All, of the Colorado Nurese Association, agrees with this recommendation, it is not enough. A single-payer universal health care system would achieve this recommendation, and more, at a cost-savings over time. " Agree "The Colorado Nurses Association urges the implementation of a single-payer system, which is a publically funded, private health care system serving all. The waste in administration costs can be reduced significantly through a single payer system. " Agree "The Colorado Nurses for Access to Health Care for All (CNAHCA) Task Force believes that a strong, national dialogue in ethics is needed to promote the work, services, and practices of hospice and palliative care. These services could be incorporated into a single payer system." Agree Absolutely! And a single-payer universal health care system would achieve this recommendation at a cost savings over time! Please work with the Physicians for a National Health Program (PNHP) and the American Nurses Association to achieve this recommendation. Agree "A one-risk pool via a single payer system, which is publically-funded, private health care for all, would achieve this recommendation. The cost-savings from reduced administrative costs would be considerable and could be shifted to providing services. Overall, costs would go down." "The core benefit package, perhaps something like the Federal Employees' Benefit Package, must be determined and could be defined through the use of a strong, effective ethics committee. A single payer system would be based on this core benefits package." Please let me know if I can contribute to this effort in any other way. 30222 08/14/06 MD Agree "* healthcare is a necessity, not a luxury, and as such I believe changes should be made and soon. My husband and I just got our renewal for our health insurance. It's going to cost us over $1000 a month-no dental or vision. I think it's disgusting that people have to worry about how they're going to pay for their healthcare. It's bad enough to be sick. I believe the solution is there, but certain groups have been enjoying the profit that they are making off sick people for so long, they don't want to give it up. I'm referring to the pharmacutical industry in particular. The US needs a universal healthcare system and it needs it now!" Agree Agree Agree Agree HEALTHCARE IS NOT A LUXURY--IT IS A NECESSITY FOR EVERYONE! Agree "Please tell the powers that be, in Washington, who supposedly represent us, and who have wonderful healthcare at our (taxpapers expense) that we would like same. It must be nice not to have to worry about who's paying for what when you're ill. " 30223 08/14/06 IL Agree "Nobody's health should be jeopardized because of their economic status. Basic health care should be available to all Americans througha simple,easily accessible national program. " Agree Agree Too much of the cost of private health care is wasted on administrative cost. The dollars that we spend should go to health care not bureaucracy. Agree Agree I strongly agree with this recommendation. It should be easily accessible to all Americans. Preventive care and health education need to be expanded greatly. Agree See above comments. Definately yes! 30224 08/14/06 WA Disagree "While I agree in principle, I feel the execution of such a policy by a national program will endanger costs for all. Indeed, with the limits of health care expanding ever outward, what will the capitation on such a plan be?" Agree "This I think is achievable, and may come from the government or non-profits well-supported by government funding." Agree "I strongly agree with this point, as Healthcare Information Technology is behind my local grocery store - standards and leadership from the government will affect change in the private industry!" Agree "I believe more private than public programs, or public programs from the community rather than the state or federal level." Agree "I agree with this more than the first point (Establish a national program), as a set of core health care services is a realistic deliverable for all Americans." Agree 30225 08/14/06 AL Agree "* First of all, insurance premiums are almost prohibitively expensive for many Americans. I am very fortunate in that my husband holds a very high-paying job with excellent benefits; even so, out health insurance premiums are our biggest expense other than our mortgage. Even with insurance, if a person has a hospital bill of , perhaps, $75,000 (not unheard of in today's environment), with, let's say a $5000 deductible and a 20% copay, that leaves the patient responsible for $19,000 out-of-pocket expense, on top of insurance premiums; if that person is the primary wage-earner, there is loss of income to consider; it is enough to put many families over the egde. Something has to change." Agree "This is vital. Access to care should not determine whether one lives or dies. For instance, cervical cancer, if detected early enough, is completely curable; but if women cannot get to a clinic for a simple pap smear the disease cannot be detected and treated early. By the time a woman is symptomatic, it may be too late for a cure, and much more expensive for her care. The same applies to low birth-weight babies, diabetes, cholesterol, etc. I could go on and on." Agree "Education and health promotion are key. It all interrelates, does it not? Our health care system is penny-wise and pound-foolish. You can do an awful lot of pap smears and screening mammograms for the amount of money it costs to treat stage 4 cervical cancer or an aggressive breast tumor. In my former practice as an oncology nurse, I have seen firsthand the consequences of delayed care, and they are not pretty. Electronic medical record systems would speed up health care delivery." Agree "* Again, this is something with wich I have firsthand experience. In this country, hospice services are contacted too late rather than too soon, and heroic measures are often implemented to just prolong death, rather than to ease dying. We in this country have a problem talking about death as a part of life. Physicians look at death as a failure. And the political posturing needs to stop. Look at poor Teri Schiavo. Those resources could have been used toward someone who had a prayer of living. I thought that entire episode was profane. She didn't die with a shred of dignity left. We absolutely need to look at the clinical realities, but still provide care to those with incurable conditions. But not just terminal conditions. For example: diabetes is incurable, yet I know of a young, physically fit, active, otherwise healthy woman who cannot get insurance because she is a diabetic. She is doing everything right, and her diabetes is well-controlled, yet she is considered uninsurable. Doesn't make sense." Agree "* I do believe that everyone should have health care. I also believe in personal responsibility. I feel that everyone should at least try to be responsible for his or her own health. Again, that takes education. That means a social structure that enables our kids to stay in school. That means EDUCATION ABOUT CONTRACEPTIVE USE, NOT JUST ABSTININCE-ONLY EDUCATION! And it means PUBLIC FUNDING OF BIRTH CONTROL! I don't think that a sick person should ever be turned away; nor do I think that they should end up having to go to the emergency room for primary care. That raises costs for us all, and is an inappropriate use of ER services. Perhaps a sliding-scale fee? I feel that it is immoral in a country a rich as ours that we cannot provide health care for our people. This is a moral value." Agree "It must be a non-partisan panel. Perhaps define the core benefits guaranteed to all, then offer options for more coverage? People with good plans are not going to want to give up anything. However, I think that most would agree that coverage of immunizations, dental cleanings 2x/year, well-child checkups, etc. would be welcome." 30226 08/14/06 GA Agree "* Hello, everyone on this earth should have health insurance regardless of age creed or color. No matter where you live or work. Each employer should provide health insurance for their employees. Medicare should provide health insurance for those that don't have a job right now, or those who can't afford health insurance. Lots of people get sick daily who needs tp be provided. Look into your hearts and minds when people go to the polls in November; don't just say, I will help getting people health insurance just to get a person's vote, please! people in Congress provide everyone with health insurance. Love in Christ, " Agree Just get everyone on earth Health Insurance Agree Agree Agree Agree 30227 08/14/06 CT Agree Disagree "* As a registered nurse now in the community and a history of working in all other settings, hospitals and clinics, the number ONE problem is the coordination of care. There is no one in charge of a patient's care,whether they enter a private practice or have an acute issue and are hospitalized; there is no one there for the patient. Many touch the patient throughout the maze yet no one person coordinates the needs, resources and ongoing followup in the community for that patient. I worked in a Community Health Center that is not the answer,lots of funding poured into the business with poor staffing, inadequate programs, with an incredible turnover of new physicians attracted there for a 2-3 year stint to help pay for their loans. Owners create an expectation of 25 plus visits per day for the poorest of poor which is impossible to see and provide goodcare. It's all about the $$$$...but there is a lot of it thrown away, don't know who watching the store, Invest in case managers and invest in prevention" Disagree Reduction in fraud and waste should be your first order of business....there is no patient centered care presently or an integrated health care system...I'm not sure federally funded clinics can provide this without those employees being federal employees and accountable to the government for the monies they get.... Agree "I agree with it all, we have made great strides in hospice care and should continue on this course. We are all going to die, how we do it should be assessed, supported and patient driven " Agree "Yes,Yes,Yes!!! " Agree A reasonable contrbution from employees and employers and investment from the state. "There is no one place that there is a continuum of care provided, if health centers are to be developed there should be dental,mental and physical health care provided for all stages of life and with chronic disease management as well as prevention....invest in prevention... " "* We need to do something, people are dying every day because of the disconnect they have with healthcare. Access should be for everyone,not wo you know, what plan you have or how much money you make. Our emergency rooms are bursting at the seams with patients utilizing this venue as primary care. Patients often leave hospitals without any discussion regarding what the patient needs to support medications, environmental and emotional needs. Then home care agencies need to try and connect the patient to appropriate interventions, sometimes acute issues. #1 Talk to the patient #2 Length of stay is more important in a hospital environment than the care of the patient #3 CARE, really care about the people you take charge of....amazing what the results can be. Educate, Educate, Educate.... " 30229 08/14/06 NC Disagree "* I agree with the recommendation,however, if we could eliminate govenment wate through medicade and medicare to start with we could help the americans in need to start with. I work in a C.V.S. pharmacy and I see medicade abuse every day. Illegal immagrents, as well as other individuals getting medicaide who are abusing the system and doctors are allowing this by over treating patients, over perscribing pain medication wich will ultimately get sold on the street. We need to focous on medicare abuse, and medicaide abuse to start with. ie. a patient with medicaide pulling up to the CVS pharmacy window in a Infinity sports car with a price tag of 40,000 dollars " Disagree "Fix the abuse in the medicade and medicare systems aleady, and the welfare system. " Agree "I work at CVS pharmacy and I see fraud and abuse of the medicade and medicare system every day where patients are over prescribed medications ie. one patient recived 16 medicaid paid perscriptions for pain no one can possibly need or can take that many perscriptions at one time, however, the doctor ordered them and the were despinsed at the cost of tax payers. We need accountability in the federal government with federal government programs. Thats why expenses are so high in the health care system. " Agree Agree "If the government could reduce fraud waste abuse this could happen, we also need to cotrol health care cost through overtreatment, pharmacutical companies over charging, and medicare and medicaide abuse." Agree I would only agree if we have ACCOUNTABILITY!!! Accountability is the problem we have now! "* As a concerned citizen, it is important for Americans to have lower healthcare cost, I really and truly belive that this can be controled if we control the abuse of the current system and hold doctors, pharmacies, and insurance companies accountable for fraud and abuse. I work in the health care system at CVS pharmacy and I see the fraud and abuse every day by patients who are over prescribed and over treated. Questions arise such as why is this person driving a 40,000 car getting medicaid, why are we giving this person 19 perscriptions for pain medication on medicaid, and it all has to do with holding people accountable for fraud and abuse. As a nation we could promote heathy living. A healthier nation ultimately will have lower health care cost, fund Physical Education classes and nutrition classes." 30230 08/14/06 NC Disagree "* I agree with the recommendation,however, if we could eliminate govenment wate through medicade and medicare to start with we could help the americans in need to start with. I work in a C.V.S. pharmacy and I see medicade abuse every day. Illegal immagrents, as well as other individuals getting medicaide who are abusing the system and doctors are allowing this by over treating patients, over perscribing pain medication wich will ultimately get sold on the street. We need to focous on medicare abuse, and medicaide abuse to start with. ie. a patient with medicaide pulling up to the CVS pharmacy window in a Infinity sports car with a price tag of 40,000 dollars " Disagree "Fix the abuse in the medicade and medicare systems aleady, and the welfare system. " Agree "I work at CVS pharmacy and I see fraud and abuse of the medicade and medicare system every day where patients are over prescribed medications ie. one patient recived 16 medicaid paid perscriptions for pain no one can possibly need or can take that many perscriptions at one time, however, the doctor ordered them and the were despinsed at the cost of tax payers. We need accountability in the federal government with federal government programs. Thats why expenses are so high in the health care system. " Agree Agree "If the government could reduce fraud waste abuse this could happen, we also need to cotrol health care cost through overtreatment, pharmacutical companies over charging, and medicare and medicaide abuse." Agree I would only agree if we have ACCOUNTABILITY!!! Accountability is the problem we have now! "* As a concerned citizen, it is important for Americans to have lower healthcare cost, I really and truly belive that this can be controled if we control the abuse of the current system and hold doctors, pharmacies, and insurance companies accountable for fraud and abuse. I work in the health care system at CVS pharmacy and I see the fraud and abuse every day by patients who are over prescribed and over treated. Questions arise such as why is this person driving a 40,000 car getting medicaid, why are we giving this person 19 perscriptions for pain medication on medicaid, and it all has to do with holding people accountable for fraud and abuse. As a nation we could promote heathy living. A healthier nation ultimately will have lower health care cost, fund Physical Education classes and nutrition classes." 30231 08/15/06 WA Disagree "Of course, Americans shoud not be impoverished by health care costs. The only viable option is Medicare for everyone." Disagree There is no need and little value to local options. They are a distraction from a full fleldged national health system. Everyone should have the standard for each type of care. Cure and treatment of disease in a medical not a local political issue. Disagree "Of course, everyone wants to immprove quality of services. However, the way to accomplish this is not from a free market let the buyer barter for the best care available. People will mostly use the closest available provider. The emphasis should be on provider education and an independent sanctioning body to weed out poor providers who do not adopt state of the art treatment." Agree Agree "A ingle payer system is key to making this goal doable. The current system is too scattered and too complicated. The mantra of adding more and more choices is fine only for a select few who are well educated and have above average income. Simplify, simplify, simplify." Agree "We already spend more on health care per person than any other industrialized nation. It is not finding new financing mechanisms that is important but rather cutting waste. A single payer system will go a long ways toward accomplishing that. Over time, increased emphasis on prevention will save costs." 30232 08/15/06 WA Agree "I greatly appreciate the chnges in Medicare, which I'm on due to a disabling injury in 1979, not because of my age (61)" Agree Agree Agree "I especially like the phrasing in this recommendation: ""in the environment they choose.""" Agree I am particularly fortunate to receive my health care through an HMO (Group Health Coop) subsidized by Medicare Agree "Once we address basic health care, how about branching out into dentistry too?" "As stated above, how about including dental care after healthcare is corrected?" "Could it really be that George Bush's presidency could be distinguished by the initiation of ""universal health care"" (aka ""socialized medicine""). - - Oh well, it comes with the job. . ." 30233 08/15/06 NY Agree "We already pay a very high percentage out of our salaries for health care. Why should we have to spend over five thousands more because the dental coverage does not include alignment, whitening or invisalign braces. I feel that if the expense of living rises then our coverage which is being paid for shall meet the need. " Agree Agree Agree Agree Agree 30235 08/15/06 NY Agree Agree No response Agree Agree Agree 30238 08/15/06 AL Agree There should absolutely be coverage for all Americans. Health care is so scarce these days unless you have a job that pays or offers health care. For those who are unable to achieve this means of obtaining health care should most definitely have an opportunity for coverage. Agree "Absolutely. This nation needs to provide for its underprivelidged, most especially our children and elderly. This is a wonderful way to do it and to keep track of the ever growing need." Agree I believe this will help to decrease the act non-compassion for those who are uninsured. Agree "In this world where AIDS and other terminal diseases are often used an ""out"" to deter health care, patients and families should have the comfort of end of life care no matter who they are. This is also the opportunity to fulfill Christ's words of ""what you do to the least of these, you also do to me."" And if the country doesn't do this to help those in need, we are still fulfilling those words, but in the wrong way. Do we REALLY want that on our conscience?" Agree "Most definitely. It is important that all Americans have the opportunity, especially the elderly, the young, and the terminally ill, and the poor. This is the cure." Agree "Yes. There are so many suffering right now who need coverage in the worst possible way and so many who have file bankruptcy due to non-coverage and inability to pay for their medical expenses. I agree it will take time to work it all out, but it should be a major priority." Perhaps the spectrum could be broadended even more to include religious influence as guidance and possible funding. "Health care coverage is so important for all of us. At this time, God and our government is the only body that can serve us in this crisis. I fear paralyzation and it just plain not happening. However, through faith in Jesus Christ and in each other, we will prevail. This is America, founded basic principals of freedom, liberty and justice for all. I believe America also was founded on faith and love. Let's make sure it stays that way. God bless you." 30239 08/15/06 IN Agree There should be a way to protect all Americans from being left bankrupt by a disaterous health issue. Agree Agree There needs to be a good system of checks and balances to prevent fraud from happening. Agree We should try to do everything possible to help those who are terminal to make the last of their time here as comfortable as possible and to help the families get through such a very hard time. Agree It must be high-quality health care. That is very important. Agree I as an American worker am willing to help pay for universal health care. 30240 08/15/06 AL Agree "Best practices and preventive care should be givens. The key word here is 'Americans'. While I have great understanding, empathy and sympathy for non-citizens and programs should be in place for emergent care for them, our citizens should benefit from our resources first and have better coverage and access to care. Our public health settings (not acute care settings)should play the key leadership role in the provision of preventive, palliative, and chronic care at the point of living." Disagree "* The concept is sound, but why do we have to establish another line of organization and accountability? A root cause and gap analysis would demonstrate that there are a multitude of initiatives already underway. The true innovators are those that are at the front lines dealing with these issues every day. The powers that be have not been able to devise a workable solution, only complicate it more. Let the people find solutions. Make information and alternatives known. Be willing to accept the unorthodox. " Disagree "1. Development of a core national healthcare IT system available to all stakeholders. 2. Bring national standardization to the law, licensure, and regulation of payors, providers, medical equipment, research dissemination, best practice development & implementation, with health care consumer responsibility & accountability for care compliance. 3. Consolidation & redefinition of acute healthcare service providers/facilities both public and private. " Agree "Our sociocultural institutions (religious & secular) should be included in providing education, resources, and fiscal support of the communitiies they serve. Open forums should be provided across the country to provide opportunities for providers and individuals to have open dialogue about end of life needs, concerns, and definition of services to be provided. " Agree "Again, the key word is 'American'." Agree "Let us look to those that have gone before us - Canada, Britian, etc.- to learn from. Immediate family for bereavement leave includes grandparents, children, grandchildren, aunts, uncles, etc. for both the husband's & wife's family. Could this not be so for health plans? If I am employed and willing to pay , why can I not pay an extended family rate to get coverage for my 'immediate' family?" "The ability to select who & where services are provided. The provision of best of care should be mobile, not the patient. If a patient in Kansas is in need of specialty care available from a provider in New York, the care should travel to a location easily accessible by the patient and family, not the other way around. " Get the people involved. 30242 08/15/06 NC Agree Agree Agree Agree Agree Agree 30243 08/15/06 NY Agree No child left behind for health care. Agree Agree Agree Agree Agree 30249 08/15/06 MI Agree "* I am a nurse-midwife with 30 years experience in women's health, married to retired professor of Psychiatry. We both strongly feel that the current system is insane, and that health care should not in any way be a corporate profit making enterprise on the stock market, so that 1) single payer government oversight system is best 2} we need an impartial board to determine basic health coverage guidelines (not everyone has the right to a heart transplant; techinology needs some restraints and just because we CAN do it doesn't mean we should; basic health care and catastrophic and decent end of life care should be provided to everyone with minimal paperwork and maximal choice of provider; other care would be two-tier, this being the real world where the rich are going to demand more, which they can jolly well pay for at capitalistic rates 3} American industry and businesses must be relieved of insurance/health policy costs which make us uncompetitive with other nations with decent government health care sy" Disagree see above Agree Disagree at the FEDERAL level with community input and modification Agree Agree SINGLE PAYER SYSTEM! "health care also includes full women's health care, including appropriate family planning services and abortions if requested." "Don't feed into corporate and legal stranglehold of healthcare. THis is the time to truly overhaul our non-system. Healthcare is not, must not be, on the stock market where investors are only interested in profits." 30251 08/15/06 SC No response Disagree "* The South Carolina Primary Health Care Association (SCPHCA) serves as a membership association for safety net providers in the state, including 21 FQHCs. The SCPHCA feels that most of the Working Group’s Interim Recommendations are good and deserve support. However, its recommendation to expand and modify the FQHC concept to accommodate other providers would be a huge mistake and should be removed. FQHCs are community-owned providers of health care and the Working Group’s recommendation would effectively serve to take the community out of the picture through the removal of the FQHC community board requirement. If other providers wish to obtain federal recognition and support without meeting current FQHC requirements, they should be required to seek independent legislative recognition and support separately. This reccomendation would simply serve to destroy one of the most successful federal health programs in existence. It has also been brought to our attention by health centers that attended " No response No response No response No response 30253 08/15/06 FL Agree "I have been an individual on a low income due to unemployment and had a major illness which required hospitalization 4 years ago. I am still trying to pay off bills from that occurrence. If insurance/financial protection had been available, my credit wouldn't be ruined now. I am an RN working full time and still struggle to pay my bills." Agree "My concern about this is ""how are we going to staff all the centers that are going to be needed?"" There is a physician and nurse shortage now, and according to projections, it is only going to get worse." Agree "Nurse Practitioners are specially trained in health education, patient centered care, disease prevention, and health promotion. I believe they are under utilized in these areas." Agree I agree that end of life care should be taught to all healthcare practitioners. Hospice should be available to all despite costs. Agree "I agree, as I commented previously, I was unemployed and had a major illness, and I am still trying to pay off those bills, despite being an RN and employed full time, my credit is poor and I have creditors calling at all times. I still struggle to pay even day to day expenses, much less be able to save anything for the future, and I am 49 years old facing an uncertain future." Agree "I believe in this wholeheartedly, but question where the resources are coming from." "What about vision health? That is also a concern, especially for diabetics (which are an increasing population in this country)?" 30256 08/15/06 CA Agree "Comment: The majority of respondents favored a national health program, which is financed by taxpayers, in which all Americans would get their health insurance. This implies a program which is public, not private. A program financed by taxes would not require premiums, co-pays, and deductibles for financing and therefore out-of-pocket costs could be minimal. This makes financial protection for low-income individuals unnecessary. " No response No response No response No response No response 30260 08/15/06 CA Agree "* I am employed to provide public assistance to the neediest members of our community in San Joaquin County, California, I am an eligibility worker, and even though I personally feel a responsibility to participate in providing health coverage for my children (I am a single parent-with no support from absent parent) I know that my income is less than what some of my clients receive per month in income to their households. This angers me emmensely. These clients receive SSI/SSP for several members of their family and some receive low income housing assistance (HUD), and then they receive CalWORKS, Food Stamps & free medical coverage through Medi-CAL/Medicaid programs. They take home more in their benefits, than my net take home pay is per month, yet I am expected to live and survive with the salary I earn and support myself and three growing children. I believe that it is time to cut the red tape preventing many people from receiving quality health care services and it is time to create and manage a universal" No response No response No response Agree "* I am employed to provide public assistance to the neediest members of our community in San Joaquin County, California, I am an eligibility worker, and even though I personally feel a responsibility to participate in providing health coverage for my children (I am a single parent-with no support from absent parent) I know that my income is less than what some of my clients receive per month in income to their households. This angers me emmensely. These clients receive SSI/SSP for several members of their family and some receive low income housing assistance (HUD), and then they receive CalWORKS, Food Stamps & free medical coverage through Medi-CAL/Medicaid programs. They take home more in their benefits, than my net take home pay is per month, yet I am expected to live and survive with the salary I earn and support myself and three growing children. I believe that it is time to cut the red tape preventing many people from receiving quality health care services and it is time to create and manage a universal" No response 30265 08/15/06 IL Agree Agree Disagree "* I think it is a waste of resources that could be better spent on disease prevention activities remediating environmental, neighborhood, socioeconomic and biobehavioral determinants of health. The goal is to improve the health status of all Americans, not just treat the sick. We must create a healthier population for moral as well as economic reasons. This money would be better spent on public health interventions, such as creating healthier community environments, access to healthy, not processed, foods, violence prevention, traffic safety, etc." Agree Agree Agree "Agree and add that we must vastly increase funding public health agencies and initiatives at all levels of government to reduce incidence and prevalence of disease, especially chronic diseases such as diabetes and asthma." "* During the past 100 years, average life span in America increased by 30 years. 25 years of this increase are attributable to public health services, and only 5 years derive from improvements in medical care. We need massive increases in funding of public health initiatives. Healthy community environments produce healthy individuals. All federal departments must work on tackling negative determinants of health such as pollution, accidents, workplace injuries, exposure to second hand smoke, and safe neighborhoods so people can go outdoors and walk, etc." 30268 08/15/06 CT Agree "* Everyone should have access to affordable health care and not be in fear of having a major medical event bankrupt the whole family. One option could be for people to have access to a low cost health coverage for only major medical events. All other health care is the responsibility of the individual. This would cause people to take care of their own health in order to not need constant medical care they would have to pay for. It would also be a way to get people to practice prevention, keeping the use of the major medical down. I think that many people go to the doctor because they pay so much for insurance they feel they should make use of it. They also don’t go to doctors who could be beneficial because their health care doesn’t cover it. This causes the price of health insurance to go up and causes many not to be able to afford any insurance even just major medical." Agree "High quality health care needs to include natural health care options including Naturopathic (licensed ND's), acupunture, chiropractic and other less expensive, less invasive, more preventative options." Agree health education is very important - patients today want more than to just be handed a pill. They want to participate in the decisions that involve thier health. Agree "Again I believe that natural options should be avaialbe for end of life care. Keeping the quality of life in place so that people don't spend the last days swollowing a dozen pharmecuticals that are not going to change the end result, but put the patients quality of life out of the picture." Agree This can not happen with a system that uses only drugs and surgery as the primary health treatments. Agree "* Patient responsibiltiy, education and prevention will be an important part of keeping the costs down. Educating patients on how they can do their part to stay healthy and oppurtunity to use less expensive health care options will help correct an out a control system that simply supplies drugs for every condition with out regard to the when and how the patient will be able to discontiunue that drug. Even when the drug has been identified as a short term only treatment - patients are left on the drugs for years with no other options offered." "* The current health care system does not include prevention. Drugs and surgery are the only answers offered becuase that is the only training MD's are given. Any medical practice, be it Naturopathic, Chiropractic etc., outside the entrenched medical system is not regarded even with evidence that it can be effective. Patients need to take control of thier health and have as many otpions as possible to keep that control. A drug and surgery only medical system is not going to be the answer. It hasn't been the answer. It has created a system that is very expensive, out of reach for many, and not that effective, while also causing the deaths of many Americans each year - while those out side the system can only watch. This needs to change - I hope that this effort can make a change for the sake of many Americans. " 30269 08/15/06 WI Agree Health Insurance in many cases is almost 1 paycheck per month...that is WAY too much money. Agree Agree "* 1.)I am a LPN working for almost 34 years...it is absolutely shameful how much nursing time is taken away fro the patient & given to ""change to medication do to Med B"", and then 5 days after the change has been made, we are requested to ""Make another change back to the orginal med, related to payor source (which is Med B"". The Person who heads up this project, needs to walk 1 week in the shoes of a LPN/RN & things woul.d change drastically. The ONLY reason I have NOT given up on my profession, is my personal goal to help as many people as I can in our Health Care System. 2.) The wastefulness of medications in a Longterm Care facility...if a patient dies, or is discharged, or goes to the hospital, all the narcotics are distroyed & can NOT be returned to the pharmacy for credit. 3.) The government has NOT been a force to promote the use of LPNs in the Healthcare system, in any avenue...Hosptial, MD office, home care, nursing homes hospice etc. If ALL Healthcare facilites were told to utilize LPNs to their " Agree "* 1.)There was a hospice patient I cared for who was charged a daily charge, and the Hopsice staff only saw him once a week...fraud?? I think so. I brought this to our fincial office & they were going to handle this. These type of hospice places gives hospice a bad name. Our facility no longer contracts with hospice. 2.) we also had a case where a patient died while on hospice care, and the family needed support...yet a hospice staff wasn't available to the family for 1 1/2 hours...not good in my eyes, what about yours??" Agree Agree "there is such a wide range of cost for health care that it would be impossible for me to comment. I am on a single plan, and can afford what I pay, however the family plan is over $350/month which for some people is too high to pay." "Yes...why would a insurance company give 3-5 days for alcoholism treament, and for a hysterectomy with bladder surgery, only ok an overnight....something seems wrong with this picture, yet it happened to me all in the same week! Our health care system is a mess, we need to have a core group that actually works in the health care system (non-management) to find solutions." 30271 08/15/06 NV Agree Agree Agree Agree Agree Agree 30272 08/15/06 NY Agree Agree Agree Agree Agree Agree 30273 08/15/06 CA Agree Universal health care for all!!! Agree Agree Agree Agree Agree 30274 08/15/06 OH Agree "We need coverage for everyone. We also need to have coverage for people who have worked long enough to retire from their jobs, not have to keep working just to have health insurance. People should be able to enjoy retirement, not have to work through it just to be covered by health insurance. We need to take care of our older americans before they become sickly." Agree Agree Agree Agree We spend so much money helping other countries. We don't spend near that taking care of our own people. I find this truly sad in these times. Agree 30276 08/15/06 FL Agree this pretty much says it all for me. We need these protections. Agree Agree Agree Agree Agree 30278 08/15/06 VA Agree Agree Agree Agree Agree Agree 30279 08/15/06 CA Agree "Universal health care is an idea whose time has come. Businesses can't afford it anymore, and since we're such a business-oriented country, I can't believe that they haven't pushed for this change. I'll soon be unemployed and probably can't afford my own insurance. What will I and others like me do? But the time has come. Universal health care now!" Agree Agree Agree Agree Agree 30281 08/15/06 NY Agree Agree Agree Agree Agree Agree 30282 08/15/06 TX Agree I agree with this as I am in the process of having to pay hugh portions of medical test which my insurance company will not pay do to change in their contract Agree Something that has been needed for a very long time Agree Again this is long over due Agree Agree "Again this is so important, especially in the Senior population as ones retirement can be completely depleated as it is" Agree 30283 08/15/06 WI Agree Agree Agree Agree Agree Agree 30284 08/15/06 CA Agree It is time for Americans to wake up to what is going on. It is pretty obvious that all Republicans care about is to ease the pain and suffering of insurance companies. They (the Republican leadership) don't care about families at all even though they say they do. Their actions and voting record speak otherwise. No response No response No response No response No response 30286 08/15/06 MA Agree Agree Agree Agree Agree Agree 30287 08/15/06 NY Agree let's turn the tide and begin to err in the direction of becoming humane No response Agree Agree Agree Agree 30289 08/15/06 CA Agree " It is criminal that many of our retired workers are being forced back into work, because they cannot afford health benefits. We are letting our parents lose everything they worked so hard for. Where is the government they fought, worked, and voted for? Obviously, letting corporate America line their pockets at their expense!" Agree Agree Agree Agree Agree " I think it is disgracefull that the only superpower in the world,does not take care of its own people! We are supposed to be a leader in humanitarian ideals, yet we let people suffer and die because they cannot afford medical treatment. I have traveled extensively, and found every other first world nation takes care of its citizens. We should be ashamed!" 30290 08/15/06 WA Agree * Health care costs are just too out of control. When a small child is in the hospital for an extensive stay and the community pulls together to collect funds so the family doesn't get evicted - there is something terribly wrong with that picture. When the elderly have to put food back on the shelves because they can't afford to get the food they want and need because their prescriptions are so expensive - there is something terribly wrong with that picture. When people can't afford to retire because they can't afford the out of pocket healthcare costs - there is something terribly wrong with that picture. How can the wealthiest of all nations treat their people this way? It is very embarrassing. We need and deserve a national health care program for all Americans. No response No response No response No response No response 30291 08/15/06 CO Agree To obtain health care should not be an economic decision. Agree I agree to the extent insurance companies are not driving the discussions. Agree Agree "I even think that Kervorkian was onto something. With the appropriate paperwork, medically-assisted suicide should not be a crime." Agree "As I said above, health care and medical assistance should not be an economic decision unless we're talking about nose jobs, breast augmentation, botox injections, and the like when these procedures are not medically-necessary." Disagree Look at societies and governments that provide health care for all its citizens and study those models. unless every segment of the affected are equally represented with equal weight accorded their voices. 30292 08/15/06 NJ Agree "We need a national system of governmentally provided health care that covers all Americans. Health care, in the US should be a right of citizenship, like it is in EVERY OTHER major industrialized nation." Agree Agree Agree Agree Agree 30293 08/15/06 NE Agree "Let's save billions of dollars each year in administrative costs, and hundreds of hours of doctor time by instituting a single payer system. Every other modern Western country has it." Disagree I think it's time to get the for profit groups out of the health care system. Their profits are corporate welfare. Agree Let's expand these groups to cover all Americans. Disagree "Again, let's make it a single payer system. " Agree Agree Payment should be based of income. Preventive care should be a major component. Lobbying by drug companies and for profit groups should be prevented. "Let's study the successful methods used by other industrialized nations to create a system that is fairer, less expensive and more effective. We don't need to re-invent the wheel here!" 30295 08/15/06 NE Agree "IT'S TIME WE START TO CARE OF OUR OWN. IT IS A SHAME WE HAVE SO MANY AMERICANS YOUNG AND OLD NOT RECIEVING PROPER HEALTH CARE WHILE OUR GOVERMENT ARMS OTHER COUNTRIES TO THE TUNE OF BILLIONS OF DOLLARS, IT IS TIME TO TAKE CARE OF OUR OWN." Agree Agree Agree "WE WILL ALLOW ANIMALS TO DIE WITH DIGNITY, WHY NOT HUMANS?" Agree COST BASED ON FINANCIAL INCOME!!! THE RICH FOLKS WON'T LIKE THIS IDEA!! Agree "IF WE MADE OUR GOVERMENT PAY BACK ALL THE MONIES AND INTEREST THEY STOLE FROM SOCIAL SECURITY FUNDS OVER THE YEARS WE COULD DO TWO THINGS, STABLIZE THE SOCIAL SECURITY INCOME FOR MANY MORE YEARS AND FINANCE HEALTH CARE THAT WORKS FOR ALL AMERICANS!!" AS LONG AS WE ARE AWARE THAT WITH MANY HEATH ISSUES THAT TIME IS VERY IMPORTANT TO THE CURE. WE COULD BURY OURSELFS AND BY THE TIME A DISCISSION IS MADE IT COULD BE TO LATE FOR THE PATIENT. LETS MAKE SURE WE DO NOT HAVE THIS HAPPEN TO AMERICANS. 30297 08/15/06 KS Agree The same quality of health care should be available for all. Agree "In order to achieve this, more and better training facilities are needed to train doctors and nurses, along with better pay. This requires government-funded universal health care." Agree "Except: none of these programs are working well, and most are under-funded. Save on paper-work fraud and waste by having one health care system available to ALL citizens who may choose it or their own private insurance." Agree Agree Agree "All Americans should pay a tax into this system, regardless of whether they intend to use it, and this tax should be steeply gradauted according to the ability to pay. Those who benefit the most from our economy should pay the most to support the economy. Of course, the homeless and unemployed should pay nothing." Are there any really unnecessary medical treatments other than the purely cosmetic? 30298 08/15/06 CA Agree Agree Agree Agree Agree Agree "We spend 20% of our $410B defense budget on weapons procurement that is verifiably not necessary or the 'best deal', according to the GAO. Let's take $$ from the Pentagon budget and use it where some measurable and beneficial results can be produced." 30299 08/15/06 PA Agree Agree Agree Agree Agree Agree 30300 08/15/06 AR Agree America is a great country and we can solve this problem. It's time to consider the common good again! No response Agree Agree Agree Agree 30302 08/15/06 PA Agree This doesn't go nearly far enough. We need a universal single=payer health care system for every single American. Agree Agree "Quality and ""efficiency"" don't necessarily go together. " Agree "Yes, this is important and too often overlooked! And we need to legalize the right to assistance to hasten death in every state, not just Oregon, for the people who wish to use that option. " Agree Yes. Only a universal single-payer system will do that. Agree "It should be operated as Medicare is. Every working adult should pay a monthly premium to DHHS, adjusted for number of dependents, and payments to doctors, hospitals, labs, and other health-care charges should come out of this fund. Medicare is THE MOST COST-EFFECTIVE health insurance system we have because it doesn't have any profi-oriented middlemen. Two per cent of Medicare money goes for administrative costs. Only TWO PER CENT. " "Include benefits for vision exams and eyeglasses, and podiatric care for those who require it. " 30303 08/15/06 CT Agree "* I also think that details should include guarantees that changing jobs or joblessness does not result in any loss of coverage for employees and their families, preventive care, prenatal care, well documented alternative medical care, home care for disabled and elderly, dental costs, mental health costs, and there should be built in protections that ensure that the quality, quantity and availability of the services are within high standards for everyone. It should also guarantee acceptance for full coverage regardless of pre-existing medical conditions. " Agree Agree Agree Agree Agree "Tax benefits to corporations and businesses that provide better health care coverage should be given. Large fines for businesses that provide insufficient coverage and large taxes on prices above and beyond reason for prescription drug companies, medical supply companies, and health care providers. Tax incentives for fair pricing of medical supplies, technology, research and treatment. " Excellent! 30304 08/15/06 OH Agree Agree Agree Agree Agree Agree 30305 08/15/06 NY Disagree "* Universal health care is a shortsighted promise that assumes that the economy will always continue to grow. Since it is taken out of the money 'on hand' rather than long term savings, once the current baby boomers retire I and those of my age group will face a crushing tax burden for health care on top of the comming tax burden to ensure the retirment of the current crop of baby boomers in their shortsighted refusal to save for the future. You have to look no futher than the European Union to se e how long term universal health care promises are dragging down their economies. It's true that at the moment there is more than enough money to fund these initiaves; but once you impliment them, that money will disappear as companies find other countries that are not hostile twords business. It won't be long before the united states, like Great Britan before us will lose our superpower status. Instead, I propose programs to educate people on proper handling of money, initiatives to get people to save and how to c" Agree "What I get from this is that somebody needs to be held accountable; insofar as that's true, I agree." Agree "Bush has not directly killed a single person in the Iraqi war, but he is and should be held accountable for every death indirectly caused by his disasterous false war. Just as politicans should be held accountable for every death caused by their disasterous false medicare system; after all, how many thousands have died from curable diseases, bureaucracy and incompetance?" Disagree "Save for your own retirement; stop buying booze, cigarettes, pop-tarts and high-defintion TV's. Generations of immigrants did it, it's perfectly doable. You're not owed anything; Your only a vicitm of your own bad choices." Disagree "I've no problem with providing services for poor and underserved individuals, but too many people choose high definiton tv's over saving and shopping around. We need education, inflation!" Disagree "* Sin Taxes? How about taxing everyone who didn't save for their own future. How about taxing everybody who disagrees with you? Sin taxes are fundamentally unfair since everybodys' definition of sin is different. The tax burden is too high allready. If the goverment was a household, and the budget was a household budget, do you think we would be paying for the arts (comic books, lewd CD's) when the family was starving? Do you think we would paying for historical restoration (storing knickacks) while the room was leaking? No. As a middle class american, I'm allready being squeezed; I can't help but notice that only democrat controlled states (with the notable exception of California) are in the toilet economically while republican controlled states grow. We need less 'taxes' and more 'accountability'. Good heavns, figure out exactly where all the money is going before you pile on more taxes and destory my quality of life further." I'm opposed to universal health care. "* I make > $20000 a year, but I can see what happens when you try to marry free markets to socialist demands. Universal Health Care sounds nice, and like communism before it people like the idea of not having to work for what they get, but it's ultimatly self destructive because it ultimatly shifts the burden to the little guy since big business will not stick around. I, for one, don't want people taking away what I worked hard to earn any more than they do. It's no different than a goup of blind religious idealouges insisting that their way is the best way of doing things and hang everybody else, just look at the language and the way these questions are phrased" 30306 08/15/06 AZ Agree Agree Agree Agree Agree Agree inancing should be based on principals of fairness 30307 08/15/06 CA Agree "Please also encourage programs that encourage people to take care of their health- eating a whole foods, plant-based diet with just enough traditional cultural foods to be comforting, finding exercises that are fun and fit into their lifestyles, programs for alcohol, nicotine, and other drug cessation. Prevention is the most cost effective health care tool there is, and helping people to enjoy a healthy life is rewarding for everyone involved!" Agree Agree Agree Agree Agree "Because most Americans eventually contract mostly preventable chronic diseases such as heart disease, diabetes, Alzheimer's, cancer, hypertension, osteoporosis, etc. because of our poor diets and sedentary lifestyles, an emphasis on prevention can bring about great savings." "Reproductive health care, especially for women, is essential. Please ensure that all women have access to contraceptives and all other services necessary to maintain control of their reproductive health." 30308 08/15/06 MO Agree This is one of the most pressing needs in this country. Agree Essential! Agree Very important! Agree Not as urgent as some of the others but important nevertheless. Agree This type of system is essential! Agree Those most able to pay should pay the most. Essential! The wealthiest country in the world should be able to provide all of its citizens with some level of health care. I'm embarrassed that we are the only industrialized nation that fails to do this. 30309 08/15/06 LA Agree I agree with the statement so long as the individual has a responsiblity in the cost of the insurance and the cost in first dollar coverage. Disagree History has shown us that any program the government has a hand in can never stay within the budget. Disagree They have not been able to accomplish this with medicare to date. What would be different in the future? Agree As a nation we have a moral resposibility to take care of the people with advanced incurable conditions. Disagree Americans already have access to core health insurance. We have a certain percentage that choose not to pay for their coverage which puts a burden on those that are paying for their coverage. Agree "The statement "" multiple financing sources winn need to coexist during the move to universal coverage "" scares me. I do not think health insurance should be another entitlement program" "I agree with this statement with some reservations about including too many services under the "" core "" definition." 30311 08/15/06 PA Agree Agree Agree Agree Agree Agree A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death. Dr. M L King Republicans since Reagan have preferred war and destrruction to helping people and attaining affordable healthcare. Hillary in '08! 30312 08/15/06 WA Agree Agree Agree Agree Agree Agree "single payer system, period." 30314 08/15/06 IL Agree Agree Agree Agree Agree Agree 30315 08/15/06 PA Agree People are about to lose their homes because of the health care system. Agree Agree Agree Agree "Yes, without going without food on the table." Agree "Yes, one, Get the green card out of peoples hands that can and are able to work." 30316 08/15/06 IA Agree Disagree "* I attended the Citizens’ Health Care Working Group meeting in Des Moines in April. Recently, CHCWG released its interim recommendations for how to make quality health care more accessible and affordable to every American. While I support the majority of the Working Group’s interim recommendations, I am writing to express my concern with the recommendation to expand and modify the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations. I do not recall this being discussed in Des Moines, and am not sure where this came from. The philosophy of the FQHC program is to provide affordable, quality, patient-directed health care to the uninsured and underserved. One of the ways this is accomplished is through the requirement that each FQHC be governed by a patient-dominated Board of Directors. The Working Group’s recommendation would effectively take the community out of the process by removing or significantly dimi" Agree Agree Agree Agree "* If the current waste in insurance admin costs, and duplicated health programs at every level were removed, there might be close to enough money now to cover all. Hundreds of categorical programs at Federal, State and local levels, each with its own administrative, reporting and managment costs. I commonly see uninsured people - say a pregnant women with kids needing shots, perhaps a substance abuse or mental health issue, in need of prescriptions. And I have to access multiple programs to get those services. A comprehnesive primary care program under one roof can manage all of these." 30317 08/15/06 CT Agree Agree Agree Agree Agree UNIVERSAL HEALTH CARE NOW Agree 30318 08/15/06 GA Agree Certainly it is way passed time for the richest nation in the world to make health care available for every citizen. It really is not American to have certain procedures and medicines available only to the wealthy. Agree My concern is that even if a public-private group acts in an advisory capacity to the government nothing may be accomplished. Look at this administration who held up funds voted by our congress to help fight AIDS throughout the world for years. Also this administration has gone against the advice and vote of the medical community in allowing oral contraception to be sold over the counter. The Recommendation sounds good but can it be successfully implemented? Agree Again my only concern is will all parties participate? Agree No comments Agree Sounds great. Agree Health insurance companies and drug companies need to step up to the plate and do their share in investing towards a national health care plan. This sounds very workable to me. 30319 08/15/06 MN Agree "Medical care should be provided on an even playing field, whereby it isn't only the priviledged who have access to it." Agree Agree Agree Agree Agree 30320 08/15/06 WA Agree "Every one in America should be able to have health care at an affordable rate. We all need good coverage, protection against high out of pocket medial cost. Financial protection for low income individuals and their families." No response No response No response No response No response 30321 08/15/06 CO Agree "Having lived in Europe for 13 years, one of the biggest fears and uncertainties in returning to the US was the high cost of health care. I see it as one of the biggest problems in our country. Excellent health care should be everyone's RIGHT, and available to all - - a SOCIAL SERVICE; it should NOT be subject to the whims and greed of a for-profit industry. " Agree "Promoting alternative PREVENTATIVE care would save billions which are currently spent on expensive, often useless, treatments." Agree "Open, clear, and transparent records should be publically available to all. " Agree Agree Agree 30322 08/15/06 CA Agree "I like the idea that unions insist in their negogiations that corporations promise to support and lobby for universal coverage. I don't know how such an agreement can be enforced, but public support by corporations will go a long way to changing our current system." Agree Agree No response Agree Agree 30323 08/15/06 MA Agree Quality health care should not be a luxury that only the rich can afford. Agree Agree "I agree, but since you are speaking of federal government programs, this must include timely and objective family planning clinics with all options available if desired; down-to-earth health and sex education programs in high-schools which are NOT faith based and should not rely solely on abstinence; and support of stem cell research which will help to cure so many diseases and improve the quality of life for so many people. " Agree Agree Agree 30325 08/15/06 CA Agree "One of the real ""weapons of mass destruction"" is the fact that 45+ million Americans have no healthcare and millions more have inadequate care. Get off the dime and help give people what they really need, not more wasteful government spending and military excursions all over the planet. Please." Agree Healthcare is a basic human right. Most developed countries of the world have healthcare for all their citizens and that is the LEAST we can do here in the U.S. Agree Preventative medicine alone would pay for all the additional coverage over time because people would be healthier and need doctors/medicine even less....stretching the U.S. health care dollar. Agree "Just ask yourself, ""How would I want my parents taken care of in their final days?"" This is so basic it's hard to believe end-of-life care is even an issue and not a basic health care right." Agree "Let the rich share with those ont he bottom of the heap. After al;l, they got rich off the backs of those same people." Agree Share and share alike. How can a poor country like Cuba provide free health care for all its citizens and the U.S can't? "Absolutely. Let the mega-rich pay for experimental treatment, etc. Let the rest of us have the best and most effective treatments that we can afford as a whole." It is unbelievable in this country that a basic human right such as access to affordable and effective healthcare is out of reach for so many citizens. This is embarassing and so totally unnecessary. If we just put our heads together and figure out a fairer way then a lot of needless suffering could be prevented. 30326 08/15/06 CO Agree I am very poor and already have high medical bills. Please help people like myself get out of the pit of poverty. Agree Agree Agree Agree Agree 30328 08/15/06 WA Disagree "I think the deductables you are proposing are ludicrous... You have not even addresssed a premium structure or what is covered in a ""core"" plan." No response I think we need a national plan with a private delivery system. This recommendation only appears to add levels of bureaucy to a system with no defined result. No response while in general some of this is good there are bad parts as well although you have great bullet points you have not defined how to ensure that is the result. again more bureaucracy and no definative plan No response don't we have this now.. if not then our doctors are not taking the time needed to discuss options with family and patient. No response while i can't really disagree with this statement what you are not saying is your reccomendation is assistance to those under 200% of the poverty level and again the deductables are too high for most families No response i see here more taxes and more taxes. there has to be a way to make this work for the 2 trillion already being spent on healthcare in this country again cant disagree about a core package but it should be very simple to define any medical services needed based on doctor's reccomendation. what is so difficult? "* While I appreciate the efforts put forth here I am a very disapointed with this report as a whole. your mission was to answer the 4 questions and in my opinion you have not done that. I participated in the meeting in Seattle and was disturbed then at the way the questions were written and the ""multiple choice"" answers were provided. Many of the answers were not what I would reccomend and at least in Seattle those sentiments were expressed by many. I see in other city's some large percentages choose to abstain from answering them. Why was Seattle not given the option and if we were not then I can only assume many other city's were not either therefore you are working with skewed data. I also found interesting the population breakdown I certainly don't think you got representative thoughts from the different ethnic groups. And finally in the interest of time your report say's you heard from 25,000 people while that may seem like a great number it is less the 1% of the population. How can the data be " 30330 08/15/06 NJ Agree Agree Agree Agree Agree Agree 30331 08/15/06 FL Agree Agree Agree Agree Agree Agree "We need single-payer universal health care coverage as proposed by Reps. John Conyers and Dennis Kucinich. This could be funded by rolling back the Bush tax cuts for the rich, and eliminating wasteful defense spending programs such as star wars missile defense and bringing our troops home from Iraq." 30332 08/15/06 CA Agree "The United States, home of the largest military in the world, stands alone among developed nations in having failed to provide all Americans quality public health care. Only in America can a fully covered person still end up in bankruptcy. This has to change. Americans deserve fully covered quality health care as much as the French, Italians, Dutch, British and Japanese people do. The time to start implementing this is now." Agree "Integration and coordination of existing health care resources and personnel is an essential transitional step in forming a fully integrated, comprehensive regime of health care for everyone." Agree "Stakeholders like physicians, health care consumers, nurses, doctors and administrators need to be able to have ongoing meetings to ensure that everyone involved in the health care system has a voice and consumers will have ongoing power to monitor and improve quality." Agree End-of-life compassionate care with dignity is an essential part of the public health care plan. Agree "Yes, the health care system must provide for everyone, including non-citizens." Agree We have to cut the military budget and tax corporate wealth to achieve this goal. "The citizen participation is enormously important. So too is the selection process, to ensure that these representatives will be accountable to the public." 30333 08/15/06 CA Agree "Although I agree in principle, I just wonder how program would be financed. To throw the cost on to the middle class so the less fortunate have coverage is not going to be accepted by the middle class. You would need to explain how this program will be financed before I fully agree. " Agree The recommendations I would agree with except again how are financing other than the federal government has not really been explained. To say the federal government is going to pick up the tab just isn’t going to happen. Bush needs all of the funds to support his war. Agree "* Your first bullet item “Using federally funded health programs such as Medicare, Medicaid, Community Health Centers, TRICARE, and the Veterans’ Health Administration, the federal government will promote:” I have a problem with and that is the Medicare and Medicaid programs are have funding problems now. So by adding this program to the list will surely break the backs of both programs unless the funding is increased through the payroll system. One way to do this is remove the annually cap on the FICA deduction. So as you earn more, more money would flow into the system." Agree All of the above recommendations required a large amount of funding. How would this affect those that are currently on a fixed income? They have a problem now with costs rising faster than there income. Agree "Financial assistance will be available to those who need it. So again, the middle class will be asked to pick up the tab. " Agree "So long as the funding, will not be carried on the backs of the seniors and the middle class. " "Overall, I support the recommendation you developed and wish you luck.. " 30334 08/15/06 CA Agree "* Our goverment should be ashamed of themselves considering that we are one of the richest nations yet other nations take better care of thier citizens with universal health care. I know you heard this before that's why I know you don't care cause nothing has changed. All politicians do is raise taxes and then line their pockets with the increase tax money. Even if someone is honest and cares about the people when they get into office they will change to being like the rest of the politicans or they will not be in office for very long. I'm sure if you do read this,(which you probably won't) your attitude will be that I'm a radical that helps you to validate the what you do. Once again shame on all of you!" No response No response Agree Agree No response 30338 08/15/06 VA Agree "There is NO REASON that the #1 Country in the world doesn't already have health care for EVERYONE, when 36 other countries DO!!! That is ABSOLUTELY SHAMEFUL and EMBARRASSING as a Nation." Agree Agree Agree Agree Agree 30340 08/15/06 FL Agree "Healthcare is one of most working Americans concerns. Many of them can't afford the costs, and if they can, the deductibles are usually ""out of sight"" Poor people are left out of the picture, unless they qualify for Medicare now that Medicaid has been eliminated in many states, except for a few." Agree Agree Agree Agree Agree 30341 08/15/06 OR Agree I have been a registered nurse for 31 years. It is past time to provide health care for all citizens. If it is good enough for Congress it is good enough for all others. Mary Anne Joyce Agree Agree Agree it makes no sense to use the majoity of health care dollars on useless ICU etc treatments Agree Agree 30344 08/15/06 KY Agree This is essential. We are self-employed and cannot afford insurance. We take care of ourselves but would be at a loss with a serious illness or accident. The current system doesn't work well for most people. Agree It is really difficult to even visit a doctor if you are uninsured. Community health networks would alleviate this problem. Agree There is so much waste in the current system that could be improved with some effort. Agree "Hospice is wonderful but not everyone has access to it, though they should. It makes no sense to spend huge amounts of money and resources on the terminally ill." Agree This is of the utmost importance. Agree It is quite possible that no additional financing will be needed if most of the waste and excessive paperwork because of the complexity of the current system is taken care of. Everyone should have basic health care. Anything beyond the basic could be payed for by individuals. This program makes so much more sense than any I have seen. 30345 08/15/06 CA Agree do not wait to long or we will all be dead!!!!!! Agree Agree Agree Agree Agree 30346 08/15/06 NY Agree Agree Agree Agree Agree Agree 30347 08/15/06 AZ Agree "If you are legal,and breach no laws that constitute incarceration and work for a living you should receive top notch, top shelf (like the Doctors, and elite receive)medical treatment. Thank you " Agree As long as the powers at be are not taking the V.A. Hospital attitude and programs. Agree Agree Agree Agree Financing should never exceed over what a family can afford truthly. 30348 08/15/06 MA Agree Agree Agree Agree Agree Agree 30350 08/15/06 NY Agree Agree Agree Agree Agree Agree 30352 08/15/06 CO Agree Agree Agree Agree Agree Agree 30353 08/15/06 VA Agree Our nation is backward compared to many other developed nations when it comes to health care fairness. Agree Agree Agree Agree Agree 30355 08/15/06 FL Agree The middle class is being strangled by this president and congress. Abandoning the middle class that made this country great is a horrible attempt. We must not let medicare and SS benfits be cut because of wealthy tax cuts. Agree "Congressmen and the heads of this country retire with great benfits: medical care, retirement benefits. While the people who made this country great are being short changed. We must let our congressmen and and heads of state know our needs. Don't let them bamboozle us with statement contrary to what our interests are." Agree Agree Agree Agree 30356 08/15/06 AZ Agree "* get rid of the insurance companies. Their administrative costs are high. Look at what their executives receive for compensation etc. Just extend medicare to everyone. Make the drug companies compete for price, use alternative medicine (chiropractors, naturpaths etc) force to FDA to police the drug companies for safety instead of just being their puppets, stress preventive medicine and healthy lifestyle changes. One way to pay for all this is by cutting out the sinfully high profits that are made by the current system. And look to other countries with universal health care and see what works for them. Expose the politicians who will be bought off by insurance and drug companies. OUR health care system is broken. Its a disgrace. " Disagree "I mainly don't like the private sector involved. All they care about is money, not the health of our citizens." No response No response Agree "Universal health care will solve this. Cut out the high profit and waste and the cost of health care will come down. Other things will help like: alternative health care, preventive information, lifestyle change emphasized. " Agree "I agree with most. Except the ""expert consensus"" I am afraid we will have the same mainstream corruption we have now. If there is a panel of experts, it must include chiropractors and naturpaths etc. Not just MD's. These MD's have too many ties to the drug companies." 30358 08/15/06 WA Agree Agree Agree Agree Agree Agree "I think something on the order of a federal tax on goods and services would be necessary. People who can afford to buy more should certainly be able to afford this, while low income people who can't afford to buy a lot, wouldn't be penalized. This is similar to a state sales tax, but at the federal level." I think things that are not necessary for the health or well-being of the patient should be elective and out of pocket rather than covered. Examples of these would be cosmetic surgery and liposuction when it is simply to make the person look better and not medically necessary. "* I belong to Group Health and am on Medicare. I feel the GH model is a good one. However, when Medicare Part D came out, I couldn't join the prescription drug plan that would have actually saved me money because GH would have dropped me. I had to use their plan which costs me $200 a year more. If I hadn't joined I would have been penalized later on and I don't think that is fair. It seems to me that if prescription drug prices were negotiated at the federal level, a lot of money could be saved. Many States negotiate with Canada and save a lot of money. The other thing I notice is how out of line the charges are to what is actually paid out. If plans can do fine with what Medicare pays for services then something isn't right with the original billing charge. That is what people without insurance have to pay, I guess. Right now, my monthly medical costs are 1/3 of my income and that will continue to go up. Something needs to be done and I feel you are going in the right direction." 30359 08/15/06 NH Agree "Universal health care coverage is essential. A healthy society is more productive and forward thinking. As I near retirement age, the state of NH is eliminating health care coverage for retiring teachers as of 2008. Health care is bankrupting us." Agree Please have highly qualified people from the health care industry on this panel. I am hoping the President of the US has a limited ability to appoint people to this to preserve its need to be unbiased. Agree Agree Agree "I feel that all Americans have health care. Bringing the costs down to fair and reasonable would make it more affordable, but even if someone cannot afford it, they should be given the best care possible as early as possible to avoid higher costs to themselves and society." Agree "Other industrialized countries do health care well. Although their facilities don't always look elegant, the care provided within is excellent. We need to get our priorities in order." 30361 08/15/06 IN Agree It is time the the US catches up with and surpass other developed countries on the health care front. Agree "For more effeciency, it is important not to duplicate. That leaves more resources to spread around." Agree "while all the parts are important, I especially like ""consumer-usable information.""" Agree "culturally sensitive, ""clinical realities,"" ""clear communication,"" and ""funding"" are words and phrases that stick out for me in the recommendation." Agree "I have nothing to add, only heartfelt agreement." Agree I am appalled when the people with so little that they do not have health insurance end up paying a higher price because there is no one to negotiate a lower price for them. I can afford more taxes in one of the above forms to support those with less than I have so that all can have health care. "As one who had never had dental coverage, I especially appreciate its inclusion. I like the rangeto be included above." 30362 08/15/06 NY Agree Agree Agree Agree Agree Agree 30363 08/15/06 TX Agree Agree Agree Agree Agree Agree 30364 08/15/06 WA Agree "It should be looked into about the Feds,local government,companies and taxpayers into some sort of financing to cover some of the costs for the program.Also,Insurance companies,Health care providers,Drug companies and Hospitals should be able to find ways to reduce costs without lowering healthcare and to help with controlling costs on their end." Agree "This is great,but the folks who smoke ,drink, do drugs and other various activities that are detimental to good health are also involved in the programs.While I have no problem with people doing these sorts of activities,it should be up to them to carry the greater part of their health care costs if they chose to do them.I would hope that guidelines would be set up to encourage people to change their lifestyle to improve their health and lower their healthcare costs." Agree "If you commit fraud,severe penalties should be implemented and carried out.No more slap on the hand or a wink and a nod.If a healthcare provider is found to be incompetent and has problems,they should be forever banned from healthcare nationwide.No exceptions." Agree "They might also want to think about a package deal that includes health expenses and some sort of funeral expenses after the person passes away.I know this sounds cold hearted,but it is a time of great sorrow and grief for most folks and they are not thinking straight.Families should not go broke caring for a loved one,nor should they go broke burying a loved one.Just an idea.Thank you." Agree "If you are doing something that is detrimental to your health,you should be expected to pay more for your health care.Spell the rules out and stick to them without a lot of red tape." Agree Comment on #1 above. Comment on #2 above. Thank you for letting me participate in this survey.I appreciate it. 30366 08/15/06 TX Agree "It is immoral that in this richest nation in the world, so many Americans must make a choice between health care and paying the mortgage or between health care and feeding their children adequately. If we think we can afford to fund an outrageously expensive war, then we surely can afford to make sure that every U.S. citizen has adequate health care coverage. Many other nations have taken this step. The U.S. is over-due to take it, too." Agree "Yes, this is an important idea but it is equally important that its implementation be carefully thought out so that it can be successful from the start. This was not done with Medicare, Part D, and many older people discovered the hard way the hole in the donut." Agree "* Yes. I am pleased to see that health education and health promotion are priorities. It's a shame that right now physicians can receive money for amputating a Medicare recipient's leg, lost due to diabetes complications, but cannot be paid if a nutritionist advises the diabetic about how to lose weight to avoid the complications of diabetes. How does that save money? Answer: it doesn't. Let's put a heavy emphasis on prevention, for both humanitarian and financial reasons. Please also recommend that the U.S. study successful (or relatively successful)instances where other countries have already implemented universal health care. Why shouldn't we learn from their successes and inadequacies? Some other countries have chosen to allow consumers choices such as massage therapy, nutritional consultation, and chiropractic medicine. Let's look at the evidence before deciding that only mainstream medicine should be included. If we're going to emphasize an evidence-based approach, let's look at the evide" Agree "* This is a very important recommendation. A terminally ill patient should not be forced to die in a hospital in order for expenses to be covered by insurance or a Government health care plan. A terminally ill patient should have a choice of spending last days or weeks in a hospice, at home with supportive medical care and enough medication to alleviate pain, in a hospital, or at home surrounded by family. Terminal illness and death need to be de-hospitalized and re-humanized. Yes, it's also important that a new breed of health care professionals be created who will be able to support a more individualized, better coordinated approach to patient care in the final weeks of life. This new breed of health care worker should understand the psychological, sociological and spiritual needs of dying individuals and their families--not just the organ systems." Agree "Absolutely! There is no excuse for a system which causes poor people to have to wait until they are seriously ill so that they can go to a publically funded emergency room. Let's give (and pay for) every citizen the right to basic and preventive health care. Let's let poor people have access to top flight doctors, just like the rich can now afford." Agree "* The financing of such a system should be protected against the whims of politics so that no matter which party is in power Americans know that their health care system won't be on the auction block. Also, let's not allow loopholes based on wealth. Those who have more should pay based on their income (no loopholes), and the poor should not have to pay more than their meager income can support. Personally, I am quite willing to pay higher taxes for universal healthcare. If I could divest all of my taxes from the War and funnel it into life-sustaining universal healthcare, I'd do it today, in a heartbeat." "* Great idea! As a Ph.D.-level mental health worker, I am gratified that your group recognizes that mental health matters, too. So many physical illnesses have a mental health component that, in many cases, a lot of money might be saved by recognizing that up front and allowing the patient to see a counselor as well as a physician. Some patients might also prefer to have counseling to supplement or replace psychotropic medication. Counseling might be used to help increase understanding of and compliance with medication or other medical recommendations, or to help patients implement wellness recommendations such as weight loss and exercise. Sometimes more money spent at the beginning to ensure cooperation with medical recommendations can save thousands of dollars over the long haul. Let's be sure that the recommended Government plan considers the evidence-based value of crossovers among physical, mental and dental health practitioners. Let's also be sure that lobby groups don't get to decide whether " "* I am delighted that this working group seems to be taking its charge seriously and is genuinely seeking input from multiple sources. It is time for universal health care in the U.S. If a program must be instituted incrementally (wrong approach, in my opinion), children should receive top priority. Money spent on insuring well children will save money in the long run. Investing in our children first, is investing in our country's future. Let's put our money where our mouth is and be absolutely sure that children are covered from the outset." 30367 08/15/06 NM Agree Agree Agree Agree Agree Agree 30368 08/15/06 DC Agree "* I agree with qualifications. I have not studied the issues in detail but I do think (i) A change in law is needed to protect people against the catastrophic financial consequences of having a grave illness. (ii) A change in law is needed so that the uninsured stop being charged many times more for the same medical care which the insured are charged. At a minimum, the government needs to organize some kind of group insurance for people who are presently uninsured. (iii) Perhaps the law should provide for only non-profit health provider corporations. The individuals working for the health-care corporation would of course be given salaries in accordance with market forces, but the corporate health-care entities themselves should be non-profit. " No response I neither agree nor disagree Agree "The federal government should by law standardize the way itemized charges are listed by the health care provider services. As it is now, it is almost impossible to read some of the bills, and therefore impossible to discuss, and dispute them. " Agree I neither agree nor disagree No response No response 30375 08/15/06 GA Agree Agree Agree Agree Agree Agree 30376 08/16/06 NY Disagree "Sounds great...a very nice statement and idea...I can barely afford my own health coverage, let alone coverage for the ""poor"". There is no way I can withstand the extra taxes required to reach this Utopia. What we really lack is a strong, financially secure, middle class. Strengthen the middle class, bridging the gap between poor and rich, take measures to put out of control insurance and drug companies in check, and our health care industry will fall back into line." Disagree "Sounds like we want to throw money at a problem generated primarily by the government accepting responsibility to pay for indigent patients then smiling and saying ""I didn't say how much.""" Disagree "The idea of pay for performance is king in our wonderfully capitalistic society...this however is the one area where I think the government needs to take an active role. Pass laws that say don't do anything ""stupid"", this is what is considered ""stupid"" and enforce the laws. Complicated studies proving ""best care"" techniques influencing how much the leastly funded health care payment plans will in my opinion only lead to more discrimination against patients with ""sub-prime"" payment plans." Agree "I totally agree. We should take care of people with no other options in the best way possible. We owe that to each and every citizen in our country, and in my opinion anyone who happens to be visiting when this need arises. No one should be turned away and any executive, employee, or political operative who takes unfair advantage of this programs funding should be executed on site...ok, ok, imprisioned and punished according to law." Disagree "No way this country or I personally can afford that...Deregulate, let the cream rise to the top, most people will be able to live in the middle, enact laws that put those practitioners at the bottom in jail or out of business whichever is more appropriate. This will put a lot of people out of work, or should I say out of work they are not cut out for in the first place." Agree "Has not worked well for any project the government has taken on...ok maybe wars, the highway system and the political payroll. Every program and every citizen I know is struggling...make a trade off...something will have to give...you can't squeeze blood from a turnip...nothing from nothing leaves nothing..." but let's have them volunteer... 30377 08/16/06 MA Agree "* Feedom is being able to follow your dreams, without having to make trade-offs based on health care coverage. I work in a union supermarket with health-care benefits that cover our children to age 25 ONLY if they are a full time college students. We have four children. Our younger son graduated from college has health care coverage. Our older daughter will graduate from college in May 2007 and neither of her employment options will offer health care. Our oldest son has a union job with health care. Our youngest daughter just graduated from high school and will have no coverage after her 19 th birthday because she has chosen not to attend college. The insurance company is basically saying to us, "" we are going to discriminate against your daughter because she wants to work for a living."" There must be some sort of profit/loss report that shows working people get sick more than college students. It is also unjust and inequitable that after 4 years of college and $60,000 worth of s" Agree Agree Agree Agree Agree 30378 08/16/06 CO Agree Go for it! Agree Agree Agree Agree Agree 30380 08/16/06 CA Agree Agree Agree Agree Agree Agree 30381 08/16/06 CA Agree I THINK THIS DOES NOT GO FAR ENOUGH AND THE OUT OF POCKET IS TOO HIGH Agree Agree Agree Agree I ALSO THINK YOU MUST BE A LEGAL U.S. RESIDENT AND HAVE PAID INTO S.S. Agree I THINK THAT WE MUST PUT COST CAPS ON ALL SERVICES AND DRUGS OR IT WILL END UP LIKE MEDICARE WITH LARGE COST OVERRUNS WE ALL KNOW DRUG COMPANIES WILL CHARGE AS MUCH AS THEY CAN AND ALL WE HAVE TO DO IS LOOK AT THE PRICES THEY CHARGE NOW IN THE U.S. AND LOOK AT THE PRICES IN CANADA AND MEXICO. 30382 08/16/06 NM Agree "With the ever increasing costs of just getting by, health care is something that everyone should be able to afford with little or no additional costs to Americans." Agree With the exception of focusing on populations and localities where improved access to quality care is most needed. I would like to see the focus set every where every place. Equal to one and all. Agree Disagree "Insurance is for this, another issue that we all need to address. If one doesn't have insurance while others do, where is the 'fairness' of that?" Agree Agree "I would not be happy to paying more in taxes for healthcare. The tax system is already taxing, and why not use the lottery's?" I'm concerned about end of life situations. There's so many who can't afford respectable care. I also believe that Doctor assisted suicide is something that should be considered. 30383 08/16/06 NM Agree Problems of inequality in America will not begin to be solved until univesal medical care is availble. The United States has the one of the most retrogresive medical system in the world. Just look at the infant mortality rate; ranked 41st. Republican facists have been resisted it. We could have had it since Harry Truman's time. We don't need the private bureaucracies to plunder the system either. Agree Same as above. Agree same as above. Agree Same as above. Agree Same as above. Agree Same as above. Same as above. 30384 08/16/06 OH Agree And dental care--it is critical to good health and just as cost-prohibitive for many people. Dental health is directly related to at ledast 122 illnesses of the body. Dental care is health care. No response No response No response No response No response 30385 08/16/06 IL Agree A person should not be forced into bankruptcy because of illness. Agree Agree Agree Agree Agree "Due to the efficiency, I believe the cost will be no more than what we are now paying for health care." 30387 08/16/06 NJ Agree "Health care for all and this country will be a better place , for all!!!" Agree Agree Agree Agree Agree 30390 08/16/06 PA Agree Agree Agree Agree Agree Agree 30391 08/16/06 WI Agree Agree Agree Agree Agree Agree 30392 08/16/06 MI Agree "It doesn't do much good talking vaguely about universal coverage, lowering costs, etc. without supporting a specific piece of legislation. The only real solution out there is HR-676. Let's dump the incremental approach to solving the health care crisis and support what 2/3 of the American people want." Agree Only one way to a rational health care system: HR-676 Agree Get to the point: Support HR-676 Agree "Again, HR-676." Agree Support HR-676. Agree The only solution: HR-676 Support HR-676 Stop pussyfooting around the issue: SUPPORT HR-676!! 30394 08/16/06 IN Agree Agree Agree Agree Agree Agree 30395 08/16/06 OH Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. 30396 08/16/06 OH Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. Agree I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. I think that financial support to fund a national health care program should come from rolling back the tax cuts & rebates that were given to the wealthy during the Bush administration years. I also believe that each citizen should have the same quality of care and coverage as our members of the senate and congress. 30397 08/16/06 FL Disagree I do not agree with the government overseeing healthcare. They have not done a good job with the programs that they oversee now Disagree Efforts like this that are not driven at the local level will not have the same effect and will not give this population of people the care that they need. Disagree Agree Agree "I believe that all should have access to healthcare, but I do not want the government to run it. Also, I believe that we should emphasize helping those that are willing to work and help themselves as opposed to our current system where we help those that want to sit back and do nothing. The working poor and uninsured should be our focus." Agree "This will be a huge task, but will go a long way toward saving the USA" 30398 08/16/06 MI Agree * Must correct health access problems in which their is too much access in high socio economic areas and low access in low socio economic areas. Also ther needs to be a strong correclation between thae amount of money spent and the health outcomes of the public. Some areas have very high healthcare costs but should no improvement in the public's health status.Also ther should be an economic consequence for people who refuse to take charge of their health. Society can not longer afford to subsidize those who refuse to take responsibility for their health. Agree Tie riembursement of FQHCs to the popul;ation outcomes. Better outcomes =better reimbursement Agree Agree Pass laws to get the lawyers out of this arena. Allow health professionals the legal option to allow citizens to die in peace and comfort without costing the taxpayers so much money Agree Should include a wellness model to prevent disease cost burdon and enlighten citizens No response Combine withholding taxes with vouchers to get the public involved in making economic choices in healthcare Should be minimum evidenced base medical interventions only. Keep the lobbyists out of the picture Without greater personal responsibility and fedral limits on mediacal liability none of these strategies for reforming healthcare systems will work 30399 08/16/06 IN Disagree "If govt., either federal or state, is to be involved in health insurance, it should be limited to regulation and/or the providing of a coverage of last resort. All Americans may need to have access to health insurance, but this should not be government-provided. People must be held responsible for furnishing this protection for themselves, just as they are for other forms of insurance." Disagree "The idea of a federal health care safety net needs further development and explanation. Local private groups are much better able to identify at-risk populations, and appropriately address their needs. Govt. funding may be needed, but tax incentives for contributing to these private groups will probably work better." Agree "I agree with everything to be ""promoted""; however, I don't see how the federal health programs can serve as the catalyst for this. This should be run by a separate federal agency, with private industry input." Disagree End-of-life care is a very personal and highly variable thing. Care of all types is available. The recommendations here are not a good use of resources. Disagree "This is an absurd and naive notion, that borders on Marxism. The fact that this ""message"" was heard consistently speaks to the incredible lack of understanding that exists with regard to the current American health care delivery and financing system." Disagree "I would suggest that emphasis be placed on developing a private financing mechanism that has some level of govt. backing (ala student education loans) that are needs-based, and are only available for certain qualified medical expenses." "This is a no-win situation, and will become highly politicized no matter what." "I appreciate the efforts that were undertaken here. I have been actively involved in the design and administration of health care benefits for over 25 years now, and I understand the great difficulties facing the current system. Government, however, must press private industry to face these issues head-on in order to find a solution, and should stay out of it generally. " 30402 08/16/06 NJ Agree "Give dollar values to terms ""very high medical costs"" and ""low income"" instead of leaving it vague." Agree No comments Agree No comments Agree The present practice of keeping terminally ill patients in vegetative state for indefinite period in the hospital should be done away with. Agree The very first requirement to make healthcare affordable to everyone is to substantally bring down the sky rocketing cost of prescription and non-prescription drugs. Agree "The comments noted above should substantially bring down the healthcare cost thereby reducing the present financial burden. Additionally, the cap on medicare tax for high income individuals should be removed to generate additional revenue for financing medicare cost." No comments "One of the ways to control the sky rocketing costs of drugs is to allow import of drugs from countries like India where reputed drug companies sell these drugs at substantially low prices. High cost of hospital service should also be contained, these are exhorbitant when compared to identical service provided by even up-scale hospitals in countries like India." 30405 08/16/06 IL Agree Agree Agree Agree Agree Agree Increase taxes fairly so that a single payer system can be developed. This will reduce administrative costs and produce a system that treats all people irrespective of income level. 30407 08/16/06 NJ Agree I am particularly concerned with the lack of coverage or very high insurance costs for people with chronic disabilities who become unemployed and lose their health benefits. Agree "A health care safety net is extremely important for low income groups, immigrants, and people with serious chronic disabilities." No response "The VA competitive drug purchasing policy should be included in best practices, particularly with regard to the new Medicare drug benefit." Agree "Legal issues should also be integrated into this model, for example, issues related to hospitals or doctors refusal to comply with advanced directives." Agree Considerations related to medication should always be be included in this set of core health care services. Agree "Tax shelters for the rich should be abolished and a federal sales tax on cigarettes implemented, since smokers are a major drain on the health care system." Prescription drugs are particularly important in terms of finances. "That a drug company should be allowed to charge upwards of $20,000 annually for one medication is obscene. Most importantly, a single payer system of health care should be instituted." 30408 08/16/06 NY Agree Agree Agree Agree Agree Agree "* It is long past time for the insurance industry and health care community to put the welfare and well-being of America's families ahead of profit, and for politicians to have the guts to do what is right. Health care should be a right in this country, not the privilege of those with sufficient resources. We believe in a free public education, as well we should. We also believe in a free public health system for all. We are the ONLY industrialized nation in the world, without a national health program. That is shameful." 30410 08/16/06 OK Agree Agree Agree Agree Agree Agree "Levy tariffs on imported goods and ""payroll"" taxes on services provided by firms in countries where national health care is not mandated." 30412 08/16/06 NJ Agree "This is an issue which the republicans hate. Republicans also hate poor people. They are making many more in the US poor as they do their worst, month in and month out. I await their demise." No response No response No response No response No response 30413 08/16/06 MA Agree WE can and have travelled to the moon and back; we can and have spent hundreds of billions of dollars (and thousands of human lives) in Iraq; we can ensure healthcare coverage for all; Why have we NOT? Apparently those corporations who stand to lose financially hold more sway with the Administration and Congress and state governments than those individuals who stand to lose financially and health-wise. It's hopeful to know IT IS NOT TOO LATE!! No response No response Agree Agree "WE can do it; the question is one of commitment and resolve. That is, if the Administration, the Congress, the various elements of the industry don't have the WILL to ensure this, healthcare for all will NEVER happen!" Agree 30416 08/16/06 TX Agree Agree Agree Agree Agree Agree We are given the duty as creatures on this earth to help and defend those who are weak and struggling. Justice dictates the decision to provide health care for all humanity. We need to demand it. 30417 08/16/06 WA No response No response No response No response No response No response "What appears to be missing is a clearly defined statement that the American public needs to be responsible for their health. While the government can provide educational information, the public needs to take advantage of the offerings. Failure to do so will leave a large pocket of unusually unhealthy people who will continue to strain the health care environment." 30418 08/16/06 WI Agree "Also, make senior drug coverage part of medicare, instead of enriching pharmaceutical and insurance companies." Agree Agree Agree Agree Agree 30419 08/16/06 TX Agree I am tired of subsidizing the poor & indigent..Either everyone should pay their way through society or die...I fall in the category as my income is too much for free anything by just minimal gov't standards or I am below the avg income for middle class..I have been working since 1968 and have yet to get anything free from the gov't..So tell all these ne'er doers to get off their lazy ass & quit making babies & quit doing dope & GET A JOB !!!! Disagree Make all gov't programs dissappear AND THEN we'll see who will survive & we'll see who keeps making babies & committing crimes.. Disagree NO MORE GOV'T HELP !!!! LET THE PEOPLE TAKE CARE OF THEMSELVES !!! Disagree GOV'T GET OUT OF OUR PRIVATE AFFAIRS !!! Agree "Either ALL or NONE.. NO MORE SEGRAGATION based on color, creed or income !!!!" Agree Everyone should pay minimun $10.00 per office visit maximum to be $50.00 and hospital stays should not be over $100.00 per day regardless of the situation... "ONLY IF it is available to all people regardless of income, race & creed.." NO MORE FREE GOV'T ASSISTANCE !!!! 30420 08/16/06 MI No response No response No response No response Agree "* We are the ""Leading"" Nation of the World and we can't provide health care to our citizens. This country needs to rethink it's stand on ""Socialized Medicine"" If we can provide free health care to Seniors in states like Florida, we should be able to make it work with everyone and everywhere. There should be not one American that is Uninsured/Underinsured.Looking back on historical health care issues, when Britin/Sweden/Norway was distributing ""street drugs"", ie Heroin through prescription We (USA) came up with Methadone the wonder drug that was going to deliver addicts from dependence and have them drug free with-in 1-2 years? and yet some 30+ years we are still funding Methadone treatment, addicts that started it years ago, are still receiving it, and the problems in the countries previously mentioned have declined . So, if others have figured out the Health care crisis, why can't we???? " Agree 30421 08/16/06 WA Agree "It should be a public policy that all Americans have affordable health care. We should have a health care system where everyone participates, regardless of their financial resources, health status, or employment status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family security." Agree "We should promote improvement in quality of care and efficiency. The emphasis should be on integrated health care systems, health information and electronic medical record techmologies, population-based preventive care and public health functions, management of chronic desease, and reduction of unnecessary care and administrative waste. The system should enable providers and patients jointly in the stewardship of health care." Agree "We should support integrated health networks. Community health centers, the Veterans Administration, and other systems are needed to provide for the special needs of certain populations, but no longer to be ""safety net providers"". With universal coverage, the goal should be to eliminate racial, ethnic, and geographic disparities in health status." Agree "A national health plan needs to include coverage of appropriate palliative care, hospice care, other end-of-life services, nursing home care, and support for home care for frail elderly and disabled. People need guidance to increase their understanding of their end of life health care options and access to these services in the environment they or their families choose." Agree Agree "There should be a national health plan, financed by taxpayers, in which all Americans would get their health insurance. A temporary program should provide relief from unaffordable health care costs in the interim." "* A sufficiently comprehensive benefit package for all Americans must be defined. This should be done by a independent panel of comsumers, providers, other technical experts, actuaries, and financing experts, taking into account evidence-based science and medical effectiveness. These benefits should cover the continuum of care throughout a person's lifespan, and will encompass wellness, preventive services, primary care, acute care, prescription drugs, patient education, treatment and management of health problems - physical, mental and dental - provided across a full range of inpatient and outpatient settings." "I urge you to reinstate a target date for making health care available to everyone. Your initial Interim Recommendations set a target date of 2012. Note that the Institute of Medicine recently set 2010 as a target date for covering all Americans. I think the latter target date will push us to achieve the goal, and I do not think our country needs - or can afford - to wait six more years to insure all Americans." 30423 08/16/06 WV Agree The price of health care and fuel are ruining middle class America. This needs to be addressed now. Agree "I hate to see the federal government get involved in anything,but I really don't see any other way. There is no other entity big enough." Agree Agree Agree Agree We need to stop spending money over seas and start using it for programs at home. Health care being a primary objective. We need something done now. 30425 08/16/06 NY Agree Agree Agree Agree Agree Agree 30426 08/16/06 GA Agree "Health care costs have skyrocketed over the past 10 years and no end appears in sight. We must establish a nationwide program which insures coverage for all Americans. Low income individuals in particular require financial protection. Our tax dollars should go into a new program to a much greater degree than present protection. I would much rather see my taxes go towards a health care program than towards rebuilding rental property in the vulnerable gulf coast region, such as Dauphine Island. " No response No response No response No response No response 30430 08/16/06 OH Agree We feel that it is long overdue to begin development of these health issues. Agree Agree Agree Agree Agree 30431 08/16/06 IL Agree This should be one of the benefits of being an American. Why would you be against this. Agree Agree Agree Agree Agree 30432 08/16/06 MI Disagree * I want to see high health care costs regulated through competition. Nationall accepted treatment guidelines need to be established based on valid studies performed by unbiased organizations (such as NIH). These studies can be funded by pharmaceutical manufacturers who mcurrently spend billions to perform studies that no one will believe just because of who sponsored them. What a waste of money which in turn is placed on the cost of medicines that do make it to market. I support paying the Drug Manufacturers for their research but their is a lot of waste in the current system. I am a single mother of three kids. I have workked hard all of my life to get a good education which enables me to support my family. We are not rich with money but we have support each other with love and respect which is lacking in many government supported families. I can no longer support those who are capable of working and decide not to because they are from families who have been supported by our government for years. Agree I have seen community based healthcare programs including Quality initiatives work to improve quality and at the same time decrease costs due to consolidation of funds and not repeating each others efforts. Agree "This is where we can let competition determine Healthcare costs (and keep an already overwhelmed and not too sucessful government, state or federal and at the same time improve efficiency and most importantly QUALITY. " Agree "We need to establish,with the use of ethics committees, cost of QUALITY life years saved for treatments of the elderly. I think we need to also take into consideration individuals choice of life style. If one chooses to smoke, not exercise, etc. than monies to treat their emphazema and/or CHF or kindney disease/transplant should not be made available to them at the end of life. Sounds harsh but this would in itself would allow MOST individuals access to qaulity and affordable health care. " Disagree I agree that public policy needs to be established but it MUST include other criteria as mentioned above. Those who work to stay healthy and so that they can afford healthcare should be able to get affordable care! No response "* For all able bodies working individuals who have proven attemps to live a healthy life style: Joine a Healthcare system in their area (plan report cards available to help individuals decide which system to join). Only able to switch one time per year. Access to preventive care for affordable copay. Catestrophic care for all with health coverage. Health coverage supporteed through federal taxes (so people can travel between states without loosing healthcare) Mandatory medical records aqccessable by any certified health system. Mandatory HRA by all person enrolled in a Health System for coverage. Standardize provider (pharmacy, physician etc.) based on cost of living in their area and quality of care provided. NO BOUTIQUE PRACTICES ALLOWED. life style " 30433 08/16/06 TX Agree Agree Agree Agree Agree Agree 30434 08/16/06 ME Agree Agree Disagree "* I believe that those who honorably served their country especially those who were promised lifetime medical care at enlistment and who served the minimum twenty years to fulfill this contract should be given special consideration. So, TRICARE and the Veterans Administration should not be included in care for the general public. However, any veteran or retiree eligble for both veteran or retiree or or medicare or benefits as a citizen should be entitled to choose any for which the veteran or retiree or citizen is eligible. " Agree Agree Agree 30435 08/16/06 NY Agree Agree Agree Agree Agree Agree "For being an advance society, it is obvious that we fall far behind the examples of other countries, ex: Canada. More effort ($$...) should be given to focusing on these sort of issues which directly effect (or will eventually) every person here in our OWN country. This country sets a poor example when compared to others. We need to be updated." 30436 08/16/06 MI Agree Provide Tax breaks and make it mandatory for everyone to have health insurance coverage. Let the Private sector compete and drive the cost. Agree Agree There is tremedous waste and fraud in our current system even if we can cut the fraud and waste by 50% it will help cover all the uninsured people in US Agree Agree Agree 30437 08/16/06 OH Agree No response No response No response No response No response 30438 08/16/06 OH No response Agree Agree Agree Agree Agree 30440 08/16/06 MI Agree I believe this right must include incentives to manage one's life-style related behaviors (such as smoking and weight control) and penalities for not managing these behaviors Agree Agree Incorporate applicable concepts from the managed care model developed by NCQA. Agree "Establish a clear and consistent and simple way for individuals to commuicate their end-of-life services preferences, that is legal across states. Hold service providers accountable for implementing the individual's wishes without interference based on differing religious tenets." Agree "Must include, in addition to the right, an expectation of responsibility with penalties for failure to assume these responsibilities (life style and treatment plan follow through)." Agree I favor a public/private partnership approach. 30441 08/16/06 TX Agree Agree Agree The waste in health care should include an evaluation and intervention of funds that are directed into high salaries of ceo's and profits for managed care companies and insurance companies Administrative costs that are incurred by managed care compnies are a waste of funding that has been created for profit and does not increase the quality of care or treatment Agree Agree Agree Utilization of wellness and preventative programs will enhance our quality of life and save millions in the healthcare industry. Mental Health Care should have greater emphasis in all future planning. It is a critical part of our health care wellness that has been damaged considerably by the insurance industry along with the pharmaceutical industry. 30443 08/16/06 FL Agree As the wealthiest country in the world our public health system is a disgrace and our health care system is deplorable. Agree We need information on the state of health services in every county of the USA. Agree "Education is the key. All our citizens need ready access to health that information ina clearly stated, concise form that is broadly available." Agree "As an educator who has promoted information about end-of-life issues and preparation for dying, I am keenly aware of the need for courses, support groups and training for counselors, chaplains and the whole health care profession and staff on end-of-life issues. We have been in too much denial about death and many are woefully ignorant of the need for education and preparation." Agree We need a one-payer (government tax funded) health plan for the USA Agree "We should have a plan that comes from an expanded Medicare program (""Americare"" has been mentioned)" It is far cheaper and more effective to prevent illness than to cure it. Health education is greatly needed. This is a valuable survey. Now to put it into operation. 30447 08/16/06 MA Agree Agree Agree Agree Agree Agree 30449 08/16/06 ID Agree "YES, YES, YES I support health care coverage for ALL AMERICANS, plus protection against very high medical costs and financial protection for low income people.We also need a healthy enviornment so we don't get ill-like organic/humanely raised food, clean air,water,soil....." Agree I've said it all already Agree "Again WE NEED clean air,water,soil,safe food no nuclear testing so we don't get ill in the first place! We need a healthy planet for ALL it's living beings." Agree "I am a music therapist and work with veterans and nursing home residents-I improve the quality of life for these people at end of life and the souless corporations that own most nursing homes don't GET IT or value what I do. Bringing life, music, pets, plants heals broken hearts and bodies and spirits. I need funding to make a living as I HAVE NO HEALTH INSURANCE." Agree "I also believe in PREVENTION, EDUCATION, andf ALTERNATIVE MEDICINE. We, the people should be able to choose acupuncture over western medicine and not have to pay out of pocket for alternative therapies." Agree "If we could get the #@$!!%^$!! out of warring with the entire globe, that would sure free up a lot of $$$$$$$$$$$$..." Nothing to add I sure hope my comments get where they are heard! 30451 08/16/06 MI Disagree The ability to hold costs down will be more difficult with guaranteed coverage programs. Focus should be on protection against catatrophic claims. If necessary a basic benefit package should be developed. Individuals should then be able to buy additional coverage as needed. Disagree FQHCs have worked well--but continue to be outside of mainstream care. Agree Agree Agree This is number one recommendation. Agree "The core benefits should be differentiated by reasonable parameters for age, sex, and othe health status indicators--rather than core benefit for everyone." "Imperative that federal and state government are enablers of such a program but do not deliver it themselves--this must be nimble, flexible, and responsive to needs---all of which are difficult for public programs." 30452 08/16/06 MI Agree It is shameful that we do not implement Universal Health Care which other countries have show costs less than what we do now and results in better health and at least two years more life. Allowing special interests to scare us into continuing what we are doing now is un-American. Agree "H.R. 676 has identified that an expansion of Medicare/Medicaid could address this need. What will be needed is a system of local units to dispense treatment and increase knowledge of how to stay healthy, prevention." Agree "One possible approach might be to make this an ellected office. Focus needs to be made to a continuous audit of the operation. One initial problem will be outside attemps to show the system as a failure, many groups (Drug companies and insurance companies) need to convince people that what we do now is best for them." Agree "These type of reforms will be hard to implement. If they succeed many interests stand to loose a sizable portion of their income. Insurance companies, HMO's, and drug companies will not stand by as their income is shifted to the health needs of our nation." Agree These principles agree with our founding fathers but contradict the views of those that control our country now. Extreme care will be needed in advancing the views. There are numerous examples of how people have been persuated in voting aginst their own interests. Agree "* The bottom line is that the program will cost almost half as much as what we are doing now. Unfortunately now the moode of the adminstration is to shift costs to those that have the least. We need the same type of arguments that President Roosevelt used during the depression. If we continue on the path we are on we risk losing the loyalty of the people. If the control of the nations's assets continue to be shifted to the rich, why would the rest care about the future of the country. Look at the masses deserting Mexico for an example. Our countries focus on the the next quarter only may lead us into the same type of future." "Again, these ideals are at the core of our better leaders from the past but conflict sharply with the thoughts of the present adminstration. They seem to need to have a suffering mass, see people in pain, work only for their own interests. They have control of the media and control the adgenta. Such a shift will take a unique approach." I support Universal Health Care. I believe that H.R. 676 is an excellent way to reach that goal. Rembering the Clinton fiasco I know that the interests aginst it are well funded and effective. Only a nationwide education process has a chance of succeeding. 30453 08/16/06 CA Agree "On behalf of the 5000 members of UFCW Local 1442,it is imperative that our govt. address the recomendations adopted by the CHCWG. All citizens deserve affordable health care provided/regulated and paid for by our government. " Agree See above statement. Agree See above statement. Agree See above statement. Agree See above statement Agree See above statement. See above statement. 30454 08/16/06 VA Agree I agree with this statement but beleive that only a single payer system can achieve the objective equitably Agree Strongly support a primary health care approach that focuses health care decision making at a population level instead of individual or specialty group interest level. Agree "* These concepts have been around a long time.....without a signle authority to ensure application of these concepts you will not get there. Voluntary adoption of the ""right thing to do"" has not worked....especially within our current ""medical dominated"", ""cure-oriented"" and ""private for-profit"" system...it has never served the greater good. This also includes the elimination of categorical funding approach used by Congress....it you fund it they will design the program to get the earmarked funding. It impedes our ability to respond to emerging healthcare issues....until the funding catches up!" Agree "This same approach should be directed at ""caregiver"" support.....if families/friends can care for individuals such as the elderly at home, we need systems to support that.....it has implications for maintaining their productivity and contribution to the economy." Agree "It should be a ""right"" for all residents (citizens and non-citizens) because the Health of All impacts each and everyone of us." Agree "I support a single payer system.....that provides the best oversight, negotiation and efficiency." This should include vision.....maintaining /correcting eyesight impacts one's ability to manage and be responsibile for one's health status. I would also include nutritional health.....you are what you eat! "* I am very pleased that we are finally asking the public to identify the type of health system that they want instead of allowing special interest groups (especially the AMA and AHA) to define what our health care system will be. A public health care system that is universally accessible, affordable, equitable, locally-driven, community-based and response to the needs of individuals is the only pathway to empowering indivdiuals, families and communites to make good-decisions about the availability and use of limited resources. Health care should be a right and disease prevention/health promotion should be the drivers. De-institutionalize health care!" 30461 08/16/06 NJ Agree Agree Agree Agree Agree Agree 30462 08/16/06 CA Agree Agree Agree Agree Agree Agree 30463 08/16/06 DC Agree "The most important challenge for the US is to finally get rid of this highly fragmented system. Health care may lead to high costs (catastrophical). Therefore an insurance is necessary. And an insurance only works when there is a large enough risk pool, otherwise low risks don't pay at all, while high risks (mostly in lower incomes) bear the highest costs." Agree "These are all technocratic measures: improving the process, getting advice towards the federal government, etc. Is the federal government willing and able to do things about it? The grass root support and integration seems good. Let there be enough financial means as well." Agree "Get some cost-effectiveness analyses done. There is huge waste, unnecessary procedures, end-of-life care without any added value, etc." Agree "When you've lived your life, old and grey, it's better to die with dignity and enough caring care, then to die with tubes and needles in your body, recovering from high-end curative surgery. Give people a right-to-die when they reach the end-of-life. There is no need for medical miracles on 86 years old people. Use that capacity to help people who still have a life ahead." Agree "I strongly agree. It will be hard to determine what is ""appropriate"". Again, an insurance in a large enough risk pool (with proper risk adjustment schemes), may work best." Agree Couldn't agree more. "Make a distinction between real illness and inconvenience. Dental problems may be very inconvenient, but normally will not kill you or people around you. A lot of pharmaceuticals deal with inconvenience. Why should that be a collective burden? At the same time: a lot of countries in Europe have broad benefit-packages, they defined necessary treatments to be available for all." "There are some good examples around the world. And good examples here in the US. Like the individual mandate in Massachusetts. There will always be people gaining and people losing. If that is a correction of a previously unfair situation, then the total result is an improvement." 30464 08/16/06 CA Agree "* As a nurse for over 30 years, I have seen both the quality and availability of health care deteriorate, at the same time health care costs for working people have skyrocketed. We are getting much less and much worse health care and paying much more money for what health care we get. A particularly frightening trend is more and more families and individuals losing their health care altogether because they cannot afford the huge monthly premiums and high deductibles and co-payments. Many of these same people now must rely on county hospitals and emergency rooms for their only health care, and this puts an even greater burden on the government and the tax-payer to provide care. This has truly reached crisis proportions and a complete overhaul is needed. These recommendations are excellent and long overdue. " Agree Agree Agree Agree Agree "Americans are payihng a disproportionate amount of their income for health care and many are forced to decide between paying rent or receiving health care, or between buying food or paying their health insurance. This recommendation is much more sane and fair, and gives us much more health care for our dollar." 30466 08/16/06 CA Agree Agree Agree Agree Agree Agree 30467 08/16/06 CA Agree Agree Agree Agree Agree Agree 30468 08/16/06 TX Agree Agree Agree Agree Agree "People without medical coverage cost more when they delay treatment and show up in emergency rooms, or go to city and county medical clinics and hospitals. " Agree 30470 08/16/06 HI Agree Agree Agree Agree Agree "This is really where it's at. Until we have universal health care, we cannot call the United States a civilized country." Agree "The operational redundancy, waste, and obscene profits of insurance companies, along with a return of the tax revenues from the super-wealthy, should more than cover the costs of the transition. We must face the fact that any move toward a more socially responsible society will require a massive redistribution of wealth -- a revolution that is long overdue." 30471 08/16/06 WA Agree "* Five years ago, my 39 year old daughter was diagnosed with rheumatoid arthritis. One prescription costs $1,800 a month. She is fortunate. She has health care insurance. But what about the people who will be crippled for life because they aren't wealthy and don't have insurance? What happens to my daughter if she loses her job? People's bodies are being poisoned by bad teeth for lack of dental care; others live with pain, chronic depression, crippling disease - all because they cannot afford treatment. Prescription drugs are outrageously expensive. It's no wonder, given the expense of running television commercials non-stop 24/7. And what about all of those high-paid pharmaceutical reps and lobbyists? When did America change its goal from quality health care to blatant profiteering? Why do hospitals have one RN for an entire floor of patients? Nurse's Aides come cheap and it shows in the quality of hands-on care one receives when they are most vulnerable. It's time we made health care affordable" Agree "Olympia, Washington is Internists and General Practitioners at a disturbing rate. 80% of our doctors won't take new Medicare patients because the reimbursement rate is so low. This and other health care issues are critical, particularly given the aging population. We cannot wait any longer. Please begin to change the system NOW. " Agree "Preventative medicine has long been sidelined. Our health care system has focused on intervention, not prevention. Let's create a system that helps people participate in their own wellness. And, let's not overlook the importance of dental health. Dental infection goes straight to the heart, yet millions of people suffer debilitating illness that can be directly linked to tooth decay. " Agree "Everyone should have access to medical assistance should they decide to remain in their own home or spend their final days in hospice. Losing one's dignity through prolonged illness is difficult enough, why should they be forced to stay in a hospital or state-run facility where they are often ignored most of the day because of understaffing and overpopulation?" Agree "Let's also put members of Congress on the same plan. If those who vote for and against adequate health care for every American citizen also have to live with the programs they endorse, we would all have first rate coverage." Agree "Let's also make sure that the agency in charge of policing this system does not become yet another politically-motivated, fox in the hen house group of governmental lackies." 30472 08/16/06 OH Disagree Disagree Agree Agree Disagree Disagree 30475 08/16/06 MN Agree Agree Agree Agree Agree Agree 30476 08/16/06 WA Agree "Why we are so far behind other, less affluent, nations on this is beyond my understanding. " No response Agree I agree that it is best to use well-established departments to carry out this mandate. It is here that the expertise and processes are in place to bring about change and expansion. Agree I have been a healthcare professional for many years and at one time worked in a hospice setting. This was when the ideas of Great Britain/India/etc. were being explored/utilized. This should be carried out with the greatest care and pragmatism. Agree Who could say no? Agree This is a solid start. I would want to assist in any way I can. 30477 08/16/06 MI Agree "However, it MUST be catistrophic coverage ONLY! Even tho we are the world's richest nation, we CANNOT afford to provide all health care for everyone." Agree "But, we MUST bring a high level of personal responsibility into the picture. We need to develop effective education about smoking, obesity, non-compliance with medicines and other treatments, lifestyle situations (riding a motorcycle without a helment, risky unprotected sex, etc.), then if some choose to smoke, eat to obesity, contract aids, etc., society should not be responsible for the cost. THEY MUST PERSONALLY BE RESPONSIBLE FOR THE COST, EVEN IT IT BANKRUPTS THEM!!!!!!!!!!!!!!!!!!!!!!!!!!!!!" Agree "Easy to understand, effective ""quality scores"" must be developed for ALL providers, so that the consumer and the insurance carrier can make good judgements re: cost vs. quality." Disagree "When we reach a life ending situation, expensive full hospital care MUST be stopped whenever a hospice or other less-expensive option is available. This must be MANDATORY, not an allowable choice. " Disagree "While this makes sense in many ways, the super big question is WHO PAYS. Yes, we have rationing of health care under the present, poor system, but if we have what you suggest, the country will go broke. We need to develop a system where CERTAIN, COST-EFFECTIVE care is provided under limited circumstances, but NOT, I repeat, NOT "". . .comprehensive. . .high-quality care, , ,"" for all in all situations!" Agree "* SIGNIFICANTLY tax imports from China and other overseas countries. When US manufacturing jobs (or engineering jobs or help desk jobs or,,,) are lost to China, the former US workers no longer have health care coverage and the former US company no longer provides insurance because it is out of business. Employers currently pay a disproportinate cost of health, and they are being squeezed and are going out of business. Some sort of a general consumption tax (sales tax) adjusted for the product based on factors such as it's healthfullness and use to low/vs high income consumers (eg. 1% on grocery products, 10% on fast food, 2% on a used car, 5% on a new car, 1% on a canoe, 8% on a power boat, etc.) could be the fairest, IF out bought and paid for by lobbiests Congress could put aside the payments they get in campaign contributions and actually act as if they are representatives of ALL of the People instead of just the special interest groups!" "* BUT ONLY IF PERSONAL RESPONSIBILITY IS A MAJOR, MAJOR PART OF THE PICTURE. We are LONG overdue to puting significant incentives AND DISINCENTIVES into the health care system. Consumers of health care must be educated as to how to enhance their health -- those who do not stop smoking, who do not lose weight, who do not practice ""safe sex"", who do ride motorcycles without wearing helmets, who chose not to take their meds should NOT have medical conditions brought on by their personal lifestyle choices paid by society in general (including me). THOSE COSTS SHOULD BE THEIRS ALONE TO BEAR! Consumers of health care MUST have the knowledge, AND THE TOOLS (real hospital/Doctor cost information, helpful quality information, etc.) to be able to make good choices. Real, long-term cost control is impossible unless the medical consumer can be empowered. Without real, long-term cost control, the system will continue it's headlong rush to collapse!" "Personal responsibility is the key. There is none at the present time, and the system is in shambles. We simply cannot afford to do everything for everyone. There is a ton of waste (and errors) in the system that must be addressed. Three examples are the computerization of ALL medical records, applying ""lean manufacturing"" ideas and concepts (we could reduce hospital costs by 1/3 to 1/2 -- easily) and getting rid of stupid, costly BS such as HIPPA. " 30478 08/16/06 IA Agree "* First of all, I want to say thanks for taking on this enormous task of key importance. I strongly agree with this recommendation, but I wonder how realistic the deductibles are. I do not believe most working class Americans have a spare $4000 or $12,000 sitting in the bank to cover medical costs. By the time families raise several children and work to help them pay for college, there is little reserve. My biggest concern is that I did not see you folks address the issue related to cost-shifting, which is a significant problem in the health care delivery system. When an HMO pays $20,000 of a $150,000 bill (it happened to a family member), and that is payment in full, something is terribly wrong. If I only had to pay 13 cents on the dollar, I could afford more health care services. In reality, someone has to pay for the real costs that were never reimbursed, and those costs get passed on to other insurers, and especially to the uninsured. I think one of solutions is to make everyone pay the same for t" Agree "* I am in favor of this solution. In my opinion, there probably does need to be federal intervention to make this happen. I've seen Physician Assistant's and Advanced Practice Registered Nurses provide capable, effective care, and politics gets in the way (e.g., turf battles from some physicians) impairing access. It is a terrible flaw that in some instances, physicians refuse the render the care themselves, but try to stand in the way of competent health care providers such as the P.A. and A.R.N.P., who are willing and able to render the service. Liability is an issue, and the idea of providing malpractice liability coverage under the Federal Tort Claim Act is BRILLIANT!!! What a great idea." Agree "* I am in favor of this, but have some reservations. Medicare and Medicaid are part of the problem sometimes, as mentioned above, with some of the cost-shifting, and not paying the full charges (leaving others to pick up the tab). My other concern is that the rules and regulations to implement such programs often are unreasonably enforced and add unnecessary administrative costs to the delivery of the service. If those types of issues can be minimized, I am all for it! I am especially convinced that evidence-based practice is a great way to proceed." Agree "I strongly agree with this. I do not believe that many individuals (including the elderly or their families) have a clue about what end of life care really involves, until it is too late. This needs to be accomplished in a compassionate manner for all prior to entering the hospital or nursing facility in a crisis. And who will pay for this???" Agree "This is a lofty goal, but how do you draw the line? If I need a stomach stapling procedure because I'm morbidly obese, do I get it? If I need a liver transplant because I drank my liver into cirrhosis, do I get that? What kind of notice do people receive, so they can act accordingly? I believe we need ethicists, clergy, health care professionals, and the public involved in making these choices, with reasonable appeal rights." Agree "* AS I noted above, addressing the cost-shifting problem needs to be a component of the solution. There should be a single rate all payors (gov't., private individual, HMO, insurance, etc.) pays for the same procedure. Giving discounts to those who can most afford it makes very little sense. The ""big guys"" already have the economies of scales, so they have some inherent savings. They should not have to pay less. Although I am opposed to some of the taxes mentioned above, perhaps there could be some taxation of services and possibly punitive damages awards (a kind of windfall in and of itself), so long as such funds are earmarked for healthcare and not for general funds. " "I strongly agree that a core benefit package makes sense, and should include physical, mental, and dental health. I also believe that prevention is essential to the long term success of improving the quality and quantity of health care in this country." "* We can do much better than we have been doing. While systems empower or stand as barriers, in many respects, it still comes down to the individual health care practitioner as well as the patient. Some health care practitioners are dedicated and competent, and others care more about the pay check than the patient. Likewise some patients make very poor choices and the consequences are very costly, but not inevitable. Let's work on multiple solutions to the problem and keep fine tuning until its better than it has ever been! Also, successful sytems (Like Mayo's in Rochester, MN) need to be used as models--its not always about re-inventing the wheel, lets learn from what is truly successful and scrap what is unsuccessful. L.B." 30479 08/16/06 MN Agree "* Have stories galore to back up the failure of current system. Too many employers hire just below benefit eligiblity levels, rural areas are predominantly small businesses that can't afford to purchase insurance to stay viable in marketplace, parents with adult children living with them but aren't in school so don't qualify on parents' policy but have high health care costs so out of pocket, children of divorce where non-custodial parent foots the bills for sake of child but corrupt court system ignores the obvious, people with pre-existing problems making them uninsurable...and their dependents unless parent wants to pay for their preventive/needed care and not the child or cover the child(ren) but not themselves for affordablity, high COBRA costs (e.g. I could have COBRA while unemployed for $1043/month but unemployment benefits were $660/month), the working poor that work too hard and earn to much because already have high debts they are trying to pay off so don't qualify for government insurance, the " Agree "Our Salvation Army has a free clinic twice a week 5-9pm. People line up at 3pm (and this is not a major metropolitan area) and by 4pm we have to send people away in order to see everyone by 9pm. Some people don't have the time to spend hours in line only to be turned away and others aren't healthy enough to wait hours, some show up week after week only to be too far in line each time and some that are seen end up being healthier than those turned away." Agree Agree "* What legislators say over and over, though, is where we draw the line so they vote against this. Even the liberal legislators ask do we do a hip replacement on the 97 year old lady(?), do we go all out with chemo when there is no hope of remission(?), do we spend our money on the infant with cerebral palsy and other major illnesses when the mom REFUSED pre-natal care that may have prevented the problems in the first place or spend our money on healthy child care when there are just so many dollars to allot. No one wants health care rationing or anything that could be construed as such." Agree Agree "* Sin tax...do we now tax the Twinkie eater that is obese or just all fat people? Do we charge the second hand smoker more than a non-smoker?Do we add fees to the mountain climber that does it for fitness over the couch potato not actively engaging in potentially dangerous activities.Where do we draw the line??? Are we not violating personal liberties? Over-regulation by the government (especially if our government, as it currently is, is inept and would add to the beauracy and make matters worse rather than streamline things, would be run by idiots that won positions due to political alliance rather than knowledge/skill)Touchy subject. While I agree with the recommendations I just don't see them gaining overwhelming support anytime soon." "* For me it is a no-brainer. Of course this is what we need and have needed for a long time!!! Money talks, though, and those that can afford health care/have excellent benefits and don't want to chance a change that could reduce what they have/those that can easily afford to pay out of pocket even if have no insurance and the businesses that profit from remedial care rather than preventive care will be loud. Those without are too busy making ends meet, disillusioned after losing hope too many times, or don't understand the overall picture to be vocal. The rich seem to vote more than the poor. Those that have never been personally affected are clueless and always will be. For them ignorance is bliss. For years we advocated against sending new moms home from the hospital within 24 hours of delivery and legislators were deaf to reason until THEIR child had health issues that developed after 24 hours of delivery but within a week of birth, unless someone has been uninsured and had a catastrophe which doesn't ex" Would look forward to serving on such a committee. 30480 08/16/06 FL Agree I also think that all governmental orgaizations should be required to provide health coverage for retired workers. Agree I also think that treatment for addictions is cost effective and should be provided on demand Agree I believe that setting limits on malpractce awards will reduce wasted testing by frighten doctors Agree I would also approve patients being able to request pain medications that might produce irriversable effects. Agree "Medical bills should not be collectable from salary, pensions or liened against a primary residence." Agree the amount now paid by doctors to malpractice coverage would go a long way to providing this benefit 30481 08/16/06 OR Agree Agree "Expansion and support of School Based Health centers would go far to protect the nations children in a convenient and low cost manner. The use of Nurse Practitioners in these clinics also reduces the cost of healthcare, while maintaining high standards of quality. School based healthcare has proven excellent in prevention and education, and can provide acute and chronic care as well." Agree Agree Agree Americans are dying of treatable illnesses due to inequities in our health care system. It's time to have government guarantee a basic level of care for our citizens. Medicare should be means-tested. Why are wealthy Americans able to get medicare while middle class families suffer from lack of resources? Agree "Means testing is essential to an equitable system. Redirect resources from war and ""defense"" spending to healthcare." School Based healthcare representatives should be included in the above. Inclusion of Nurse Practitioners and Physician Assistants for balance. FQHC and School Based Health Centers can provide communities with high quality healthcare. They shoud be funded as part of the safety net for families. 30482 08/16/06 CA Agree It is a disgrace that we are the only superpower in the world econonmy that does not assure basic coverage for all Americans. We would save money and enable the realization of our potential as a country if we reversed our thinking and provided coverage for all. I am thrilled with the steps Massachusetts has taken. Agree I agree with this as there will probably always remain a need for FQHC but the nature of their services may change if all citizens had coverage provided for healthcare. These centers may become prevention and education centers. Agree These would be essential to implementation of a high functioning health system in which citizens were empowere or incentivized to be active in their health status improvement. Agree This is absolutely essential. We are spending too many resources on fuitle care and patients are not dying in a manner that is compassionate because of the misaligned payment incentives. Agree I strongly believe in the play or pay model. Agree We are underutilizing health information technology. A model similar to the ATM systems for banking would have potential Evidence based approaches are essential I am happy to see that more are willing to take part in this courageouse and essential conversation. We must reverse our way of providing and paying for health care. We have a government run system with Medicare and the Federal employees and VA but people do not recognized that fact. 30484 08/16/06 CA Agree Agree Agree Agree Agree Agree "* Alternative medical needs to be included in the current system to bring down the overall cost of financing, and to offer patients a more holistic approach to their medical needs. I have had chronic fatigue and fibromyalgia for 6 1/2 years and there was nothing available to me in my medical insurance, except for accupuncture, which has helped me. I have sought help through alternative physicans for my health problems, and additionally I have used Prolotherapy for severe injuries to my neck, back and right knee. Prolotherapy needs to be available as an alternative to surgery." "Except for not including alternative as part of the core package, the components of the plan appear to be satisfactory." 30487 08/16/06 WA Agree "Yes, we need to do this. Coverage for all americans, not associatged with employment." Agree "Yes, community based health centers is a great idea. Efficient use of resources. " Agree "Yes, efficiency, quality of care and evidence based practice." Agree Absolutly. We must allow people to make lower cost choices and die with dignity. Agree Absolutly. Let's look at countries like Australia and NZ. Health care is a given. We are way behind on this one. Agree "Yes, finding alternative sources. Even a flat tax similar to Australia would be good. " "Core benefits, and then specific plans for specific groups. AGain, look at Australia. There can be plans on top of basic plans if necessary. Minimal health care for everyone. " Keep up the good work. I would love to see a health care system like this. 30488 08/16/06 CA Agree Basic health care should be a right of every citizen and is cost saving by a healthier work force and less demand on costly emergency care with preventive care not provided. Agree A role of government is to assure all are served with adequate health care and education. Agree Cost controls were necessary and effective in experience with Medicare and Medicaid (MediCal) program development. Agree Everyone should know their options. End of life directives and Hospice services have proven how comforting such planning can be to the individual approaching end of life and decision making of loved ones. Agree Too many families have faced bankruptcy over health care costs. Others have died for lack of care. Agree Only with a universal pool can health care costs be insured. There need to be use charges not just to help pay for the system but for individuals to share costs and not abuse or overuse the system. A broad representative group that functions independently but is led by experts must be responsible for overseeing and updating the system. Our country is overdue in establishing a universal health care system. 30491 08/16/06 MI Agree this coverage needs to be available to all Americans and should be established through a national program (private or public) that does not seek to make a profit of any sort. Agree Agree Agree Agree Agree 30492 08/16/06 WA Agree Agree Agree Agree Agree Agree 30493 08/16/06 WA Agree It is shameful that people suffer or die not because they are ill but because it's too expensive to do anything about their illness. Poverty is not a disease. Agree Agree Agree Agree Agree 30494 08/16/06 VA Agree Agree Agree Agree Agree Agree 30495 08/16/06 MA Agree "* There is no good excuse for the country that used to have the best medical care in the world to have none at all provided for over 45 million people, including children. Our infant mortality rate is way up, our weight is way up, and we're spreading this through other countries with our heavy fast food restaurants. But mostly, we are the only industrialized nation in the world not to have national health care. Only greedy Republican politicians would treat their constituents with so little respect. They claim to be the pro-life party but prove every day that they are the opposite." Agree "No one state can afford to pay for the kind of health care that's needed by all Americans. The Federal Government should take control of the situation, if they can be trusted to do so properly and completely." Disagree "I disagree with the idea of electronic files on all Americans. We are losing too much privacy already. Electronic systems can be easily hacked, just like voting machines." Agree This should absolutely be up to the individual who is dying and/or a health care proxy who has papers saying what that person would have wanted and not wanted done when he/she is unconscious or brain dead. Agree "Again, full health coverage should be provided for all whether they can afford to pay for it or not." No response I believe I have made my beliefs on this clear. This whole form is much too long and complicated for most people to wade through. You need to simplify it. 30496 08/16/06 VA Agree Agree Agree Agree Agree Agree 30497 08/16/06 WA Agree "Establish a public program, not private. Keep profit out of health care! Perhaps a cooperative program would be best." Disagree "Considering the current administration (Bush & Co.), I cannot imagine any worthwhile programs coming out of the federal government. State programs, regional programs, cooperative programs? Yes. But until we in the USA have a regime change, I want no part of the federal government having a say in my health care." Agree "This sounds good, but first we need to shape up federally funded health programs, especially the VHA." Agree "I'm wary of private, profit-motivated programs. Otherwise, I feel the above recommendation is sound." Agree "Yes. And again, yes!!" Agree "Well, duh! Take the money we're spending to destroy Iraq and use it for health care. Stop corporate welfare and collect taxes from corporations and the super-wealthy. Do NOT take $$ out of the worker's pay check." "1) Members of the ""recommendation group"" staffed by experts? What does ""staffed by"" mean? Who are ""experts?"" 2) I have always considered teeth a physical entity; but since it's mentioned separately above, I would add eye care." "From my perspective, too much confidence is placed in the ability of federal/governmental organizations to act in the interest of its citizens. As far as I can tell, cooperative organizations (the people having ownership of what affects them, in this case, health services) are not even considered. " 30499 08/16/06 OH Agree Agree I would love to be involved in this group how do you sign up? Agree "* I agree with this to a certain extent. I would hate to see the private practice family medical doctor get squeezed out anymore than they are presently with all the HMO's. Most small town doctors can not afford to join all the insurance plans because of the pay structure. I think it is a shame that the insurance companies dictate what type of care or medications that a doctor can prescribe. I work for a small town family practice doctor and my main job is calling insurance companies to get pre certification on everything and the wait on the phone lines are terrible and then sometimes it is very difficult to understand the person answering the questions. I understand that they are trying to keep their costs down but someone has to make up the lack of that and unfortunately it is the small family doctor's office. The doctor's office has to pay for someone to precert everything (ie; tests, x-rays, prescription medications)and he gets no income in return for this service. His office call covers the time " Agree "I have had experience with Home Health services (hospice included), which are paid by Medicare, and I think this program is very worthwhile." Disagree "I don't believe in free lunches, but I do believe anyone working, trying to support themselves and/or families should be given healthcare services. There are people on welfare that would go to work if they could get healthcare coverage but can't afford to take a low paying job that doesn't offer healthcare or it cost to much to pay for. " Agree "The ""sin taxes"" would be the first place to start(ie: ciagrettes, alcohol). The next tax should be a small national sales tax the same across the board in all states that way the high spenders pay the taxes, it would not effect the lower income people as much because of lower income means lower spending. Also it would gain money from tourist who buy in America. One other great source of income would be a National Lottery, however statitics show that more middle to low income people buy lottery tickets." I would like to be appointed how will that process work? "The medical needs of patients should be put back in the hands of doctors and not insurance companies dictating the ""standard"" care which most of the times seems to be substandard!!! When a person is facing major surger (rectal cancer Colon removal and resection with possible colostomy) the pre approval stay is 4 days!!!(Anthem Blue Cross/Blue Shield standards)We need to outlaw insurance companies lobbyists!!" 30500 08/16/06 NY Agree "I strongly support everyone participating in their own health care costs. However, if expenses exceed a persons or family's ability to pay then financial protection should be available. This should be a comment our government must undertake. A healthy country is a productive country." Agree Agree Agree Agree Agree 30501 08/16/06 MD No response No response No response No response Agree "* I believe that all Americans should be guaranteed affordable, quality health care. It should be public policy, established in law, that all Americans have affordable health care coverage, regardless of income level, health status, age or job status. Reform should be fundamental - incremental change is not acceptable. Shifting the cost of health care to individuals and families under the guise of ""consumer driven health care"" schemes - such as high-deductible plans or Health Savings Accounts that exclude needed services - will do nothing to deal with the real causes of high costs and is not acceptable." Agree "* Any system must provides affordable and equitable coverage where everyone pays their fair share. Financing for the health care system must be fair and equitable. Everyone - employers, government and individuals - must pay their fair share in our health care system. We need a system-wide mechanism for containing costs. Simply shifting costs to families and not dealing with the real causes of waste, high prices and skyrocketing costs is irresponsible. Public funding mechanisms must be a central part of the financing and cost-containment structure. The Medicare program offers a model for how the public sector can insure all Americans, keep costs manageable and allow people to get care from the provider of their choice." "I believe all Americans should have a core benefit package that includes catastrophic coverage. All Americans should have access to a set of core health care services across the continuum of care throughout their lifespan. Core services must include benefits such as include preventative services to acute care to patient education. We believe that catastrophic coverage can guarantee protection from financial ruin, but only as a bridge to universal coverage. It is not a comprehensive solution." 30507 08/17/06 WI Agree I agree as far as no one should be refused a life saving medical procedure such as transplants or surgerys because of their inability to pay for such procedure. Agree Free clinics or ability to pay clinics would be helpful in areas you describe. Agree "Fraud is one area I believe needs strengthening. You report a case of fraud and the comments you hear back are we do not have enough resources to check out your complaint, this is federal and state also." Agree "I have strong experience in this area, lost my father and husband to lung cancer. Most doctors give options, but don't really inform if it will actually help cure or just prolong a life that is basically over. I found hospice most helpful in fully explaining the situation, and some of the nurses, almost never the doctor." Agree "i agree in principal, however after living in the minority area of a Phoenix suburb for 18 years, I saw way to many people play the system and go to emergency rooms instead of waiting and calling their doctor on their state medicaid program. I also overheard many talk about different ways to beat the system, so I have very mixed feelings on programs with little or no fraud investigating systems in place." Agree "Ideal situation, I want all people to have access to health care without going broke doing so, I'm just not sure a lot of government programs will work when there is so much fraud in health care and welfare already with nothing being done to find and punish the people perpetrating the fraud." "Again, fraud investigation units or ways to catch the people who defraud the american people must be a big part of any additional government programs or they are meaningless to me." 30513 08/17/06 CT Agree Disagree Your group should not try & change the community health center system. It works well and should not be part of a plan to fragment care. Disagree I do not understand where the changes to the community health center are going to benefit anyone. The consumer based majority must remain. Agree Agree No response 30625 08/17/06 VA 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-training to 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 "As you all know, we pay at least twice as much for health care than any other industrialized country and still we fail to provide quality and affordable health care to all of our citizens. AMSA strongly believes that a single-payer financing system, with progressive taxes, is the best and most equitable way of financing a Universal Health Care system in the United States." "• 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. " 30692 08/17/06 IL Agree Agree Agree Agree Agree Agree 30749 08/17/06 NJ Agree "* I have no strong opinion on the above because privatization is so ingarianed and established and I am amanipulating it to my benefit that I CANNOT imagine a nationalized healthcare system. I guess i feel like a have in a have/have not society and at midlife with a family I don not want this to change if the govenment can't REALISTICALLY solve the problem, matching the great healthcare that I have already in timely fashion. In theory I would beleive in coverage for all, but it doen't jive with capitalism and what we've done so far.We'll need to live with and manage the system we've already created." Agree Agree Agree Agree Agree 30869 08/17/06 OH Agree It makes no sense to have a health care system that may save your live and ruin it at the same time. The fact remains that if health care costs are allowed to spiral upwards it will eventually affect the economy in a negative way by reducing useable income for other items. In many cases everyday necessities will suffer right down to the cost of food. What is the point of working if you have nothing to show for it and cannot afford to live after retirement? Agree "It's fine to provide health care to all, but let's not forget the working class that make it all possible. Let's look for a way to provide them with low cost health care after retirement." Agree Agree Agree Agree "A review of what is considered health care should be done to include unprovoked health problems and exclude self induces problems. For example a health care system should not be used to pay for alcholism, drug abuse, and criminal activity. Those funds should not be wasted on someone who cares less about them selves that than others do." 30870 08/17/06 UT Agree Who will pay for this and how? Agree Agree Agree Agree Agree "Three levers - government, consumer, or managed care alternatives. Which levers will play which roles? Must define what it means to have ""access"" to healthcare services." mental health is presently woefully funded. Thank you for including it. 30896 08/17/06 AZ No response No response No response No response No response No response "* Citizens' Health Care Working Group: Your "" Interim Recommendations of the Citizens' Health Care Working Group June 1, 2006 (updated July 18, 2006)"" includes ""A requirement that all Americans have coverage against high out-of-pocket costs"". I want to discuss one political problem with requiring citizens to purchase healthcare insurance coverage, such as in the recent Massachusetts' state legislation, and how that problem might be avoided. I also have some suggestions for a more comprehensive healthcare plan. The ""Comprehensive Individual Healthcare Insurance Market Restructuring Plan"" section is long and tedious [for most], so a ""summary"" section of the "" the restructuring plan"" precedes it. The ""summary of the restructuring plan"" follows the ""Healthcare Insurance Requirement for Citizens"" and ""The Solution(?)"" sections of this commentary. THE HEALTHCARE INSURANCE REQUIREMENT FOR CITIZENS: Approximately 3 years ago I read the NYT article ""Why a Centrist (No Fooling) Wants Universal Insurance"", By" 30898 08/17/06 PA Agree "Just like every other aspect of life today, large companies and CEO are hurting this country. Drug companies and hospitals are no different, not to mention insurance companies." Disagree If greed was not a factor then people could afford healthcare. Among the greedy are the companies we work for. They keep huge profits for themselves. Agree Agree Agree Agree Too much talk about financing!! This is not the real problem the problem is corporate greed. Focus on corporate greed and we solve many problems!!!! 30905 08/17/06 OH Agree Agree I feel there should be public/private sector review of the networks. Agree my concern is the lower to middle middle class that fall between the cracks-they cannot afford to pay the middle bills that Medicare won't pay and are not eligible for medicaid as it is currently. Agree Agree Agree With the rising costs of everything not everyone would have the additional funds to make financial investments to protect themselves against the rising costs of illnesses. 30909 08/17/06 VA Agree Agree Agree Agree Agree No response 30910 08/17/06 CA Agree "The Social Compact that forms the basis of government mandates that citizens get protected, and that includes health care." Agree Agree "This is a systematic approach to the problem, and could be the basis of a startup effort." Agree Agree "Public policy, the law, should establish that all Americans have affordable health care coverage, regardless of income level, health status, age or job status. Reform should be comprehensive and fundamental, and attempts to shift the costs to individuals and families through high-deductible plans or Health Saving Accounts that exclude services and don't deal with real causes of high costs are not acceptable. " Agree "Financing must be fair and equitable, with everyone(employers, government and individuals) paying their fair share in our health care system. We must deal responsibly with the real causes of waste, high prices and skyrocketing costs, and the answer is not to shift the costs to families. The Medicare program offers a model of how public funding mechanisms can bs used as a central part of the financing and cost-containment structure." "Citizen rights should include access to a set of core health care services, including preventative services, acute care and patient education, throughout their lifespan. And, catastrophic coverage to avoid financial is not a comprehensive solution, but rather a bridge to universal coverage." 30911 08/17/06 OR Agree "* We will be unable to accomplish this unless we can separate out some of the extremely expensive kinds of healthcare technologies that raise the cost of insurance for everyone. Some healthcare technologies are simply not sustainable at this time. Just because we have the technological know how to do things does not automatically mean we can afford to use these new technologies nationally. Currently, expensive technoloties are generally available to those who are lucky enough to be provided with insurance by their employer, but increasingly the cost of insurance is rendered so high by this situation that many cannot afford it. Simply having the government underwrite these high costs using tax dollars would not be a solution." Agree No comment Agree "1. A central component of success here will be to focus on wellness activities and programs. It is much more cost effective to invest in wellness initiatives that prevent illness than it is to treat illness after it occurrs. In addition, treatment options should be tied to a person's willingness to participate in wellness initiatives. Currently it is routine for people to be provided with asthma inhalers, steroids, and even oxygen therapy while they continue to choose to smoke." Agree No comment Agree Excellent! Agree "* 1. ""Sin"" taxes are important. Cigarette sales should generate the large amount of funds needed to treat the huge increase in healthcare costs caused by smoking, for example. Current extra charges for insurance coverage sometimes instituted for smokers tend to be merely tokens rather than amounts that cover the extra healthcare costs created by the choice to smoke. 2. Tax funds currently earmarked for military exploits to secure control of third world countries' resources, and to prop up Israel's desire to dominate Palestine should be redirected towards providing healthcare for our people. " "* In addition to the ""medical effectiveness of treatments"", sould be added the ""cost effectiveness of treatments"". Treatments that cost hundreds of thousands of dollars that might be 50% effective should not have the same weight as treatments that cost less than $100, but might only be 10% effective, for example. Another factor affecting the ""cost effectiveness"" issue would be the frequency that a certain treatment might be needed. If a treatment costs $1,000,000 but the frequency of need is 1 in 1 million people annually, that treatment would only add $1.00 to the per/person annual healthcare cost for society. Another treatment that costs only $100,000 but that would typically be used for 1 out of every 250 people annually would add $400 per person to society's annual healthcare cost." 30912 08/17/06 MI No response No response No response No response No response Agree "My particular concern is that we spend money wisely by promoting prevention. Incentives for healthy lifestyles with diet, exercise, and regular testing and services that will save us all dollars and diseases in the long run. Well patient visits to M.D.s to detect potential problems in advance. Chiropractic maintenance care, nutrional counseling, exercise advice and coaching, incentives to stop smoking. Make these things affordable and available to every citizen and we won't need so much ""disease care""." 30917 08/17/06 IL Agree It is ridiculous that the richest country in the world cannot provide adequate healthcare to all its citizens. It is also unacceptable that too many Americans are bankrupted when a family member becomes ill. This government needs to stop being in the pocket of the Healthcare and Pharmaceutical industries and start helping tax-paying citizens. Agree "Every citizen of this country, except illegal immigrants, should be provided with excellent healthcare whether rich or poor." Agree There is too much waste in the healthcare professions. Agree People who are terminally ill should receive the best healthcare possible. Agree Agree 30922 08/17/06 IL Agree Disagree Disagree This is not realistic. Integrating the various federal and state health programs is a good idea. But the rest of this proposal just ain't gonna work. Agree Are we talking Hospice care? I agree that something needs to be provided for a more humane and respectful end of life situation. Agree Yes!! But how will we provide this?? Agree This concept is a bit too broad and non-specific. "None of these scenarios address the unbelievably high cost of liability insurance for Doctors, Hospitals, and nursing homes. These costs are passed through to the public. Why not handle mal-practice and negligence cases in much the same way we do Workman's Compensation. It would eliminate the high cost of litigation, and the often unbelievably high cost of settlements. Medical professionals need to be held accountable but not to the tune of tens of millions of dollars. Just a thought - -" 30924 08/17/06 FL Agree I feel that everyone should have coverage there is alot of us who can not pay high money for medical so please let us all have coverage. Agree Agree Agree Agree Agree 30926 08/17/06 WV Agree I also feel the govt should allow nurse practitioners and physicians assistants to run the community clinics. The Medical doctors are the ones who will lose the most money should universal health care be adopted so it is the AMA that will pose the biggest challenge. Agree "Same comment as above. The ANA is a large advocate of great patient care. The AMA is more concerned with MD profit. Therefore, the group needs to allow the NP/PA's the ability to start and run the community clinics WITHOUT MD input." Agree Look around nationally. It is NP/PA's that care for patients in rural and underserved areas. Agree Agree Agree 30928 08/17/06 NY Agree Take action and correct this travesty of justice and economic human rights. Agree Agree Agree Agree Agree 30930 08/18/06 NY Agree It is clear that we need this and that people want what would be provided in a single payer system. Is our political system still capable of serving the public weal? No response No response No response No response No response 30937 08/18/06 NY Agree "Practicing as a nurse since 1979, I've experienced changes for the worse in health care coverage. Our pay does not keep up with the cost of living, and our health care costs continually rise. The wealthy have no concerns, the poor have free or low-cost care, but we middle class seem to get the worst coverage at the most expensive price. " Agree Agree Efforts to improve quality of care and efficiency are greatly needed. The current health-care system is greatly stressed. There needs to be an improved RN to patient ratio in order to provide improved services. Finding area's in health care where costs can be cut or shared need to done in area's other than cutting back on RN staffing. Agree "I have limited knowledge as to what support systems are currently available for individuals and their families experiencing a loss. However, I do agree that it is necessary to promote programs on how to deal w/ death and dying." Agree I have witnessed the aged population suffering from this problem more than any other age group. The adult population should not have to make a decision between paying for the roof over their head or buying the medication that they need. Agree "As a middle-class citizen, I am opposed to making higher employee contributions toward health care. " 30965 08/18/06 MI Disagree "Healthcare is a personal responsibilty, however if a person can not afford health coverage and they live a healthy lifestyle we should have limited basic care. This applies only to US citzens and not illegal aliens!" Agree "Please include term ""US Citizens"" and not people-- Illegal aliens should not be included PROVIDE A FINGERPRINT ID CARD FOR ANYONE RECEIVING FREE OR SUBSIDIZED HEALTH CARE" Agree rEDUCE BENEFITS FOR THOSE NOT LIVING A HEALTHY LIFESTYLE. Agree Disagree "Healthcare is a personal responsibilty, however if a person can not afford health coverage and they live a healthy lifestyle we should have limited basic care. This applies only to US citzens and not illegal aliens!" Disagree i DISAGREE- FOR A THOROUGH SOLUTION PLEASE CANTACT ME AT 616-977-3640 30994 08/18/06 NH Agree "* Recommendations 1, 2, & 4: The recommendations seem to focus heavily on affordability and financial access. While this is key concern in both rural and urban areas, it fails to account for one of the most serious barriers to care: geographic access and resource adequacy. We suggest that: • Access to care be defined in terms of the time required to reach the various levels care in the system (primary, secondary, tertiary, ancillary), and the associated core benefits • Resource planning and workforce development initiatives be undertaken which incorporate the parameters of geographic access set forth as goals " Agree "Although the principles emphasize that health care core benefits encompass “wellness, preventive services,….” recommendation 2 only specifies “outpatient and inpatient settings”, without recognizing the significant role of communities and non- medical settings, such as schools, in the provision of prevention and wellness programs. Upstream activities and financial resources for health promotion activities at the community level are essential for an effective and efficient health system." Agree "A recommendation should be added/incorporated that the government implements routine monitoring, through data collection and analysis, of health care disparities across a range of potential disparity categories, including rural vs non-rural. The data for such monitoring exists at many levels, but it is not comprehensively and routinely analyzed and incorporated into an ‘evaluation’ methodology that would guide and inform the implementation of this initiative." Agree Agree "* Recommendations 1, 2, & 4: The recommendations seem to focus heavily on affordability and financial access. While this is key concern in both rural and urban areas, it fails to account for one of the most serious barriers to care: geographic access and resource adequacy. We suggest that: • Access to care be defined in terms of the time required to reach the various levels care in the system (primary, secondary, tertiary, ancillary), and the associated core benefits • Resource planning and workforce development initiatives be undertaken which incorporate the parameters of geographic access set forth as goals " Agree "* We question the assertion that the recommendations “call for actions that will require new revenues”, as this will likely serve as a barrier to implementation and an excuse for inaction. The US currently expends a higher percentage of GDP on health care resources than other developed nations, yet fails to achieve commensurate outcomes. We believe that the types of system realignments being proposed should focus on legislative and policy changes that more adequately and equitably share the costs and benefits of our health care resources." "Although the principles emphasize that health care core benefits encompass “wellness, preventive services,….” recommendation 2 only specifies “outpatient and inpatient settings”, without recognizing the significant role of communities and non- medical settings, such as schools, in the provision of prevention and wellness programs. Upstream activities and financial resources for health promotion activities at the community level are essential for an effective and efficient health system." "* The comments submitted were developed and approved by the Policy Committee of The New England Rural Health RoundTable (NERHRT). NERHRT is a non-profit, membership-driven organization composed of a diverse group of individuals and organizations committed to improving health and health care throughout the rural New England communities. We serve as a regional rural health advocacy group for the states of Connecticut, Massachusetts, Rhode Island, Maine, New Hampshire and Vermont. In general the NERHRT applauds the work of the Citizen’s Working Group and the initiative of the Secretary of HHS for convening it. We hope that the recommendations are both taken seriously, and implemented as a top priority of our government. We offer these comments on the draft recommendations in a spirit of collaboration. " 31001 08/18/06 UT Agree "Coverage should be simple, easy to understand and apply to all." Disagree "Let's make the health care system simple. The recommendation is too costly, complicated and ambiguous." Agree "Emphasis should be on providing appropriate medical care. The onus should be on the medical provider, not third party administrators, nor government bureaucrats. Keep it simple and it will be affordable." Agree Hospice care is essential Agree "As a middle class citizen, health care is now more expensive than housing. This is outrageous." Disagree 31003 08/18/06 UT Agree "Costs of these premiums should be on a percentage basis of the persons ability to pay, or ability to work doing some menial task to assist in paymnet...picking up garbage or guarding a park while they eat Twinkies on a park bench..." Agree see above.. Agree Agree as long as it is within reason... Agree see #1 Disagree geting control of the illegal residents would more than pay for this...as well as keeping them out of the emergency rooms for non-life threatening problems... "that's a tough one...people that don't care about their health, i.e., couch potatoes should be treated accordingly..." "The way the system works now is ""wrong""...something definately needs to e done...anything you do will be an improvement...thanks for trying..." 31005 08/18/06 NY Agree Countries that are piss pour provide health coverage for every resident. Why can't we? Agree Everyone here deserves health coverage. Agree This will prevent more disasterous health situations which will need more money and attention. Agree There should be multitudinal intergenerational activities offered. Agree Let us follow the example of many European countries. No response 31006 08/18/06 UT Agree "Healthcare should be delivered responsibly. And there should be a thorough discussion of the end of life issues, balancing cost for everyone." Agree "Some of our best healthcare comes from integrated community health networks. As all healthcare is local, supporting the already successful local healthcare groups should decrease costs as there will be no need to replace everything." Agree Especially focus on reducing fraud and waste. Agree Emphasis on equal access! Agree Agree "Financing should be everyone's responsibility, copay's and some form of deduction service would help." "I would love to help with any of this research. I was very impressed with Mr. Brent James and if he needs an assistant, please contact me. Thank you, " 31008 08/18/06 FL Agree "Costs are very high, of course, but no where nearly so high as foreign aid, military adventures, etc. Medical needs must be paid for, regardless of the ability of the ill to pay. This is a necessary activity of government. I am willing to pay increased taxes to finance the activity." Agree "There is not the ""unit with specific responsibility""; there are many such units in the broad spectrum of governmental responsibility. All must be adequately funded and encouaged to strengthen the health care cafety net." Agree "The Veterans Administration here in Florida is especially in need of oversight itself, and may not be capable of promoting improved care and efficiency." Agree "Final day care efforts should include ending of life where the patient can agree and wishes the procedure. ""Proactive"" care is impossible, where religious bans on life-ending care exist." Agree "Financiaresources must be upgraded, using the participation of the medical profession, the pharmaceutical profession, and the legal profession to reduce the exorbitant costs of the health care system. " Agree "Government must act to reduce medical costs, especially in the pharmaceutical area." "The core benefit package must include hospice type care for end of life patients. It should also provide for caring activities designed to end life itself, when the problems and pains of a deterioratng life become unbearable." 31012 08/18/06 CA Disagree "We already have a healthcare safety net for American's, California has seven [7]different programs for the uninsured and underinsured. We need to send back the people that are here legally, they are taxiing our system beyond anything we can afford. " Disagree we need to get the word out that a number of goverment and public programs do exist and coordinate what we have now. Agree "I agree and disagree with some of the above statements; your 4th item should be left out. It is to ambiguous, some of the best Doctors and Hospitals take the hardest cases and thereby there numbers may not look as good as a Doctor or Hospital that just does simple or routine procedures." Agree In the last days of our lives over 80% of the health care dollar is used. We must use our health dollars were we can make the best impact on quality of life. The wishes of the patient and family should be weighed heavily. Disagree We have the systems in place NOW we need to coordinate and get the word out. Disagree " Come on, we are over spending now because of the illegal immigrants that are using our medical system. Let’s clean that part of our health care system up first then look at what we have already in place and do some coordination. " "We should not be looking at another ""non-partisan public private group"" bureaucratic group that we have to pay to much for and receive to little. LOOK at the overhaul we have had with the VA system FANTISTIC! Get the man that started that turn around and have him make some recommendations. He has a proven track record! " "Let’s not add another layer on top of what we have, let's drill down and expose what we have and make it work. We here in the United States have the best health care system. We do not want to end up like Canada! We need to coordinate what we have. " 31013 08/18/06 CA Agree We are the only industrial country in the world that is not taking care of its people. We need universal health care. No response No response No response No response No response 31019 08/18/06 WI Agree Agree Agree Agree Agree Agree "* The perspective I bring to this discussion is diverse. I am a insurance consultant; practicing chiropractor; chair, Department of integrative health services at Aurora Bay Care Hospital; Trustee at University; and consultant for Department of Workforce Development, WI. My perspective, relative to affordable healthcare, is different depending on the position I view this issue from. Developing a cost effective system will involve more than reducing provider's fees or putting limits on their services. It will require a system that is based on evidence based practice (allowing efficacious care) and having a fair and open market. When you allow one profession to make all the rules then the model is not effecient, fair or efficacious. There are biases that cloud an open and scientific process to undermining the outcome. The individuals who participate in this entity must have strength, conviction, be open to all evidence based practices, and not be swayed away from what the literature supports. Competit" 31020 08/18/06 NY Agree This feature is crucial - it is difficult enough for families to cope with a serious illness - there should be a safety net for those with catastrophic medical costs Agree Agree Agree Agree Agree "* I am a victim of medical malpractice who was also victimized by the malpractice system. While malpractice issues do not effect as many Americans as these other issues, for those of us victimized by the system, it is a devastating problem. I feel that medical malpractice should be removed from the attorneys. I would like to see boards of professionals and laypersons set up to assist in determining professional misconduct and appropriate awards. Even those who succeed in the system lose 30 - 40% of their awards to attorneys. This issue negatively affects providers and patients. I believe that malpractice insurance rates would stabilize with this approach. I am a nurse educator and chair of a major nursing dept - I would be very willing to speak out on this issue. It is hard to mobilize laypersons on this issue because ""no one ever thinks it will happen to them"" - I didn't think it could happen to me either, but my life has been altered forever due to basically careless diagnosis and treatment of a ma" 31025 08/18/06 MO Agree "It is embarassing that in the country with the best high end health care in the world, many citizens do not even have access to the most basic health care." Agree Agree Agree Agree Agree Reducing administrative costs through a more standardized payer system would reduce costs and allow more complete coverage for more people. "Health care should definately include prescription coverage, dental health, vision, mental health, reproductive health, and end-of-life services in addition to primary care, emergency care and access to specialty care when needed." 31028 08/18/06 NY Agree "A study last year concluded that 2/3 of all bankruptcies were caused by high medical expenses. The irony is that many of those people HAD health insurance, it just wasn't enough to meet the need." Agree It is an unfortunate irony of the medical infrastructure that those most in need for medical care are also those least able to afford it. Agree Agree Agree Agree "Removing or raising the income cap on Social Security taxes would fairly provide cosiderable sums of money for health care. It's absurd that a family of four with both parents working and making a total of 75,000 dollars a year pay nearly the same in social security taxes as Bill Gates. It wouldn't even need to be a progressive tax. Just use the rate for the current cap applied to higher income levels." 31032 08/18/06 CO Agree Agree Agree Agree Agree Agree 31036 08/18/06 IL Agree I support this recommedation. Agree Agree Agree Agree Agree 31039 08/18/06 CA Agree Agree Agree Need to increase citizen's awareness of their own health as well as encourage personal responsibility for their own health and the health of their communities. Agree "Have public forums, discussion groups, classes etc regarding end of life preferences and choices, advance directives, etc. Should come from the point of view that end of life is a developmental stage, a normal part of life." Agree "Should be financial incentives (lower premiums) for healthy choices, i.e. not smoking." Agree "agree with streamlining and reducing administrative costs in health care i.e. insurance forms, billing, etc." 31043 08/18/06 na Agree Agree "There should be no ""unisured"" because the insurance companies will be deleted from this highly profittable business--public health. We need to come up with a one payor system and we'll save so much money and eveybody will have coverage." Agree Effort should be made to greatly reduce the time health care workers spend on paper work so they can take care of clients instead. Disagree "Get rid of the ""private"" payors ie insurance companies. End of life issues should be regarded the same as religious choice. The only reason there should be any involvement of government is possible elder abuse." Agree Agree A one payor system should eliminate procedures being done for the financial welfare of the preforming health care professional. Thank you for doing this work for America! It is on a level with the work done by early American's who wrote the Declaration of Independence and Bill of Rights. 31044 08/18/06 FL Agree "* I agree with this proposition, because I am disabled and I can't get any federal or state help, even though the disability is permanent. I am only 25 years of age and I have not had any health insurance for over 4 years. I can't pay for the out-of-pocket expenses for my medication, nor can I pay to go to a doctor. I haven't been to a doctor in over 2 and a half years, because I can't pay for what I need, even for asthma. I can't get a job because of my disability and I've been through various governmental organizations, including Social Security, and they don't want to help me. I am a low-income United States born citizen and I think it's time that people, like me, who can't work nor can they get any help anywhere else, to get something affordable and to help with their prescription payments. " Agree This is a great idea. Meeting on a local level instead of on a national level to begin with would benefit us all. Agree Agree Agree Agree 31049 08/18/06 CO Agree "* Using the Federal government as the catastrophic events is an idea I support. This should, however, be reserved for truly catastrophic costs, not politically catastrophic. My thinking is $75,000 or greater in today's dollars out of pocket patient costs per event or in care of chronic. onditions. Payments should be not be based on an arbitraryly determined cost amount such as the current Medicare and Medicaid programs, but on a true cost of care and additional margin to allow for adequate financial performance that providers can maintain and develop their services. Treatment should be for certified medically necessary procedures and not for any life style of elective care." Agree Disagree "* The agencies and programs identified above dictate payments to providers that are arbitrary and do not accruately reflect the true cost of providing care. Their artificial payment amounts based more on budget balancing and incomplete cost formulas do not recognized the coast of providing care. This results in continuing cost shifting to the private sector through higher premiums for cost shifting that occurs by providers. This proposal continues the cycle that has, in large part, led to the increasing number of uninsured and under insured that exacerbates the problem and the costs for care that result in rising ""medical bankruptcies"" for the uninsured." Disagree "* Training is good, but payment systems must be restructured to provide forthe payment of these services after the families and providers have been educated and demand for the services increases. this is especially true in rural settings where tratidtional urban payment systems do not provide the incentives or financial support for these services to be adequately provided. Rural adjustments are face saving for Federal and state sponsored programs, but fall far short of the true cost providers bear for trying to meet these needs. The platform for delivery must be developed before the promise of servce should go forward." Agree Agree "* Trying to work with a patchwork of financing as suggested above will not provide the reliable and sufficient source of funding that will be needed. A new funding source must be developed or the program should be supported through a general fund obligation (which I recognize is politically not doable). Individuals, business and other taxes should be adjusted DOWNWARD to compensate for the reduced burden that will be put upon them and a VAT (value added tax) should be established to support the health care delivery system that we all seem to want." "* 1. Vision care should be included in the core. If people can't see, they cannot be educated and it reduces their ability to compete and be productive. 2. The Medicaid experiment in Oregon was a solid start, but political pressure drove the inclusion of non essential services. Many Medicaid programs cover Viagra and the like. Where do we get the political will to keep a program on focus with what is truly core services. If this is to be successful, a body such as the Federal Reserve Board must be created to make the difficult decisions as to what is covered and what is not." 31050 08/18/06 LA Agree Agree Agree Agree "Hospice of Acadiana in Lafayette, Louisiana is a role model for this type of structure caring indescriminately for both paying and indigent patients." Agree Medicare/Medicaid recipients have better access to health care than the average middle class American family with insurance. The co-pays and deductables can financially devistate a young family. Agree I am glad to see the expansion of the defination of health to include mental and dental. This area of care is underserved in America and a great need exists. The entity that pays the bills needs to dialogue with the group that defines the rules for hospitals. Rules are set forth and no funding exists for implementation of these rules. 31051 08/18/06 MD Agree Agree Agree Agree Agree Agree "Why has it taken our great country so long to demand and achieve what every human being world-wide should have? We should be leading the pack, not bringing up the rear." 31052 08/18/06 RI Agree "I believe that The United States is ready for socialized medicine, do you agree?" Agree I believe these programs will work but I would support socialized medicine and or input from the public. Agree Education for the public can only make the public healthier. A small investment now will make people live longer. Agree This type of health care works for most but not all people feel comfortable in groups. Agree A national health care system will bring us closer to socialized medicine. Agree Healthier employees will increase productivity for big business. A small investment from large corporations will result in fewer sick days and greater profits for the company and employees. A set of core benifits is nice but socialized medicine will put people on an even keel. As this country moves to a health care system that is monitoring patients by computer and people are living past 100yrs. old. The government should seek to make this process a smooth one. 31053 08/18/06 KS Agree Agree Agree "I agree to a point. However, let's make sure that we are looking at real quality parameters. Be careful about calling things ""evidence based"" until it is truly proven that the evidence is actually true. We regularly see reversals in the conventional wisdom, i.e. vitamin E for prevention of coronary disease, new studies on the validity of the current BMI, etc. " Agree Agree "* First of all, I commend you and our government for making this public discourse possible. I have been employed in the health care field since the birth of Medicare in 1966. We can only imagine the horrific situation we would be in by now without such a program. I know that it is not by any means simple, but when one considers that today we have Medicare for the aged and Medicaid for the indigent SCHIPS for the uninsured kids, SSI for the disabled, TRICARE for the military GEHA for government employees, township, school district, city, county, and state employee health insurance, there really aren't that many left to cover! Let's get it done." Agree "* Isn't entirely possible that the financing for a universal health program could come from current taxes plus a portion of the current premium base that is out there? It would seem that the efficiencies derived from moving all the coverage under an ""Americare"" for all Americans would contribute a substantial portion of the cost. Currently hospitals and physicians provide services at below their cost to Medicare,Medicaid,Tricare,uninsured,and underinsured patients. That leaves the remaining 38% of our commercially insured patients to make up the difference, essentially making a user tax that affects every employer and individual policyholders' premiums. A universal tax and the removal of the profit levels for health insurance risk could contribute mightily to the cost without being an undue burden on the citizens." "What a huge task youall have taken on! I have 40 years in the field and it seems to be more complicated each year. Thank you for your efforts! If there is any way in which I can be of assistance to you, I would welcome any opportunity to do so. " 31057 08/18/06 VA Agree It is a tragedy for americans to have to chose between health care for their family and perhaps food or other necessities. Agree Agree Agree We should all have access to the type of care we choose for when our lives are coming to an end. Agree Though I believe in capitalism I also believe companies and stock holders could forgo a little profit margin to help provide health care to all. Agree Companies and individuals should in most cases be able to share in the costs with the companies assuming the greater share. 31058 08/18/06 CA Agree We should be a society that takes care of our sick. Health should not be a priviledge of the rich or fortunate. Agree This will save us money in the long run. Agree "I'm concerned with government control, though. Too much opportunity for corruption and waste." Agree This isn't as high of a priority for me. Agree Take money away from special interest and corporations and put it into caring for the citizens! Agree Decriminalize marijuana and prostitution and tax the income / proceeds to fund this. Health care decisions should be made between doctor and patient - no organization should be in between them. 31059 08/18/06 AZ Agree Agree Agree Agree Agree Agree "We are in a health care crisis and these recommendations are excellent. We need a national health plan that is both public-private support in order to provide basic services to all so that everyone is covered. 45 million uninsured is a disgrace for the U.S. By combining all the federal and state programs, the US should be able to administer health care in a more efficient, cost effective manner. " 31060 08/18/06 IL Disagree when do you stop treatment when the money ends Disagree Agree Disagree Agree Agree 31061 08/18/06 CA Disagree a national program is unrealistic under current politicalclimate .you would be better off to concentrate on universal coverage for all americans under 18 yrs of age. Disagree get real!! this will never pass.concentrate instead on real life solutions.offer incentives to private enterprize to create clinics to help people who do not have access to affordable healthcare.this is already being done and is most cost effective. Agree why?are we waiting to impliment these common sense solutions!! Agree where`s the beef? Disagree start thinking not just taking the easy way out!with general concepts that all americans should have universal coverage.the biggest obstacle to better Disagree the biggest obstacle to better health coverage for all americans is cost.the solution already exists we just need to see that private and goverment must work together.more bureau more bureaucrats is not the answer!! i am shocked to see how little thinking went into this survey!! 31064 08/19/06 UT Agree Disagree "* There are already enough government agency's to follow the underpriveledge. It sounds great to say that people in rural areas will receive high quality coordinated health care. It will never happen, because no one will ever make doctors accountalbe for what they do. I have suffered at the hands of rural medicine. I have son who is 13 years old. he was born prematurley at 26 weeks due to poor rural medical care. He has had 78 surgeries, is physically and developmentally challenge. he lives in constant pain. Tell me what agency is going to stand up against the medical doctors. As it right now the government is trying to take away our individual right to seek justice through the courts for doctors poor medical care. I would love to see you guarantee high quality medical to everyone. If you could do this then medical malpractice cease to exist." Agree "Yes these ideas are sound great. But, they are not realistic. It also will take millions of dollars to put these reccomendation into practice. How do you propose that these reccomendation be payed for?" Agree Why do we provide a humane way for people in our community to die with dignity. Agree "If your first recommendation was a success then all these recommendations would not be needed, would they. The fact of the matter is, those who truly want medical care will find away to obtain it. It is a reality that the truly poor and homeless are less likely to seek medical care even when it is avaliable. they also are the most likely to not keep appointment." Agree If fraudulent billing practices would be stopped and doctors only bill for actual services needed and performed you would have the money to pay for these programs. Crack down on the programs already developed and you will accomplish your goals. I work in the health care field. The waste of precious medical $$$$ is pathetic. the difinition is great. But why does the government feel the need now to define what should already be defined. * Tell me who in Washington will risk his political career to go up against the powerful medical lobbysist. I guess I am so skeptical because I have been involved in medical malpractice. I through the justice system have seen first hand the reality of the power the medical world has with our political system. I would like to see some truly realistic ideas to help provide adequate medical care to all. Your recommendation sound very good to the average american who has not had a lot of dealings with the medical world. It sounds great for a quick look. The reality of creating this and paying for it will never happen. 31065 08/19/06 TN Agree Why are we the only industrialized country without universal health care for all citizens? Citizens should NOT have to choose between health care and food. Agree "Since community health networks have had to step in and fill the gaps, there should be a way to coordinate their efforts in order to fully serve our most vulnerable populations." Agree I totally agree! Agree "Quality of life should be preserved in all situations, especially in the last days. People have the right to transition as they see fit and should be aided in every way possible to make their last days as dignified as possible." Agree This is a concept whose time is way overdue. Agree There should not be a problem with coming up with adequate revenue streams to finance this health care initiative. Memtal health care should definitely be included in the health care package and should be given as much priority as physical and dental health. "The ""donut hole"" in the current Medicare plans should be eliminated. It should have never been included in the first place." 31066 08/19/06 CO Agree Agree Agree Agree Agree Agree 31068 08/19/06 KY Agree Agree Agree Agree don't allow the system to take what we have worked for all our life. Agree Agree 31069 08/19/06 CT Agree I strongly believe the program should be puclic so there is no consideration of profit anywhere in the system. The program should alwasy be accountable to those it's serving rather than to stockholders and should do all that's mentioned in this recommendation. Agree * I strongly agree with this recommendation. Perhaps there could be incentives for new medical personnel to spend time in sparsely populated or poor areas or a rotating system so that experienced health care workers would be available in these areas. These people should be well compensated so the care is every bit as good as that in wealthier areas. This should be publicly funded so that profit and shareholders' concerns are not part of the equation. In sparsely settled areas a public transportation system may be necessary for access. ALL U.S. RESIDENTS should have adequate care no matter where they live. Agree "This can only be done well using a single-payer system. And such programs must be adequately supervised. There should be a strong emphasis on ensuring that clinics have adequate staff to provide for their patients. There should no longer be long waits for appointments or, even with an appointment, long waits to see a provider. Providers in clinics should be paid every bit as well as those who work with wealthier patients." Agree "Again, I would like to see all of this be provided by public funds so profit considerations don't enter the picture. And all of this should be available even in sparsely populated areas." Agree "School systems must provide for all children without asking about income or if they are new to the community. And they can't ask if a child is an A, B, C, or D student. They must take each child and provide what is needed. Health care should be as available and comprehensive as education is expected to be." Agree * This is the major roadblock to effective health care. It MUST BE TAKEN OUT OF THE HANDS OF FOR-PROFIT ENTITIES AND PUT SQUARELY INTO PUBLIC FUNDING. I would be happy to pay more in taxes for such a system to insure access to all in this country. One possibility would be to cut back even a tiny bit on all that currently goes into the military. We're overdefended and underhealthed. And concentrating on and funding PREVENTION should cut down on huge expenses when a preventable condition has been let go until it reaches a crisis stage. "* Absolutely. And, again, prevention should be a major component. Education and availability are equally important. There should be an educational program to encourage organ donors to ensure that needs not dependent on money can also be met. And public funding is the key. Another piece would be a fairer way of dealing with medical mistakes. Fear of lawsuits may keep mistakes secret. If there were a fairer way to compensate those who have been harmed then medical personnel could learn from mistakes rather than keeping them hidden. This does not mean condoning carelessness or incompetence, but all mistakes do not result from these. " "* All through this I've been saying that we must move to a single-payer, publicly-funded system with accountability to ALL RESIDENTS. Our society in general is based on greed. We must learn how to put human beings first in this area as well as all other areas of our lives. Moving in this direction will be an excellent first step. The insurance companies will do everything in their power to hang on to their power and profits and we must rebuff those motives and move to a society that cares for all, wealthy, middle-class, and poor." 31072 08/19/06 MI Disagree "* I agree that no one should be impoverished by health care costs. However, providing coverage for all Americans or requiring that all Americans have coverage is not the solution. Providing or assisting low income people with the cost of coverage, should they choose to have it, is the correct thing to do as long as it is not a mandatory thing. But, will doing so result in costing everyone else more money; if so, how much more, and is it right to compel everyone else to provide coverage for those who cannot afford it themselves? Health insurance is expensive for many reasons, but the major reason is because the cost of health care is expensive. If the cost of health care were more affordable, it would not be necessary for anyone to have anything more than a policy to protect against catastrophic financial loss for the most serious of medical conditions. The goal should not be to insure everyone in the country. The goal should be to bring the cost of care down to a level that everyone can afford." Disagree "* Other than as a source of funding for the safety net, and, perhaps, to help new initiatives get started, the federal government needs to get out of the business of health care. One of the major reasons there are issues with affordability and access to care is that the federal government has disrupted the natural workings of the free market. It began with Medicare and ERISA, and has only become worse with time. With regard to this recommendation, the question is how much will it cost to implement and run? How will it be financed? I strongly recommend it not be financed by increasing the cost of health care, increasing health insurance premiums, any unfunded tax credits or tax deductions that increase the national debt, or any new fees, surcharges, etc." Disagree "Keep the federal government out of the business of health care. Let the free market determine how to do things and everyone will be better off. Anytime the government gets involved, there is a greater cost to the taxpayer via the creation of beauraucracies, and systemic inefficiencies. In addition, the cost of the services provided increases." Agree "As long as the government stays out of this and the free market is permitted to restructure this, it should work and result in less cost than the current system." Disagree "Do not tread on me. If I choose not to purchase health insurance, I should not be compelled to do so. Nor, should I be taxed, penalized, or incur higher costs in order to subsidize those who do chose to have it. As stated previously, the goal should not be to insure everyone. The goal should be to bring the cost of health care down to a level that everyone can afford." Disagree "* There is more than enough money flowing in the health care industry to finance any changes necessary to implement effective and meaningful reforms. Historically, any time new sources of revenue have entered the system, it has created a ""feeding frenzy"" with resultant higher prices and insurance premiums. As stated above, any changes to the system need to be made on a revenue neutral basis. This means that no one should incur higher taxes, or higher costs for anything. The dollars currently in the system need to be used more efficiently and waste eliminated." "* This recommendation presupposes that everyone will have coverage. Many, if not all, states mandate all drivers to carry automobile insurance. Despite that mandate, approximately 15% of all drivers are uninsured. It is not possible to enforce a mandate of this nature. Attempting to do so will only result in higher costs with no commensurate increase in value or benefits derived. Likewise, attempting to determine a core benefit package will be futile at worst and leave almost everyone feeling as if they are not receiving the value for their dollar at best. A true core benefit will cover far less than the majority of people will think it should. You will receive a better return on your time and money by working to eradicate the entitlement mentality that appears to be so prevalent within our society." "* Health care is not a right. It should be recognized that health care is a scarce economic resource and treated as such. No one has a right to it anymore than they have a right to live in your house or travel on an airline for free. Health care is a matter of personal responsibility. If one fails to accept that responsibility, there are natural consequences; financial catastrophe among them. Yes, provision should be made for those who have less than adequate financial resources due to their situation in life. But, for the rest of us, it is incumbent upon each of us to make provisions for the potential medical event that could arise and jeopardize our personal and family's financial situation. Part of this provision is doing all that can be done to maintain a state of well-being. It also means, if necessary, purchasing health insurance to protect against financial catastrophe. As this is a matter of personal choice, it is not the government's to usurp nor to choose for us." 31074 08/19/06 IL Agree "There should be at least basic health care coverage for every American. For profit groups make money for businessmen and shareholders. We need the profits to go back into improving patient care,which I believe the non-profit groups try to do." Agree Community networks can be of the quality to serve both the insured and non-insured in order to be easily accessible to all in every neighborhood. Agree "* I just did a Geriatric Fellowship at Hines Veterans Hospital and saw how wonderful the govt electronic medical record(EMR)is. It would be good for all clinics and offices and hospitals to use the govt CPRS EMR so that information on a patient can be retrieved in moments. Private companies trying to sell their products for EMR will not like a system that is universal,I believe. Health care quality depends on correct patient information. Right now,we have a very fragmented system where one EMR system does not talk to the others. For quality health care in our country,it would be a great step forward for us physicians to have full access to our patient's medical record on line and retrievable by a universal system like the government VA system. " Agree Agree I agree that all Americans should have access to a set core of health care services. I worked as a physician in England and in Ireland for several years. I was impressed with the care patients received in the National Health System in Britain. Agree "* As a physician,I believe that the health care of our nation should be a priority. England and other countries around the world recognize the importance of patients having a family physician who is the primary care physician and very involved in the patient's care. Here in the USA,emergency rooms are being filled with patients because we are not encouraging young doctors to go into primary care. All that is needed would be incentives to young doctors,as I saw in England when I worked there. The National Health Service in England paid family physicians a higher salary than many of the specialists in order to have doctors in every area of the country in order to give health care to all. Patients were allowed to have private health insurance as well as universal coverage in England." "I am definitely for coverage of physical health. If we can afford to also cover mental health and dental,that would be an added bonus." "Thankyou for addressing this problem. I am very discouraged by the present system. I am a well trained family physician and also trained as a geriatrician. It is hard to do patient care in a climate of heavy regulation & litigation. I am looking at other job opportunities. Please let me know if there are job opportunities,other than the practice of medicine." 31075 08/19/06 MI Agree Agree Agree Agree "* End of life care should be emphasized in all aspects of the health care continuum. We spend a lot more money in this country on ineffective treatments and inpatient care, when a person who is terminally ill could be supported in their own home much more effectively and compassionately for less money. Survey show that 9 out of 10 Americans want to die peacefully and painfree in their own homes and right now only about 25% of deaths in this country are at home. We need to improve reimubursement and support for hospices as they do the work of meeting the needs of those at the end of life." Agree Agree 31081 08/19/06 CA Agree "Not all of Health care Needs to be provider by physicians. Nurse Practitioners( Nurse Anesthetists,Pediatric Nurse Practioners, Geriatric Nurse Practioners, Adult Nurse Practitioners, Family Practice Nurse Practitioners, Neonatal Nurse Practitioners etc) Physicians Assistants, and Certified Nurse Midwives provide excellent care. Language in this document needs to be inclusive of these providers." Agree Agree Agree No response "Again,not all of Health care needs to be provider by physicians. Nurse Practitioners (Nurse Anesthetists,Pediatric Nurse Practioners, Geriatric Nurse Practioners, Adult Nurse Practitioners, Family Practice Nurse Practitioners, Neonatal Nurse Practitioners etc) Physicians Assistants, and Certified Nurse Midwives provide excellent evidence based care. Language in this document needs to be inclusive of these providers." No response "Significant effort needs to be directed at reducing the cost of premiums, and damages given in medically related law suits. There needs to be a way to separate out frivelous claims vs legitimate claims where adequate provisions need to be made for on going health and daily living problems that result from true malpractice." "Health care also needs to include eye care and hearing related problems, prosthesis etc which often are not covered by insurance providers." "* Care needs to be taken that the only providers of health care are simply physicians who tend to be exclusive, not so much for the safety of the public, but for their own financial benefits. In the Journal of Higher Education each year, freshmen entering college are surveyed as to their life goals and expectations of their education. Not to many years ago the majority of responses involved preparing themselves to provide service to others. Now the majority response is to make money. I see much less dedication and self sacrifice in providers of health care now compared to the traditional ""family physician"" of years past who at least knew your name and past medical history." 31083 08/19/06 OH Agree I certainly agree tht Americans should hve access to health care without bankrupting them. A system under which we all share the costs is preferable to the present one which denies adequate health care to those who cannot afford insurance coverage. Medicare has worked well--why not for all Americans not just the aged. Agree Agree Agree Agree Agree "I certainly am willing to pay for a single-payer health care system for this country which would be much more equitable than what we have today. It is my belief that we as a country would end up paying less than we do now with the hodge podge system of private insurance. The medicare model is one which should be followed for all people in the U.S., including, of course, immigrants." i cannot emphasize strongly enough my belief that we must catch up with the rest of the world and adopt a single payer system of health care that will guarantee to all residents that their health care needs will be met. 31086 08/19/06 PA Agree Agree Agree Agree Agree Agree "This effort will require additional manpower in certain areas and elimination in other ones.Individuals who are displaced by this change in the health care system, will be offered the opportunity to be retrained in new areas that develop. The expense of retraining should not be the responsibility of the individual being retrained, but should be built into the budget of this new health care system. " 31090 08/19/06 AZ Agree Agree Sounds like a lot of layers of bureaucracy. Agree "Incentivize the public to stay well by making wellness tax deductible: vitamins and minerals, massage, gym memberships, health books and videos, exercise programs, etc. Right now the only ""government"" incentive is to become desperately ill!" Agree Yes! In America we take better care of horses and dogs than we do terminally ill people! It should not be a crime to die in a chosen way. Agree "Many have died simply because they couldn't afford better care. For example, is it really in the country's interest to have people lose teeth because dental insurance will pay for extractions but not for bridges or crowns? For someone to become bedridden because Medicare would no longer pay for a chiropractor for someone with chrinic back pain (my mother)? Don't you think the wheelcare and home-care services ultimately cost more?" Agree "Prevention -- health education -- is the best option I can think of. That doesn't finance healthcare, but it reduces it. Most Americans don't understand what can be gained by increasing handwashing and decreasing sugar intake! Spend on education first -- that it affects diseases and lifestyle." Well-stated. "Stopping fraud and price gouging in clinics and hospitalds would help. I understand agencies need to cover the cost of mandated ""free"" care. But there needs to be a way to do it honestly, without creating outrageous margins (like 400%)." 31091 08/19/06 CA Agree Agree Agree Agree Agree Agree 31092 08/19/06 WI Agree "My agreement with the recommendation is limited to establishment of a public national program. Private, for-profit programs need to be eliminated from from the health care caverage arena entirely." Agree "My agreement on this recommendation is limited to public, not private for-profit, health networks." Agree Agree Agree "It is my belief that all Americans should be covered by a national health insurance plan. I support legislation to create such a plan, such as The United States Health Insurance Act (or the Expanded and Improved Medicare for All Act) H.R.676." Agree "I would be willing to pay an additional tax to finance a national health care plan that would cover all Americans. Currently, approximately 6% of my family's income is used for health insurance premiums and out-of-pocket costs. A tax of that percentage or slightly more that would cover a plan that would replace my current insurance premiums and out-of-pocket costs would be acceptable. " 31093 08/19/06 NY Agree Agree Agree Agree No response Agree 31097 08/20/06 MI Agree "As a health care provider in the USA for over 40 years, I have observed the negative personal and societal impacts and unfavorable clinical outcomes from the lack of adequate health care coverage. In addition as a visitor to both industrialized and impoverished nations I am aware that we can do better to protect the health and well-being of our nation." Agree "Well run integrated systems can provide continuity and streamlining of health care to improve resource utilization, enhance quality and increase consumer and employee satistaction. Safeguards must be in place that allow for consumer choice and patient confidentiality. " Agree Valid consumer information is essential to informed consent and shared decision making. Agree "As a family member of seven recently deceased elderly relatives, I have witnessed a wide variety in end-of-life care. In some cases there was unnecessary extension of life, expenditure of resources, and/or disrespect for patient/family wishes, that proper hospice care would have prevented. " Agree Agree These short-term costs should result in long-term savings both financially and with regard to quality of life. "There is a great need to improve all health care, but especially to improve mental health care due to the poor level of current funding." 31098 08/20/06 AZ Agree Agree Agree Agree Agree Agree 31099 08/20/06 AZ Agree Agree Agree Agree Agree Agree 31101 08/20/06 NY Agree Agree Agree Agree Agree Agree 31103 08/20/06 MA Agree "If we can waste billions on a moronic war and be robbed of billions on this same war by a few freedy Americans, then we can damn well afford health care for all Americans. You would think that self serving, holier than thou hypocrite of a President would know that, but then again it doesn't benefit the idiots cronies." Agree Why not? Agree "And for those who cheat, steal, overcharge or defraud the system give them mandatory jail time and triple indemnity." Agree Just seems humane doesn't it? Agree Republicans won't like this. Oh well! Agree "Guaranteed with the government involved you'll need to have an unbiased, intuitive, non-political watchdog group to keep waste at a minimum and efficiency at a maximum. Like this is going to happen." You might want to have a common sense group for those who will undoubtedly fall through the cracks because of government bureaucracy. "Considering the Republican bastard that control Congress now I think we need to reinvent the Democrats as a party of the people and for the people, so we can this goal attainable. One thought...show people what Karl Rove really is and the influence, negativity and underhanded tactics he employs and make him the posterboy for the Republican party and how they do business." 31105 08/20/06 OR Agree "School-based health centers provide the best and most efficient way to reach children without health care. It also monitors and strengthens health care for those children who are fortunate enough to have medical insurance. With the increased use of illegal drugs, our teachers and law enforcement personnel are becoming overwhelmed... we need physical and mental health care in our schools." Agree No response Agree Agree America stands for freedom and one of the most basic freedoms is access to health care. Agree "The private insurance companies continue to ""get rich"" through our current system. Although I believe in democracy and free-enterprise there has to be a way to stop companies who are taking advantage of the systems. STOP THEM... " "Our children are our future and at the rate they are being abused because of meth and other illegal drugs is just terrible. We need school-based health systems to find them, protect them and allow them to learn." 31109 08/20/06 TX Agree Agree Agree Agree Agree Agree "I agree that financing should be based on fairness and should involve taxing certain areas, especially ""sin taxes"" which are often placed on items that can cause an increase in health issues in the first place." 31110 08/20/06 CO Agree Agree The standards for being a FQHC should NOT be weakened by eliminating the consumer-board majority requirement or other characteristics germane to 330 grantee status. This FQHC feature is a fundamental element to the success of CHCs. Agree Agree Agree Agree 31111 08/20/06 CT Agree I absolutely agree with this recommendation. Agree "I have not been impacted by this issue, but strongly endorse the recommendation." Agree Absolutely. We must build more accountability into the system. People should not be forced to go to court for redress of medical errors. Providing Consumer-usable information is essential to this goal. Agree "Palliative care should not be limited to those who can afford it. As in the first recommendation, the stress on the family to care for the terminally ill can be devestating both emotionally and financially. Our current drug policy prevents use of demonstatedly beneficial drugs (e.g. heroin and, perhaps, marijuana). " Agree "Yes, and I understand the difficulty of defining the core set. Much of this effort should be aimed at keeping people from getting ill or injured, i.e. prenatal and wellness programs. But every effort should be made to provide those services that will allow people to fulfill or maintain a productive role in society." Agree "Once again, our current drug policy drains resources that could be used to provide healthcare. If all of the non-violent drug offenders were released from prison and drug addiction were treated as a medical problem, rather than a moral and criminal one (as recommended by a commission in the Nixon administration), there would be ample resources to begin the process of providing healthcare to every American." "I think this approach to pursuing the definition of a ""core"" benefit package is sound." 31113 08/20/06 MO Agree "* Lets be realistic. Reports generally end up on a shelf collecting dust. Its been almost 3 years since the bill that created this working group passed in Congress. The group is just now completing what it was chartered to accomplish. At this pace, millions of Americans will continue to suffer and die because we're waiting for our elected officials to take action. The best action is to replace all elected officials with people really wanting to serve and do so without being paid. I've read all 6 recommendations and it does not take rocket science nor individuals in the health industry to develop them. I am neither a democrate or republican. I am an individual that believes it should not take a gizzillion laws or a heavy ladened bureaucracy to provide what ought to be common sense. Consider the following: what do firefighters and doctors have in common? Of course its saving lifes. Do firefighters get paid equivalent to doctors? I don't think so. Why does my hospital bill my insurance over $1000 " Agree Read Matthew 25: 31-46 in the Holy Bible Agree Provide everyone with the same type of health coverage given to our elected officials. Agree Family should take care of each other rather than depend on the government. Agree A 6 year old could have told us this. We can learn alot from watching children and being as honest. Agree "This is always the bottomline and the reason NO ACTION has happened to date. Its going to cost something, but everyone wants it for free. Its like do we want lower gas prices OR security from terrorist. Many sadly would choose lower gas prices. Life is not valued any more. Look at all the abortions. Lets get rid of anyone that is not healthy because they are burdening the costs of medical care." Copy the Federal Employees Health Benefit (FEHB) program. Do you really think this is going to make any difference? If this is shared with our elected officials I would expect to hear from them. But I doubt that would ever happen. They do not really care or else someone would take the time to contact me. I have taken my time out of my busy schedule and provided what I consider constructive comments. 31115 08/20/06 AZ Agree "Any coverage plan should include payment to nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists when they provide services that are included in the covered benefits. The payment should be performance based, so that it is the level of service that is the basis of the payment, not the credentials of the person who provided it. The reimbursement should not be conditioned on a contractural arrangement or oversight by a physician." Agree "Support for the health care safety net providers should include funding for nurse managed centers, without a requirement for oversight or supervision by other disciplines." Agree "The funding and implementation should include the sites that educate nurse practitioners, certified nurse midwives, nurse anesthetists and clinical nurse specialists, not just medical residents. These graduate nursing programs should be treated the same as residency programs under the GME funding." Agree Agree Agree "Savings could be immediately realized by eliminating the service provider redundancy that currently exists in the system. Laws and policies (public and private industry) that require unnecessary physician oversight of advanced practice nurses add the cost of that physician to the cost of care that could be safely, efficiently and competently provided by the advanced practice nurse alone. " "Evidence-based practice should include expert consensus and patient preferences, not just evidence from research." "* Nurse practitioners, Certified nurse midwives, registered nurse anesthetists and clinical nurse specialists are an untapped cost effective resource for excellent primary, chronic and acute health care. Due to restrictive state laws and discriminatory insurance policies (federal, state and private)patients who would benefit from the type of patient centered care that advanced practice nurses (APN) provide are unable to access them for care. Laws and policies that tie APN practice to one or more physicians prevents APNs from autonomously practicing to their full scope of practice. They prevent APNs from direct payment for services which makes it financially impossible for APNs to enter into practice and increase the number of available care providers in the community. Research has demonstrated that the nursing model of health care -patient centered and prevention oriented - results in improved patient outcomes, improved health status and health care cost savings." 31116 08/20/06 TN Agree We need healthcar for all Americans that is affordable before we spend our money in other countries. Agree Agree Agree Agree Agree 31119 08/20/06 MD Agree Disagree "* Although I strongly agree with the need to provide more communidty networks of health centers, I strongly disagree that these should be only for the vulnerable/disadvantged. My MAJOR CONCERN WITH THIS REPORT is that it virtually neglects the strongly felt need of over 90% of the population for one place/doctor responsible for primary care and coordinating care. In its almost exclusive focus on financing of health care, the report neglects the serious organizational limiations of the US health care system that are responsible for suboptimal care of most of the population, not only the vulnerable and disadvantaged. " Disagree "* Although I agree with the recommendation, it falls short in not recognizing what would be required to accomplish it: a strong primary care infrastructure backed up by appropriate specialty care. Our specialty-oriented health care system is responsible for an excessive amount of unnecessary and dangerous care. The reason why other industrialized countries have better outcomes at lower costs is because their health systems have a strong primary care base that coordinates care to be more effedtive, efficient, and equitable." Disagree "Although I agree with the thrust of the recommendation, it does not recognize that planning of effective facilities requires recognition of population needs. Only when facilities are organized around population needs can individual needs be taken care of." Disagree "Although I agree with this recommendation on principle, as worded it misses the mark. The point is that people should have access to affordable APPROPRIATE care, not just affordable care. that is, it is a reorganization of the health system that is required, not access to a poorly organized health care system." Agree Financing is important BUT FINANCING WILL NOT WORK IN THE ABSENCE OF A PROPERLY ORGANIZED HEALTH SYSTEM. "THE CORE BENEFIT IS PRIMARY CARE. An extensive literature documents the evidence for this statement. No amount of tinkering with the current specialty oriented system will achieve the desired goals. The US needs a basic re-structuring of its health system, as all polls have shown. (See the most recent--August 2006--Commonwealth Fund representative poll.)" "I donot believe that the Commission tool adequate note of the evidnce underlying the problems with the US health care system. Therefore, its recommendations are not quite on the mark, although they are well intentioned. " 31122 08/20/06 CO Agree "* I agree that Americans should not be impoverished by the cost of healthcare. It is important to remember that it is not only catastrophic illness, but chronic illness such as diabetes, hypertension, obesity, cancer, and HIV are bankrupting people. It is the high cost of medications and treatment procedures that hurts people also. I support a publically funded, universal coverage program for all Americans. The idea of ""finacial protection"" is not sufficient. The Maine plan to offer ""subsidized insurance"" for the poor continues to pay insurance providers but lacks the ability to truely cover the needs of and protect from financial ruin. Note that most bankrupcies due to medical costs are from those that are insured. Private insurance is inadequate to protect people and needs to be done away with. " Agree I agree with the FQHC concept fully. I also support funding community based programs as it is the community that best knows how to serve its needs. I disagree with the safety net concept. The safety net approach to fixing this problem is a bandaid on the hemorrhaging artery. The change that is going to be effective is widespread system change to adopt a national health care system for Americans. The safety net approach needs to be abandoned it clearly is not working. Agree I agree with all of the above recommendations. I would include the IHS in the federally funded health program list. A way to control costs not mentioned is to start negotiating with drug companies for lower prices on medications. Reducing administrative duplication with all improve efficiency. Agree Agree "Again, ""finacial assistance"" rings of the Maine program and safety net ideas. I believe that health care is a right. If all Americans are appropriated the right to health and wellbeing, then the responsibility lies within a public system to provide for the public health. These basic healthcare needs should not be paid for out of pocket." Agree "* Financing of a national healthcare system would benefit if we went back to the days of taxing corporations at a higher level than the individual. Corporations are already cutting jobs, outsourcing labor, chosing to build in countries were health care is provided by the government so the corporation does not have to pay to insure its employees. Issuing a tax would cost the corporation less then insuring its employees. Also by decreasing the disjointed, patchwork system that increases administrative costs to one public system the savings would be substantial. It is likely that the individual would have to see a small increase in income tax. But if the system were streamlined and corporations paid appropriately I don't think this would have to be a large amount. After the infrastructe was obtained-electronic records etc. then individual taxes should be able to go down again. " "* There are several things here that need work. Health includes vision too. Core health services are generally health promotion and disease prevention services, acute care, primary care, specialty care, prescription drugs, durable medical equipment, long term care, mental health, dental, vision, emergency, chiropractic care, acupuncture, physical and occupational therapy. Unfortunately there are many accepted medical practices that have not been ""proven"" yet because the concept of evidence based practice is fairly new to this country. We must look to UK, Scandinavia, and Canada for some of this." Thank you for providing this opportunity to voice our thoughts. 31125 08/21/06 CA Agree * As an R. N. for 30 years from '69 to '99 I experienced the decay of our health care delivery system firsthand. The Hill Burton Health Care Act provided guidelines for improved health in our country while the loss of economic security and welfare reform doomed our citizens to witnessing an increase in the infant mortality rate as well as other significant indices of national health status. Unless we want to lose our national strength and viability we must return to the policy of the Hill Burton Health Care Act. We must see health care as a national responsibility. The very preamble of our constitution indicates that our national responsibility for life rests with the federal government. Agree Agree Agree Agree Agree "* Whle revenue streams have been cut by ther present administration the $250 billion that has been spent on the war would more than pay for health care. Taxpayers with good jobs would easily pay for health care. Where are the good paying jobs? Not at McDonalds but at massive infrastructure projects that must be carried out along the lines of the Tennesee Valley Authority or the Three Gorges Dam. We must mount a campaign for adequate transportation with high-speed rail system for the Americas based on nuclear power generated electricity. We must retool the auto plants currently declaring themselves bankrupt to produce the needed products and jobs to keep the U.S. healthy economically. A SICK ECONOMY PRODUCES A SICK POPULATION. When health and sanitation go we lay ourselves open to rampant disease, death, and loss of human progress for generations to come." "On the basis of our constitutionally mandated responsibility for health care for our citizens we must chose to provide for our generation and also the coming generations. To do less means death and destruction of our nation, ligitimized by its concern for the 'general welfare', and giving over of our national sovereignty to the economy driven multinational corporations which FDR tried to root out and decartelize before his untimely death." 31149 08/21/06 VA Agree Agree Agree Agree The government should stop playing god and let the terminally ill and their families decide!!! NO MORE TERRY SCHIAVO IDIOCY!!!! Agree Agree We need to stop being a society where we have the best medical care money can bye. The best medical care should be available to all. 31150 08/21/06 OR Agree Agree Agree Agree Agree Agree 31151 08/21/06 FL No response No response No response No response No response No response I sent my two comments and some Kudos to you before I filled in the from blank. Hope you can put them together. 31152 08/21/06 DE Agree Coverage for all Americans will cost less in the long run than the present system. Agree These are all good ideas. Agree No comment. Agree No comment. Agree I agree with the idea of Medicare for all. Agree We need to change the system so that all Americans are helping one another. All good ideas. No. 31160 08/21/06 PA Agree Only if t he person was or still is gainfully employed. Freeloaders and illegal aliens should not participate in benefits paid for by working or retired working people. That should be the state's responsiblity. Disagree Agree Agree Agree Agree 31161 08/21/06 CA Agree "Health care is a right, not a priveledge. The wealthy should NOT get the best health care. WE are all human beings." Agree Agree Agree Agree Agree 31164 08/21/06 TX Disagree Who decides who can afford what. Disagree WAY too much government influence and the probability of a one size fits all approach that will not meets anyones' needs Disagree "The big drug companies are already in the governments pockets, this just encourages them more" Agree Disagree "Your statement AMERICANS, it is the illegal immigrants that have stretched our hospitals and health care systems to the max. This is the real reason for higher costs that no one wants to address." Agree "Statistics show that over 30% of Americans use alternative methods of healing, this has not been addressed. Homeophathy, acupuncture, herbal remedies, spiritual healing etc. Who wants to pay for others to support the drug companies when they don't use those methods for their health care needs" 31168 08/21/06 FL No response No response No response No response No response No response "* The focus of health care needs to be the ability to produce and maintain a LITERATE and WELL NOURISHED populace. My HEALTH CARE concern is the over 50% High School Dropout rate that has been happening for over 20 years. The 15 year research with over 3000 youth offenders concluded that functional Pre-School Academic Readiness Assessments & Training need to be made available in all school districts. The KEY to this program is to develop coordinated eye movement with two eyes at the NEAR POINT READING DISTANCE before learning to read and then master eye movement coordination while reading silently at the near point distance. Eye movement coordination - the training the six muscles of each eye - is NOT trained BEFORE being taught to read. Studies show that eye movement coordination and comprehension are linked. The more efficient the eye movement coordination while reading at the near point distance the better the comprehension of the material. Cost effective, 5-minute, functional eye movement a" 31169 08/21/06 FL No response No response No response No response No response No response "* The focus of health care needs to be the ability to produce and maintain a LITERATE and WELL NOURISHED populace. My HEALTH CARE concern is the over 50% High School Dropout rate that has been happening for over 20 years. The 15 year research with over 3000 youth offenders concluded that functional Pre-School Academic Readiness Assessments & Training need to be made available in all school districts. The KEY to this program is to develop coordinated eye movement with two eyes at the NEAR POINT READING DISTANCE before learning to read and then master eye movement coordination while reading silently at the near point distance. Eye movement coordination - the training the six muscles of each eye - is NOT trained BEFORE being taught to read. Studies show that eye movement coordination and comprehension are linked. The more efficient the eye movement coordination while reading at the near point distance the better the comprehension of the material. Cost effective, 5-minute, functional eye movement a" 31174 08/21/06 OK Agree "I distrust the language ""very high health care costs"" as that leaves too much ambiguity. What is affordable for one person would impoverish someone else. Most attempts to define low income persons leave too many people out who still can not afford whatever the commodity is. Only a plan of universal healthcare coverage is acceptable." Agree "* The current federal emphasis on rural communities and its definition of medically underinsured area (MUA) fail to address the needs of the urban uninsured. Location os a healthcare provider within 30 minutes by public transportation in an urban area (part of the current MUA definition) does not constitute access if the patient does not live on the bus line, has no dependable transportation, or is refused access by the provider because of inability to pay. The current requirements to be a FQHC or a look-alike leave out the valuable contribution of ""free,"" volunteer-staffed medical clinics that are filling the gap. Any expansion of the community health center concept needs to reduce the administrative requirements that create a barrier to volunteer-based clinic participation and needs to revise the definition of MUA. Any national plan to expand Medicaid would have to address the wide disparity in income limitations and elective populations state by state." Agree "* I have the same comments as above. The current federal emphasis on rural communities and its definition of medically underinsured area (MUA) fail to address the needs of the urban uninsured. The current requirements to be a FQHC or a look-alike leave out the valuable contribution of ""free,"" volunteer-staffed medical clinics that are filling the gap. Any expansion of the community health center concept needs to reduce the administrative requirements that create a barrier to volunteer-based clinic participation and revise the definition of MUA. Location to a healthcare provider within 30 minutes by public transportation in an urban area (part of the current MUA definition) does not constitute access if the patient does not live on the bus line, has no dependable transportation, or is refused access by the provider. Any national plan to expand Medicaid would have to address the wide disparity in income limitations and elective populations state by state. Expansion of current funding programs needs to ad" Agree "Patients should not have to choose between ""treatment"" and ""palliative care,"" something that is now required to qualify for Hospice. Currently, Hospice requires a caregiver in the home, thus many individuals who live alone do not qualify or must 1st be institutionalized. The emphasis on end of life care (within 6 months of death) or certification that one has a terminal illness also are deterrants to many persons obtaining hospice care." Agree "* This is fundamental and should be # 1. It is a national disgrace that the US is practically the only Western democracy without universal healthcare, yet we are the richest nation in the world. The failures of the British and Canadian system are spurious arguments, since they spend far less of their GNP on healthcare than the US. Unfortunately, our system of private for-profit health insurance and health delivery systems, which lives 45 million people uninsured, is not very efficient at delivering a core of basic health care services to all Americans. " Agree "* A transition to universal coverage is a pragmatic approach and understandable; nevertheless, a ""seamless"" system necessitates that the payment source not be a barrier to access. The US spends more of its GNP on healthcare than any other Western nation, yet we have 45 million uninsured. We need to redirect our healthcare dollars away from private insurance company overhead and healthcare administration (much of it related to billing and collection) toward basic access to healthcare. Instead of continuing to give big tax cuts to the wealthy, I favor taxing the wealthy to help meet the needs of the poor, including universal healthcare coverage (inheritance tax; luxury tax). After all, the wealthy have benefited disproportionately from current economic policies relative to low-wage, hourly workers. I am opposed to any kind of regressive tax (e.g. sales tax or value added tax) that would disproportionately affect the lower and middle classes. The Medicare Part D plan (and any other similar financing plan) " "* For reasons already stated, the core benefit package needs to be for more than ""high-cost"" protection. We see many patients at the free clinic who cannot afford basic maintenance items like glucose test strips to monitor their diabetes. Glucose test strips are basic to managing diabetes but are not necessarily ""high-cost"" protection items. re: the benefit package, I am concerned that a full range of mental health and substance abuse services be included in the package and would support whatever NIMH/SAMHSA and/or NAMI propose as essential in the core package. Lack of affordable dental care for low income adults is a serious problem in Oklahoma. Medicaid only pays for extractions for adults (and few non-elderly adults even qualify for Mediciad in Oklahoma). Dental and vision care also needs to be part of the core services." "* Even when patients have health insurance, the Oklahoma City area has insufficient doctors in certain medical specialty areas. Any attempt to remedy the access problem also will need to address the lack of trained medical specialists to meet the current demand, let alone the needs of the uninsured population. The shortage of healthcare professionals, including nurses, needs to be addressed as part of a proposed solution to the healthcare needs in America. The clinic where I work has several patients who have been waiting for a year for one of very few cardiology openings for charity care. There are no orthopedic doctors in town we can refer patients with broken arms or legs who will see uninsured patients." 31179 08/21/06 TX Agree Decent health care should not be for the rich alone. Agree Decent health care should not be for the rich alone. Agree Decent health care should not be for the rich alone. Agree Decent end of life care should not be for the rich alone. Agree Decent health care should not be for the rich alone. Agree Decent health care should not be for the rich alone. All Americans deserve decent health care. 31181 08/21/06 MI No response Agree Agree I strongly support single payer Medicare model. Increase number of geriatric professionals. Agree Agree Allow US citizens to import prescription drugs from Canada. Agree I strongly support the inclusion of dental and mental health in the definition; also abortion as a medical decision between the patient and her doctor. Regulate or put limitations on advertising of prescription drugs to the public. 31183 08/21/06 IL Agree Agree "We need to make sure that a federal program doesn't become such a convoluted plan that it is basically unworkable. The Medicare Part D was a fiasco that has not nearly been resolved. Way more costly than needed to be and ""too many cooks spoiling the broth"" syndrome. Need good leadership to carry this healthcare plan forward." Agree Same caution on leadership as question above. Agree This is a priority as baby boomers begin to age. There will be more families delaing with this issue. Agree Agree "If it could be worked out that everyone could be covered by healthcare, I would not have a problem with more taxation, but let's find out how much up front. I get tired of politicians who make all of their decisions based on the idea that no one ever is willing ato pay more taxes. Thinking people realize, you get what you pay for!" "* Our system is the neither a socialized nor a free market system and seems to encompass the the worst parts of both. It is expensive, but doesn't cover all. It has the most technilogical advances, but unless one can pay or go bankrupt, it is not accessible. We have a need for a streamlined, easily accessed system, one that doesn't generate a ton of paperwork that must have thousands of people to administer. Even the government employees system would be a better alternative. The layer upon layer that we have built up with Medicare is an albatross around the collective neck of this country. Let's learn from other countries and determine what is working and tailor a system for this country." 31184 08/21/06 MD Agree Agree i agree but It's most important to have local involvement and the people being served having their input. Agree Agree No response Agree 31186 08/21/06 OR No response "I notice that no where are the bad words ""universal coverage,"" although this is discussed. the plan to have high-risk insurnace with a $400).00 or more deductable is great if you have $4000.00 + lying around when you are out of work and sick. taking the stress of the individual at the point of service is a big goal for me in this: on out of pocket exp. when the service is required would be best. " No response No response No response No response "There is NO mention anywhere of complementary medicine being included, it would be easy to add in the bullet that lists the different kind of health care." No response 31188 08/21/06 IL Agree "core coverage should provide basic catastrophic (not all bells and whistles)to all US citizens. Coverage should be through existing insurance chanels, portable and tax supported for low income citizens." Disagree Agree Disagree Agree "Everyone should be enrolled.If you have health benefits through your job, you get a waiver and your employer gets tax benefits. If you have a job but don't take your employers plan, deductions are taken out of your pay (like for Medicare, but higher). If you don't have a job, you are automatically enrolled and pay on a sliding fee schedule." Disagree "state by state contracts should be bid on by exisiting private insurers. Do not tax employers any further! Additional tax should come from guns, alcohol and tobacco." "Core benefits must be more basic, preventive and catastrophic initially in order to be affordable. Where is the individial behavior accountability?? Must tie coverage to patient compliance with proven wellness initiatives or chronic disease management. Bring back mandatory Phys. Ed in schools too." "Don't throw out the exisiting system of employer based health coverage. It covers 60% of the population and as a function of compensation, IT WORKS. Focus on WHO is really uninsured and why. Also, chronic diseases. Get rid of the GUNS and TOBACCO!!!!!" 31189 08/21/06 CA Agree I agree all Americans should be covered under a national program. The cost of this program should be covered by our taxes like national security. In other words there should be no out-of-pocket costs to access this program. Disagree A national program providing coverage for all Americans eliminates the need for these costly programs. Agree "I agree with most of this. However, a national system would replace all these programs with one program. Best practices can be identified and incorporated into one program. Controls can be put in place to ensure quality and efficiency. Eliminating the middle layers in plan adminiatration generates cost savings and reduces waste/fraud." Agree Such programs should be financed as part of a national program from our taxes. Agree All Americans should have access to health care services financed as part of our national budget. Agree Health care can be financed by a combination of employer/employee paid payroll tax. A percentage of gross with the largest share paid by the employer. Shifiting administration and financing to a national program eliminates employer administration costs and reduces overall costs because of economy of scale. Core health services should include all necessary services. The only exclusions might be elective or cosmetic not related to a medical necessity. "Our current multi-layered system allows for waste, fraud, errors, duplication, and excess profit. The health of Americans need to be on par with National Security." 31193 08/21/06 CO Agree "* Thank you for your important work! I believe that the simplest and best way to cover all Americans is to expand our Medicare program. Canadians have a universal, single payer plan that is paid for through taxes. The highest income earners in Canada pay only $900/year per person. I think we should start by including our youngest citizens, because as a group they do not require a lot of money. Over the years include other age groups. Administrative costs (dealing with so many insurance companies) of our present system would be saved and transferred over to our better system. And the mega-bucks the federal government already pays for health care would be transferred into the single payer plan. We wouldn't be paying any more to cover all." Disagree "I don't like the ""safety net"" approach because it implies that people are going to fall. All citizens should be covered from cradle to grave, ASSURED of education/screening/preventative care and necessary treatment. This recommendation is a band-aid approach. It doesn't give much dignity to people, either. " Disagree "Information on prices, cost-sharing... Of course, a single payer system would need to consider and discuss costs to the system with patients, but I believe that the Group's recommendation is that the patient will have to deal with an insurance company whose main reason for existence is to make a profit. Doctors must deal with hundreds of health care insurers. This is not efficient; it's a huge waste of time and money." Agree "Throughout your recommendations I think you're running into financial blocks that could be avoided if single payer was being advocated. It occurs to me that when everyone is covered for educational and preventative care we would be seeing fewer ""younger"" patients at end of life. (""Community level"")funding would be there if we had a universal, single payer/private provider program. " Agree Financial assistance will be available to those who need it.: Where's the preserving of one's dignity? Canadian system does not emphasize the have/have not divide. Everyone is covered. Agree "During the move to universal coverage...I like the way this is going! I recommend widening the Medicare pool, starting with prenatal, babies and children and filling in more age groups over some years. Removing our health care system from the for-profit insurance companies can be done!! Rampant fraud especially by for-profit nursing homes needs serious watch-dogs." "Everybody in, nobody out; From cradle to grave...YES!!" "I have gotten very interested in our health care ""system"" and marvel at how bad it has been allowed to get. I read everything that comes my way (lots) and feel very educated about this issue. I've decided that the most efficient, humane health plan is single payer pooling of our tax dollars to cover everyone. The profit must be taken out of health care. Thank you for this opportunity to comment." 31194 08/21/06 MA Agree Agree Disagree "* This is almost right but not quite. Rather than comment at length I urgently direct your attention to a new book by Michael E. Porter and Elizabth Olmsted Teisberg, Redefining Health Care. On page 342 they layout recommendations for improving the structure of health care delivery as follows: 1. Enable universal results information so the public can identify the best care for themselves; 2. Improve pricing practices by encouraging episode and care-cycle pricing; 3. open up competition at the ""right level,"" that is competition based on results (the real definition of quality); 4. enable technology and information sharing; 5. reform the malpractice system; 6. reform Medicare by making it a health plan not a regulator or payer; 7. align Medicare and Medicaid into one program; 8. invest in medical and clinical research. I am an insurance broker with 35 years experience in health insurance for individuals and businesses. I am sure this book is THE tranformative document for the health care industry. I urgen" Agree Agree Agree 31197 08/21/06 TX Agree "For many, the cost of health care is the major factor in making decisions about worklife, retirement, and general lifestyle. Choices are limited because of concerns over the cost of and availability of health care. Responsible citizens, at any income level, should be free of these concerns when making their choices." Agree "I agree, but this seems like an interim ""fix."" A new system may take a a completely new approach to all of this." Agree "Efficiency across the board is vital. Doctors must not be hampered and straddled with administrative chores. Access to information (in this information age) can be instantaneous. A viable health care system must enable and provide the incentive for all its elements and players (providers, financial, researchers, private companies, etc.) to work towards a common goal rather than at odds or against each other. " Agree This is excellent because it reflects the realities of longer lives and the increased need for these kinds of services. It is a relatively new field of medicine requiring new types of skills. Agree I strongly agree. This recommendation should be the cornerstone of any policy initiative. There must be universal coverage. Agree "If people believe the system is fair, they will support it. There should be no ""give-aways"" or pandering to special interests. Politicians must have the courage to ask for shared sacrifice from the American people for a resulting shared benefit. " "This is well stated, but, of course, the devil is in the details. Researchers, doctors, and patients must be major players in this group. Care must be taken to ensure that no specific political agenda is predominant." "* In this global society, there are many health care models to observe. We must not be so arrogant as to assert that ours is the best because it is ours! Experts in all related areas - scientists, providers, patients, economists - need to examine the models, identify the good and bad aspects of them, and formulate policy. Disparate groups and organizations representing all sides (and interests) must come together for the common good. Gradually the extreme positions on all sides will be filtered out and something workable and fair will emerge. Start with the premise that in this 21st century, access to health care is a right. " 31198 08/21/06 IL Agree Agree Agree Agree Agree Agree "My only concern is that financing be equitable so that those who can afford to contribute more do so, while those on a limited income do not have to pay the same money, but are asked to contribute a reasonable amount that still leaves them enough money for necessities." "No, but thanks to everyone for the work involved in moving us forward on this top priority." 31199 08/21/06 TX Disagree unless all take part in cost i know people that buy coverage while others say i dont neet to worry the ggovernment will take care of me but those same pople buy a new car every three years they take nice vaciations have 4 or five guns cover themselves at work but dont cover family members because thay have to pay 50%of the cost Disagree show me something the fed have done of this scale that is fair the post office changed my mail after 30yr and i cant correct it cantcall post office must go there stand in line to find they cant help you have to make three trips around lot to find parking service !!!!!!!!! Agree need to do it i will belive it when i see it VA drug benefits in conroe texas any VA care Agree Agree we all need to pay something should be = to what we have Agree good luck geeting fed to be fair look at taxes that come to the ststes good luck 31201 08/21/06 UT Agree Agree Agree Agree Agree Agree "* The idea of measuring the performance of providers is the most logical concept I have heard in a long time. In the market place, the business that delivers the best service draws more customers. As a Chiropractic physician, I can compete in many areas of health care with superior results than my medical counterparts. It is one thing to pay for crisis care intervention yet another to reduce cost by paying well for preventative wellness care. Chiropractic excels in this area. Statistics show for every dollar spent on Chiropractic wellness four dollars is saved in medical crisis care. This would be a highly effective cost containing strategy." 31203 08/21/06 CO Agree "* I favor universal coverage, single payer, which by its very nature should protect all Americans against very high health care costs. If anyone wants more protection or care than will be provided by the universal plan, he should be able to buy catastrophic insurance from the federal government. The role of insurance companies making profits from selling health policies must end. Insurance will have no function in a universal coverage, single payer plan. All Americans deserve the same health care. This is the fundamental principle that MUST be accepted in order to design a new system." Agree "This is nothing more than administrators figuring out how to deliver the universal health care most effectively. once providers stop competing for patients and focus on delivering care, they will find many new ways to do it more efficiently. It should include more than just ""safety net"" care. Community health networks will be cheaper than the current system of large hospitals and doctors offices and clinics locaated at a distance from most patients." Agree "Improved quality and efficiency must be demanded, and those who provide care should be sanctioned for substandard care. Any fraud or cheating should be cause for license revocation, as should malpractice." Agree "The sooner we all accept the concept of palliative care the better. The vaat majority of Americans want it, and no interference in its delivery should be allowed. If someone doesn't want it for religious reasons, the universal health care system should no longer be paid by the single payer, but by the peerson who denies use of hospice or other palliative care." Agree "This is the most important recommendation, and it should be placed first in all respects, including in your written and graphic materials. It should be considered a right of citizenship. " Disagree "* This is the second most important recommendation, and almost goes without saying, but there WILL NOT be a smooth transition, so don't waste a lot of time and delay implementing aa universal coverage trying to design one. Most Americans are willing to pay higher taxes to have universal health care. When it is in place, employer sponsored plans will disappear. So will government sponsored plans for their employees. You need to design a single payer plan for a core health care benefit package, and the payer needs to be the federal government. Businesses will save huge amounts of money, so they should pay some of that to the federal government as taxes to support the new universal system. Individuals will do the same. DO NOT BE AFRAID TO USE TAXES AS THE FUNDING SOURCE." "What do you do about health care that is needed by the patient but is outside the ""core?"" " All of this is taking much too long. 31204 08/21/06 CA Agree We cannot succeed as a nation if our people are unhealthy. We are one of ther very few countries that lack health care for all. Agree Agree "Please include midwives in the system. We are highly trained and reduce health care costs. In some for-profit hospitals the midwifery services have been eliminated, as they don't generate as much revenue! We are experts in normal birth.Restrict physician involvement to the high-risk groups." Agree Agree I care for a number of families that are left out of the health care system and cannot afford adequate coverage and so go without preventative or even basic care. Agree Much can be save with a comprehensive system that guarantees basic coverage in a not for profit system. Our office spends too much time in insurance billing and rebilling and appeals that could be spent on patient care. Yes! Much of what is done in obstetrics today is not evidence based. Midwifery care for low risk women is the evidence based system of care! 31208 08/22/06 CA Agree Agree Agree Agree Agree Agree 31215 08/22/06 TX Agree Agree Agree Nurses need to be paid more and given more respect for this to work Agree Please no repeat of Teri Shiavo Agree Agree It is good dental health is included 31217 08/22/06 MA Agree The need for such protections should be measured in proportion to a person's income and/or net worth. Agree These community networks must be the most cost efficient with above average quality so that they won't become a typical governmental bureaucracy. They should be run by a qusai-governmental or a private-public entity subject to congressional oversight. Disagree "Controlling cost across the entire hc system is one of the three pillards besides access and quality. Merely ""promote"" such effort is simply not sufficiently enough. We must take concrete initiatives directly at the cost control." Agree Again cost control is essential here as well....see more comments below. Disagree "While i agree with your premise that we all need a hc system where everyone can have a sufficiently comprehensive health care (rather than benefits, which is more approprite for insurance but we are talking about universal health care here), I do believe that addressing only the need without also addressing the cost issue will only make such system a national burden to all citizens, business communities and goverments, which will have dramatic impact on our economy." Agree "While seeking appropriate revenue sources is an important effort, the design of a efficient hc system must also direct resources/efforts toward managing public and private investments in technologies and researches in a most effective and comprehensive way." One-size-fit-all standard may not be most approprite for all diseases/medical conditions. Considerations should be given for variations in medical conditions and/or treatments. 31218 08/22/06 TX Agree "Absolutely! As a physician, I see these heart-breaking catastrophes every day. This is one of the first things the government of a civilized nation should do for its citizens." Agree Very wise recommendation. I agree strongly. Agree "Some care must be exercised to not adopt the 'lowest bidder' aspects of Tricare and its pitiful, expensive electronic medical record, CHCS/AHLTA. Tricare's mission is to improve access, but in fact it is often an obstruction to timely, appropriate care. The Canadians have done much of this correctly, except that they ration some surgical care - waiting lines are often too long." Agree "Emphasis must be placed on educating the families, too. Often they have unrealistic expectations which prolong suffering and waste spectacular amounts of money and effort." Agree "Absolutely. Our wealthy society can afford this, and should provide it in an exemplary way - for the rest of the world to imitate and modify for their own situation. Instead, we are the example of poor structure and how to leave a large percentage of our citizens out of the system." Agree "As a retired Colonel with over 30 years of service, I can tell you there is much waste and redundancy in DoD's large budget - that's the first place to look for funds to divert to this important initiative! Let's use taxpayer dollars that are already collected before collecting more." "Emphasis on the providers in this process - the folks that were left out in Mrs. Clinton's efforts 10 years ago. Lawyers and business people need a voice, but we are not building a ""business"" and they rarely have the patient perspective. The product is human being to human being communication, touch, empathy - not a widget." This is a wonderful effort. I pray that the one-issue Members of Congress will open their simple minds to see the wisdom of these recommendations! 31219 08/22/06 OH Agree "* I do not recommend, however, that the health care be run by the government. I have worked with a health care system run by the government that is very hard to navigate because of rules/regulations. Exactly what most people don't want. Sometimes it takes 6 months to get approval for surgery. There needs to be some other type of system besides government run. It's hard to believe that people who are on Medicaid state they don't have enough money for health costs when nurses who I know work in the Medicaid program state everything is paid for. I also don't want to pay for persons who continue to have children and can't afford them and have no jobs and no desire to get a job and work. " Disagree As stated above the government has to stay out of the system!!!!! Disagree * Keep the government out of it!!!!!! Plus get rid of high malpractice suits by attorneys. Go back to the basics of good nursing care. In the 70's we cared about our patients. Nurses worked extremely hard. The nurses now do not want to work hard. They want easy jobs that pay well. Nurses who have masters degrees and higher are placed into desicion making positions. They do not have enough experience with actual nursing practices. These areas are in desperate need of change. How can someone make a decision about nurses in the hospitals who can't even start an IV? Agree Agree "* Get rid of high malpractice suits and pharmeceutical companies. Our medical care is based on ""pill popping"" prescribed by physicians who either don't care or don't have the time to give other medical advice. I also don't want to assist patients who have life threatening diseases but won't take the advice or inititive to help themselves. Example: Many people continue to eat excessively and smoke after they have diseases that could possibly be assisted with a lifestyle change. How can we state that a person who has lung cancer and continues to smoke should get medical assistance? " Disagree No government run health care!!!!!! And please have nurses and medical personnel who have experience with actual medical care. The degree means nothing if you have no experience. * evidence based science and expert consensus is not always the same. How do you decide who is an expert? Someone who has done research based on monies given to them from a pharmaceutical company? Example: Evidence based science can change. Recommendations of chemo therapy for women with breast cancer has been the normal evidence based treatment. They are now looking into some women not really needing the chemo and the side effects have caused more problems and caused more deaths. Our whole health system needs to be changed. Not just everyone getting health care assistance. * As you can tell I am totally against a government run health care system. I think the goals are commendable but with the rising costs and the way our health providers now give health care I think it is unrealistic. Start with revising the system instead of starting with trying to get funding for every one. If you start with the basics people will be happier with the health care field. I can't remember any type of discussions in the 70's like this. We all cared about our patients and helped in any way we could. Now every decision is made based on money and how much can be made. The health care was not perfect but much better than it is today. I have been a nurse for the past 35 years. 31220 08/22/06 OH Agree "We have waited much too long to provide health care to all citizens. Along with this, we must prioritize how our dollars are spent. Primary health care needs much more emphasis than it has ever received in this country." Agree Agree Agree Agree Agree 31222 08/22/06 NH Agree "I recently experienced the brokenness and high costs (related issues) of the health care system during my mother's illness, hospitalization, and rehabilitation. It was difficult to have to deal with the system's broken parts while trying to offer support and love to her. I can't imagine how it is for someone to navigate this alone, since it was so difficult to do it as a healthy, supported person." Agree Agree Agree Agree No response single-payer system I don't agree or disagree - I think this has been done ad nauseum - 31223 08/22/06 NY Agree * The target date should be by 2008. If we took the high profits and bureaucracy out of health care we could do it. We need a single payer government run program. If we pass campaign finance reform we would take the influence from the large companys and make the decisions based on the best way to deliver quality affordable health care to the citizens of this country. It is rediculous that you must job hunt based on health care benefits provided. If you are lucky your family has benefits through an employer and your career stops there because of fear of not finding another job with those benfits. National health care is a matter of will on the part of our leadership. Agree If we had National health care we would not have vulnerable populations. With our current system we are all vulnerable. Many times until you are faced with a serious illness you are not aware of what costs you have and what your insurance covers if you even have it. In the interim I agree we have to work within the system we have but our energy should be directed toward health care for all. Agree "Expand Medicare to all and we will not have uninsured. Take the profit out of health care and we will be able to develop best practices, desease prevention, health education and promotion. The money will be there for these valuable programs." Agree Agree It must also be portable. We need National Health Care. Expand Medicare for all. Agree HR 676. The physicians for Natioal Health Care have done the math. Let's take advantage of their work and get going on the solution that is right in front of us. "* I am an RN and witness the cruelty of our Health Care system everyday. We need quality affordable health care now. We as a nation have the ability to end this chaotic inefficient health care system and replace it with a government run program. We are spending more than any other industrialized coutry and yet a recent study stated that health care is the #1 concern of working women. 46 million uninsured and many underinsured, employed and unemployed alike under our current fragmented system. We need change now. " 31225 08/22/06 CO Agree "I agree for the most part with the statements made - except I believe a solution including the private insurance companies would NEVER work; private health insurance is great, until a person actually needs it, then they seem to want to get rid of someone who has become a liability. Private insurance will always have the fundamental problem that ""nobody insures a burning house"" - in other words who would want to insure someone who is actually sick?" Agree Agree Agree Agree Every other industrialized nation has universal healthcare and they pay less per capita than we do - and have better health stats to boot. Agree "Eliminate the private insurers, they make their money by insuring a generally healthy population of working Americans - use the money they have been getting to actually provide healthcare." "* There is already a bill in Congress that would go to the heart of what is wrong with healthcare - HR676. It would provide Universal Health Care, change many of the for-profits to non-profits, and eliminate the HMOs unless they were providing a service. I've seen what the for-profit motive can do to an area of medicine. In the field of kidney dialysis 80% of the clinics are for-profit. During a ten-year period in which the for-profits bought up clinics government stats show the number of patients doubled while the costs tripled - and to add further insult the number of deaths increased percentage-wise!" 31229 08/22/06 CO Agree Disagree "* Although not mentioned in the summary above, the full recommendation proposes to ""relax"" the requirements to become an FQHC. I attended the Denver session and I do not recall that even being discussed as an option nor was there any public comment to that effect so I am puzzled as to where that recommendation came from. I am even more concerned at the lack of specificity on how these requirements would be relaxed. FQHC's are incredibly successful in delivery high quality, culturally sensitive health care to the uninsured of our nation and this success is, in part, because of the mandates and expectations placed upon us as community-based providers. Any relaxation of these rigouous standards would dilute the impact that FQHC's can provide. If others are interested in the financial benefits of cost-based reimbursement, I would recommend separate legislation (such as the legislation for Rural Health Clinics)and not attempt to dismantle a program which has shown itself to be highly successful." Agree Agree Agree Agree 31233 08/22/06 OH Agree Agree Agree Agree Agree Agree "People can have the American Dream once again, if there health care is not tied to their job." 31235 08/22/06 OH Agree Agree Agree Agree Agree Agree 31242 08/22/06 MI Disagree Disagree Agree Agree Agree Disagree 31247 08/22/06 OH Disagree * All people must contribute to their own welfare; there is no free lunch in life. Executive compensation for insurance company officials should be capped at two million dollars max/yr with no stock options available for the self-serving management. No discrimination should be permitted regarding providers by ins companies. Governmental oversight must be stringent to assure insurance companies pay doctors' fees in a timely fashion and strong financial penalties must be levied against offending companies and their individual corporate officers if patterns of payment-delay tactics are uncovered. Disagree The federal govt is incompetent to administer such a program effevtively. The fees it would pay doctors would make medicaid and medicare reimbursement levels appear robust. Personally I would rather volunteer my time to poor people(and I have done so) rather than deal with the morons in government health care who try to micromanage everything I do. Disagree Keep the government out of the healthcare world as much as possible other than to look for fraud committed by insurers. Agree Much money is spent during a patient's dying days/weeks. A algorithm which is reasonable and somewhat flexible for dealing with end-of-life medical issues would be helpful. Disagree Working people should not have to pay for the health services needed by the lazy. Poor people already have access to emergency care in hospitals per the law. Disagree I disagree with much of the above "350.000,000,000 dollars/yr are spent on healthcare administration(about $1100 per american) and this doesn't include any treatment. Managed care must be dismantled and insurance must be reinvented in such a way that there are severe penalties for meretricious policies of insurers against their providing doctors and especially against their insureds." 31249 08/22/06 PA Agree "I believe the Single-Payer Healthcare System is by far the best we can come up with. We have read the issue ""Health Care for All"" in ""Yes"" magazine and agree with it 100%! Why are we taking so long to do it? In the article they say ""The drug and health care industries spent $800 million in lobbying and campaign contributions in the last seven years--more than any other industry"" WOW1" Agree Agree Agree Agree Agree 31252 08/22/06 OH Agree "Do not be constrained by the current private payor system to support this recommendation. Basing any such guaranteed coverage system on voluntary participation by the insurer, or voluntary acceptance by the healthcare provider, effectively limits the access to such services through legal loopholes" Agree "* One of the key components of controlling healthcare costs is preventative care. Any progarm that can provide preventative helathcare services at reasonable cost and with efficient use of resources is a good investment, especially of public money. Consider basing some primary healthcare services at public schools, allowing greater exposure of the service to the community, and integrating preventative healthcare practices into the public school environment and curriculum. This would also allow greater use of the publicly funded physical plant facility of the school building." Agree "Health information systems need to be nonproprietary, and accessible to all providers across the healthcare continuum. Appropriate safeguards for privacy need to exist, but universal provider access will allow access to the entire health history when it is needed, and shoudl improve patient safety. " Agree I strongly agree. Too many resources are consumed providing futile care when patients and their families are not inofrmed about options for less costly (less profitable to the provider) care. Agree "I agree with universal access to essential healthcare. Again, do not base it on ""affordable"" in the context of our current funding system- it doesn't work, and can't be fixed using the same old private payor methods. " Agree "I strongly agree. The cost needs to be shared fairly by all, and all must participate. Work to eliminate employer-based coverage." "Focus on essential and preventative services. Recognize that many services provided today gained acceptance as standard care because they were profitable to provide. Also recognize that when significant profits are taken out of the picture, there may be a decrease in development of new technology. Do not provide coverage for ""lifestyle "" drugs such as erectile dysfunction meds. " "* I am an RN, and have been in the provider field for over 30 years. I spent most of the last ten years managing community hospital emergency rooms. The emergency care system is considered the safety net for healthcare today. It is neither efficient or effective in meeting the healthcare needs of the uninsured patient. ER care is costly, piecemeal, and overpriced, especially to the uninsured. What a hospital charges is based on what it hopes to recoup from insurers, usually discounted significantly. This means that private pay patients pay full price, while insured patients bills are paid at less than 50% of billed charges. The entire healthcare funding system is built on imaginary costs and figures. " 31253 08/22/06 NC Agree "I agree with most, but would include coverage of both Americans and non-Americans. By including non-Americans, the costs incurred to taxpayers would be reduced because this population would be assimilated under primary care management versus Emergency Room care - which is very costly and lacks follow-up. " Agree Agree Agree Close ethical scrutiny MUST be applied to end-of-life care so as to avoid any possibility for euthanasia. Agree Agree Contraceptives and abortion should NOT be covered. 31255 08/22/06 OH Agree "* · Government could put pressure on pharmaceutical and medical equipment companies to lower prices. · There should be consideration (safeguards) for catastrophic emergencies (for example, some families have been bankrupted and their homes have gone into foreclosure to pay for medical bills). Catastrophic coverage must be reconsidered – it could be offered using a means tested sliding scale, and government should guarantee the fund. · Medicare Part B premiums should be looked re: income levels. Are premiums too high, too low or just right for the population? " Agree "* · Should emphasize preventative health. · Continue to educate young and old for healthier well-being, offer incentives for wellness programs. · Offer complementary services to stay healthy as part of preventative care. · Need federal dollars to support faith-based facilities (allow exemptions for these facilities sponsoring community health centers). · To remove barriers to care, provide funding for transporting patients to and from appointments. · Encourage collaboration among health networks, schools and other social service agencies. · Replicate good models like Caritas Connection, a collaborative effort with Catholic Charities Health & Human Services, Inc. and the Sisters of Charity of St. Augustine Health System (and its sponsored health care facilities) in Ohio. The resulting continuum of health and human services - including transportation, housing, clothing, mental health counseling, health care services, food, legal services, and advocacy - is designed to be as accessible and cost-e" Agree "* · The system should be simplified, there is too much bureaucracy. Currently the system is so complicated that many cannot use it. (And is particularly hard for some to use, for example the homeless population.) · There needs to be a paradigm shift away from a disease model towards a health model. · Best practices should be shared throughout the United States. · We should study the most successful countries in the world and duplicate those efforts. · Medications and medical equipment should be made more affordable. · More money should be invested in home health care. " Agree "We agree with the recommendation. · The legal realities of palliative care need to be re-examined or special care given to these realities. · If a person has a terminal illness and they are approaching their last few weeks of life, some may argue that they should be allowed to pass on with dignity rather than continue futile efforts to prolong that person’s suffering. · A setting that offers dignity and comfort does not strain costs. " Agree "We support this recommendation. · The term high-quality should be replaced with “quality,” or more clarification should be included in the definition. · Need to define “All Americans,” we support coverage for all, regardless of citizenship. " Agree · Define Principles of Fairness further. · Sin tax should be removed from the choices of financing. o Other potential funding sources could be explored such as an income tax or consumption tax. · How would we reimburse those facilities that already provide charity care? More info is needed. · It should be one system for everyone (perhaps one payer). · Should have the ability to go “outside” the current system. " · There are concerns about how special interest groups may try to influence their respective category, how will you ensure the package is based upon health needs? · Re: the underserved: How do you reach those who do not want medical care but who need it? · We must consider not forcing providers to provide services that are not in keeping with their beliefs. " "Comments were generated during a staff development lunch at the Sisters of Charity of St. Augustine (CSA) Health System. The CSA Health System serves the communities of Canton and Cleveland, Ohio, and Columbia, South Carolina. We are the parent organization for five hospitals, three foundations, and several health and social service organizations and programs." 31256 08/22/06 IL Disagree "The bold recommendation and bulleted points are, to me, not necessarily the same. The implication of the recommendation (which I agree with) is that all Americans should be able to pay into some kind of high deductible, catastrophic plan. The first and third bulletted points are more general and too vague for me to blanketly agree with. " Agree I also support the idea of requiring specialists to rotate in said clinics. Agree I would recommend also publishing health outcome information of practitioners and hospitals. Agree Agree Agree Why can't we just pull out of Iraq? The billions that this war is costing could easily finance a new health care system. 31257 08/22/06 UT Disagree "* I am concerned about establishing a public program that would turn into public healthcare. Also, this recommendation does not include that consumers take responsibility for their own healthcare. Healthy people should not have to pay for those who smoke, drink, eat high fat diets, obese or have other high risk behaviors. Also, the middle class is the one being hurt right now, not the low income individuals. Low income individuals have access to free or sliding scale health care, medicaid, medicare or get their care ""donated"" by the hospital who takes a write off. The middle class, because they make too much money have to pay their bill and then they become impoverished. Also, you wouldn't go to a restaurant to eat and expect not to pay the bill because you are low income. Why do we expect that of health care. " Disagree "Again, why only low income? The middle class also has these issues. Where is the concept of prevention and responsibility for one's own health introduced? " Agree Disagree What about choice for the consumer? What if the consumer wants alternative medicine and not best practice? Disagree "I don't agree with public healthcare. I have seen government run healthcare and people wait for necessary treatment, often unable to work until the treatment is provided,therefore depleting their income and their ability to contribute to society. This would also bankrupt someone. " Disagree "We are missing personal responsibility here. I choose not to smoke and not to tan. I should not have to pay for treatment for someone who does. Alternately, I am obese and will proably die from my clogged arteries, but that is my responsibity and no one elses. I should not have to pay for someone elses poor choices. " What about visual health? "* I don't see anything that addresses timely care. In systems such as this, people what 6 months for a procedure that is necessary and in the meantime they can't work or contribute to society. Also, there is no emphasis on personal responsibility. I recently saw an article about a woman with diabetes and she was complianing because she couldn't pay her bills, but in all 4 pictures of her she was holding a cigarette. She can afford to smoke which is really bad for a diabetic and only causes complications thereby increasing her costs. Maybe she should quit smoking and use the money to pay her bills. I am very concerned that there is no personal responsibility here. I would feel better if there was more about preventative care, then just giving free healthcare to everyone and increasing out taxes." 31258 08/22/06 NJ Agree Agree Agree Agree Agree Agree 31259 08/22/06 OH Agree It is self evident that this country should have universal health care. Agree I would modify this to expand public . . . rather than public/private. Disagree The federal government should focus on expanding and accelerating its use of resources . . . but NOT while controlling costs. Agree The area in which this needs the greatest expansion and support is with Alzheimer's Disease in the final stages. Agree Health and education should be accessible for all persons in the U.S.A. Agree Financing should be totally public--not private. And there should be equal coverage for physical and mental health. "If H. Clinton is elected as the next president, these recommendations may have a chance." 31260 08/22/06 CO Agree Agree Agree Agree Agree Agree Why no specific recommendation(s)? Let's get on with things. 31263 08/22/06 CT Agree "I favor a single payer public system. A hodgepodge of private offerings only confuses users, wastes money on multi middleman agencies, and rewards private agencies for denying services." Agree Agree "Our current multi-payer system seems designed to confuse, confound, fatten the middleman, deny services." Agree Agree "I have read that an estimated 18,000 Americans die prematurely each year due to failure to seek medical care related to lack of insurance or cost. This is a national disgrace." Agree "At every contract renewal my employer increases my percentage cost for health insurance. Business cites the need to compete, at the expense of workers. We must act to stop this ""race to the bottom""." "I suspect the private insurance sector is the biggest obstacle to meaningful change. What do the people want? What are our national values with regard to health care? Do we care about people, or profit?" "I am a state social worker, I just found out my son's dental coverage was cancelled a few months ago, without my knowledge. This is how our current system tries to save money, at the expense of the workers." 31264 08/22/06 CA Agree Agree Agree Agree Agree Agree 31265 08/22/06 WA Agree Agree Agree Agree Agree Agree "I am against abortion; including ""plan-b"", and euthansia. I would not concider either ""health care""." 31266 08/22/06 MO Agree "* I think the out of pocket expense scale is to high. $4000.00 is too much as it is but to save money for my family today and go with the $30,000. seems impossible to me. My health insurance company makes these statements annualy can you imagine oweing this annualy? An auto accident could mean the loss of your home. I think we are oly going to fuel the lawsuit industry in an effort for the average American to avoid paying this when something horrible happens to them. Reduce the lawsuits, equals reduced cost, equals reduced individual burden." Agree "Each area, culture and population mix is unique, this makes good sense to tailor what is needed. I like the mix of both public and private appraoches to define what is needed and how to assist in getting the job done. " Agree "This area is tougher to fix. There is a lot of waste, I do not know about fraud but it is wrong as a society to have the technology and supplies that can heal a wound but only a few can afford the supplies and the specialized skills to use them. The patient is the one who suffers. Disease prevention needs to cross over from just high taxes on alcohol and cigarettes and target fast food that spurs obesity, diabetes and all the co-morbidity they enhance. Lets make healthy food cheaper and tax all the junk. " Disagree "* I think this area works well like it is. Hospice is medicare funded, if doctors would start utilizing this process sooner, the patients would be more comfortable and the care they get generally is far better than the dug out often futile care they get in inappropriate acute care settings. When we stop playing God and running every test, trying every avenue to buy only time and treatments, what is the eventual outcome going to be. No different, just later. Education by non-biased providers would give the patient a clearer picture and they would more often opt for this. I have heard many partial truths told, it sickens me to hear a physician tell the benefits of XXXXX and not tell the true side effects. Be clear, give them the choice....." Agree "This is the main problem, how do you fund it. Cap the costs, stop the lawsuits that make all the cover your butt tests, times and documentation unnecessary. Lets improve the care giving skills and decision makers and there wouldn't need to be so many lawsuits. Educate doctors and nurses for free, and test them yearly, it should be an honor to be a doctor or a nurse." Agree "Set a date in the future plan for it, and do it. Change is always a struggle for some. Come up with a plan and carry it out. " "* I look at the mental health issue and wonder which way is cheaper and which works best. I see so many poorly managed patients that can not fuction outside an institution for very long. They decompensate and come to the ER, have acute medical illnesses second to this, they are difficult to reregulate and they are transfered right back out to mental health centers where they are short saty, ""regulated"" and returned to less than adequate supervision where they decompensate and the cycle begins again. In the long run are they happier, is it cheaper or are we just suffling the cost between mental health and acute care system. Neither one is designed to treat the patient where they land. " 31267 08/22/06 MS Agree Agree Agree Agree Agree Agree "* I will sign up if Chiropractic is included. Me and my family use natural health care and I will not be signing up for any plan that does not include natural health care choices. Including Natural Health care is a win win situation for this program. You will achieve more people signing up for this program because the demand for natural health is rapidly growing. and also, those that use natural health care have lower health care costs in general. Medications, unnecessary surgeries, they all raise health care costs, and that is what the system is now. And we agree above that we need a change! Prevention is the key. A whole system and action change. " 31269 08/23/06 CA Agree "There was a time when healthcare costs did not impact my living expenses, but, it has become increasingly worse and I feel myself drowning in credit card debt due to just my medical expenses." Disagree "I don't agree with the second bullet as past experience has said to us that going public equales prices for services going up or exclusivity. Besides, there is no money for the Federal Government to establish an agency specifically for healthcare, we've seen that the govenment only takes money away from public services not puts money into it. Our funds are being spent overseas anyway. I agree with the other bullets." Disagree "It all sounds good but I just can't see how our govenment is going to be able to monitor these things without digging deeper into our pockets, there are no specific methods listed as to ""how"" these suggegtions will be developed." Agree "Yes, I agree, but where is the money going to come from?" Agree "Yes, there was a time when health care didn't dig a hole in your pocket can't we get back to those days? It seems as though ever since health care went public the costs have increased way beyond a reasonable cost." Agree Let's find out how other countries like Canada are providing country-wide health and bring that to the table to see if it will suit us as well. "I agree but also in the bullet of ""Health is defined to include physical, mental and dental"" you should include vision as well." "In trying to get healthcare costs down included in this research you should also include pharmaceutical costs which can be just as expensive if not more. My perscription drugs cost over $100. why so much? These costs should be monitored, it highway robbery for me to chose to buy my medication or food. Most of the time, generic is not offered especially if it is a new medication, that's not right!" 31270 08/23/06 WA Agree "I do not think that a national program should be private. This is the root of the problem of cost and lack of quality. If we had a national health care program more like the VA system or Medicare, costs would be reduced, quality would be improved, and everyone would have access to good quality care." Agree "I agree with the development of community networks, but this should be an obvious inclusion into a coordinated, national health care system." Agree "Quality and eficiency would be improved under a coordinated national health care system. The VA system is a model for efficient care that exceeds other models in terms of indidces for quality, while costing far less. It is difficult to control quality in a haphazard, profit-motivated conglomeration of private networks, as the preponderance of studies have clearly demonstrated." Agree "End of life care is neglected in the current fragmented system, it would be improved with a true national health care system." Agree "This goes without saying, and really is consequence of meeting recommendation 1, if it is done correctly." Agree "* Any cost savings obtained through reforms in technology and QI measures, are minimal compared to what would be achieved through the creation of a true national health care plan. Removing the administrative excess that is the hallmark of our country's current fragmented and privitized system would enable univeral access to quality care without increasing overall costs. It seems that the clear majority of respondants to your survey and community meetings support this solution, as do most people responding to other surveys, so I am perplexed as to why this opinion is not displayed more prominently in your recommendations to Congress." "I only partially agree with this statement. The group that decides benefits should not be ""public-private"", but simply representative of all people, and therefore ""public"" only. Private interests have no place in defining the set healh care coverage that should be afforded to all people. Private interests are of absolutely no concern when deciding this matter." "* I generally agree with the recommendations you have put forth, and I applaud your efforts. However, I think that you are misrepresenting the majority opinion of the American public, and skewing your recommendations towards existing political sentiments and the financial interests of those private entities that have great influence in Congress and the White House, particularly the health insurance industry. Stay true to the public opinion and I think that these recommendations will be a strong pronouncement of the need for fundamental change in our health care system." 31281 08/23/06 CA Agree Agree Agree Agree Agree Agree 31288 08/23/06 CA Agree Agree Agree Agree Agree Strongly agree with this recommendation. Agree 31290 08/23/06 NC Agree Agree Agree Agree Agree Agree "Eyecare/vision should be added to the statement, ""Health is defined to include physical, mental and dental health."" The statement then would read, ""Health is defined to include physical, mental, dental, and eyecare/vision health.""" 31292 08/23/06 MA Agree "This should be a public, NOT private, program." Agree Agree Agree "I completely agree, there needs to be easy access to and ample support for planning for end of life care." Agree Agree "Dental care is especially important (see Gladwell, New Yorker, Sept. 05, ""The Moral Hazard Myth"")" 31293 08/23/06 WI Agree No one should be financially injured due to health caare costs. Agree No response This recommendation provides help and protecction for the individual. Agree Agree All Americans should have access to care that is affordable and which does not impose financial worries on the ill or their care giving family members. Agree Let us hope that time does not become a deterrent. The breadth of this recommendation is comforting. 31294 08/23/06 WI Agree " I believe if we can afford billions of dollars for wars ... we should have long ago been able to provide health care for our most at risk citizens ... the low income, infants and the elderly." Agree There must be a place for the uninsured to go for adequate health care. Comunity health networks are vitally needed. Agree " Providing health care for all citizens is the most humane action our government can offer. Costs of health care are the primary problem for all citizens ... the retired, the elderly cannot survive at ordinary circumstances and keep incurring more and more staggering health costs and drug cost ... these costs cannot continue to spiral ... and their MUST be a reduction of fraud and waste that drains our health system. " Agree These choices should be made by individuals and their families ... not by government. Agree I am 70 years old and cannot retire because of health care costs and prescription costs for my husband... I must continue to work to maintain insurance at my place of employment. Without my employment and insurance we WOULD be endangering our financial security. I cannot afford NOT to work. At my age this should not be a dilemma. Agree "It seems we are always able to finance wars, strange requests by senators and congressmen for their home states ... we squander money on government experiments and lose money on failed projects. We are able to send millions to foreign countries ... wouldn't it be wiser to take care of our own impoverished, children and elderly. In that manner we strengthen our country and are better able to stand strong to help others." 31295 08/23/06 CA Agree We need a universal coverage plan! Agree Coverage for all supporting local systems is what is needed. Agree Lets use the best of the digital generation! Agree The more the patient knows the better. Agree Health care for all is what must be provided. Agree All you can should pay a fair amount. Glad to see that dental care is included. Be sure to include good foot care! 31296 08/23/06 CA Agree It is ridiculous that people do not go to the Dr. especially if they feel there is really something wrong beause of the fear of the cost. Agree Living in a densely populated area I never thought about it. Agree Agree It all sounds great in theory but it is Agree No response "I think it should be based on pre tax dollar contributions. We do not need any additional income taxes, better yet we should use the monies we give away in earned income. Or tax companies that outsource their business to other countries in order to dodge paying employee benefits and taxes and leave Americans here with out benefits and jobs. Example the LA TIMES. First American Title Co. " 31300 08/23/06 NE Agree "* While it is worthwhile to eliminate the uniquely American phenomenon of medical bankruptcy, this is only part of the affordability problem in health care. The goal needs to be to remove financial barriers to health care. Shared responsibility for financing care cannot mean high patient cost-sharing. Making premiums affordable by requiring high deductibles or high co-pays at point-of-service would create shallow insurance that Americans could not afford to use. The recommendation for a national program is also hampered by the statement that it should be public OR private. It might combine both public AND private elements. Medicare has won widespread support by combining private delivery of care with public coverage." No response "Coordination has to be between ambulatory care and in-hospital care, between primary care and specialty care. The problems faced by providers in the current safety net stem from both UNDER FUNDING and obstacles to obtaining hospital and specialist care. A true integration would mean the gradual disappearance of a separate sector called ""the safety net.""" No response "The 5 specific areas in which the promotion of better quality and greater efficiency are proposed are all reasonable and important. As stand-alone goals, their utility is limited. To the extent that health care remains fragmented and sicontinuous, they cannot achieve their potential. The promotion efforts in these areas need to be designed to accelerate the integration and coordination of care, to promote continuity of care, and to allow for choice." Agree "These are laudable goals. While the provision of palliative care is a specially challenging phase in families' lives, the principles and concepts from this sector of health care need to be applied to everyone with chronic diseases." Agree "* This goal must be achieved no later than 2012. Unfortunately WG switches from the values language of ""shared social responsibility"" to the concept of ""financial assistnace"" to individuals in this recommendation. ""Shared social responsibility"" is another way of saying ""we're all in this together."" ""Financial assistance"" conjures up programs in which the assistance can be cut when budgets are tight. Survey resonses clearly wanted broad, inclusive, comprehensive benefits, and reject exclusion of types of care as a main tool to limit cost." No response "* The approach to containing costs should utilize societal tools such as: --slashing administrative costs by eliminating the complexity of thousands of different insurors and plans, --capping the share of health insurance premiums that can be used for administration, marketing and profit, --federal government negotiations to cut drug prices for Medicare and all Americans, which over 70% of online survey pariticpants support. Coupling cost controls with coverage expansion would make broad and deep coverage affordable now. *Fairness means financing care in ways based on one's ability to pay, not on one's health status. *70% of survey participants disagree with requiring people who use more health services to pay higher premiums." "* Clearly some types of services are not medically necessary and should not have their costs shared. But, the delivery of non-core benefits is not what makes American health care so unaffordable. The cost problem in American health care results from the 3 main sources: --prices for care in the US are too high --administratie costs of highly fragmented private insurance --to many core services are performed in clinical situations where they are of little to no benefit. Shared social responsibility for covering the cost of health care also entails social responsibility for containing costs, including prices. Cutting prices cannot be left to indivual pateients' comparision shopping." "* The recommendations do not: --Include a specific target date for making health care available to everyone. --Acknowledge the wide-spread support for national health insurance that was voiced among the 20,000+ participants in the initial phase of public comment. --Address the steps necessary to implement public policy that would guarantee health care for all. Ideally the recommendations of the Working Group should provide a roadmap, a set of paths by which the United States could get from here to there, from a disorganized, haphazard, frustrating, expensive set of health care arrangements to an integrated, high-quality, affordable, user-friendly system. While the Interim Recommendations raise important issues, they don’t shine much light on the actual paths America needs to develop to ensure that “health care works for all Americans.” The paths to affordable, quality health care for all will ultimately require substantive legislation to be enacted at the federal and state levels. A valuabl" 31301 08/23/06 CO Agree Agree Agree Agree Agree Agree "We need more doctors and nurses. Many qualified students are turned away from these fields because of inadequaate school capacity. Switzerland, which spends about one half as much per capata for all of its citizens health care, has almost twice as many doctors per capata as does the USA. It is outragious that we refuse to finance the needed medical schools to train our own sons and daughters in these health fields" 31302 08/23/06 WA Disagree "It cannot, should not, will not be a private program. For-profit insurance does not work: it's very basis flies against the needs of Americans for healthcare. That's why every other major industrialized nation in the world except the US and South Africa have a national health system." Disagree "Patchwork, piecemeal. You can't even read the recommendation without gasping for air. It is a bandaid that won't stick." Agree Agree "The main problem will be having any government involvement in this restructure, if the actual care/structure is driven by the latest administration's fiscal or political motivations. For example, the Bush administration's actions surrounding end-of-life issues (ie Terry Schivo)were terrifying and obscene for a large majority of caregivers and people facing end-of-life decisions. " Agree "...which means a national health system, not a patchwork of for-profit companies. (The Medicare Part D plan comes to mind as an example of failed policy.)" Agree "The ""expert consensus regarding medical effectiveness"" MUST include the expert consumers, not just the medically-trained professionals. Too often what the ""experts"" say doesn't reflect on-the-ground reality about either quality or effectiveness." 31303 08/23/06 CO Agree People with long term or chronic health care needs NEED to be protected from high health care costs. The population I am referring to specifically are those persons with disabilities or special health care needs. No response No response No response No response No response 31304 08/23/06 CA Agree "All people have value, no matter their income status. Any injury or illness that is life threatening or disabling should be treated." Agree "Good ideas. To implement the ideas it will take many, many trained people to find out the peples' needs. " Agree "Several members of my family have gone to the hospital for various reasons, and when they get a copy of the bill, they are outraged at the charges, which they reported to their insurance companies for their information." Agree "Dying is hard enough, but if hospice, etc. is sensitive, they can be made comfortable until they die." Agree "My husband would love to retire, but he can't find an affordable health insurance system that will cover us individually. " Agree "All people who make a certain amount of money pay income taxes. A certain percentage of one's income could be ta xed to pay for the health care, varied as the more money you make." "Physical, mental and dental health cover our beings. Many times health insurance doesn't cover mental health, and that is a big medical problem, whether caused by an imbalnce of chemistry in the body or a stress in life. Many people are walking around mentally unstable because of the cost or stigma of getting help." 31307 08/23/06 OH Agree "All of the recommendations are important; but this one is most basic and should be a priority. Without good health care available to all citizens, none of the others are meaningful." No response No response No response No response No response 31308 08/23/06 CA Agree It just makes common sense. There's no reason for people to be impoverished from high medical bills that line healthcare businesses' pockets. Agree It makes sense for units to be coordinating and bring down costs thereby. Agree Again - efficiency Agree This would make it easier on the patient and the family. Agree "If America is a caring country, this needs to be the policy." Agree "In the end, it's worth whatever it takes." Why not include all areas? 31310 08/23/06 MO Agree Disagree "This sounds like a ton of bureaucracy for not a lot of result. The concept is good, but it needs more ""meat."" We need a more comprehensive change in the very broken system for the poor and those without any coverage." Disagree "Again, the concept is good, but we need much more sweeping reform than just ""tweaking"" the current system." Agree Agree Universal coverage is the best way to go! Agree Take all the money currently going from businesses into their own private plans and make the system work right. Mental health must be included as an essential part of physical health. 31311 08/23/06 NY Agree "No one, and I mean NO ONE, should be denied protection against the outrageous high costs of many medical procedures. The ability to pay should be based on a realistic formula that uses true cost of living formulas rather than those watered-down statistics conceived by uninformed individuals who do not understand the needs of the poor and non-rich. " Agree "I agrre in general with this; however, the ""unit"" intrusted with this undertaking MUST not be govenrment controlled group. This is not a Senate/Congress debate item. Those selected should be from the community at large, individuals who deal with the public, and are the public, who are not directed by party politics. Once need is determined, the government has to unanimously support those recommnedations." Agree "Medicare and Medicaid have been almost destroyed by the current administration. Both programs need to completely overhauled with NO POLITICAL interference. In fact, all of the programs proposed une this recommendation would be better run by public agencies that are not under the jurisdiction of the government. The worst business skills and practices are employed by government because it caters to the rich, powerful, and influencial, instead of to the people for whom it is meant to govern. " Agree "The patient and/or family must have the last say in how far care goes, no matter what the medical profession or the political arena believes. The choice of receiving treatment or allowing nature to take its course is strictly an individual's private right, and no one, and especially the govenrment, does not have one iota of power in telling an individual or his/her family how that individual is to be treated." Agree "This means AMERICANS. I do not advocate the foreigners visiting here and happen to fall ill, etc., should not receive care. But I do insist that illegals should receive only the care needed to stablize them so they can be returned to their own country for further care and treatment." Agree "Instead of local ""pork-barrel"" politics, the government needst to look at health care as the most important item in the national budget. Personally, I feel that anyone with a family of four who earns over $200,000 a year should be paying 80% of every dollar earned above that toward the national budget. That includes govenment officials, whether elected or appointed." "Just keep ""politically"" minded individuals out of the loop. " 31312 08/23/06 UT Agree I would suggest that we have a federal program available for all U.S. citizens. Medicare extended to the populace should be the starting point. Private insurance companies have not proved their mettle in meeting the country's needs; they have an inherent conflict of interest and have proved very inefficient (cost-wise) compared to medicare. Agree "Neighborhood clinics are an obvious solution to keep people out of the hospitals, especially the ER units." Agree Careful oversight and strategies for over-billing of services should be implemented Agree Most people I have talked with would prefer to die at home or among their family and/or friends. Hospice care should be available for everyone. Agree "In addition to Medicare for everyone, carefully study the way other countries such as Sweden and Canada are and have been dealing with their healthcare. We need not re-invent the wheel, but perhaps we could make some improvement to programs that already exist." Agree To have universal coverage will need universal payment: taxes are the obvious solutionH 31316 08/23/06 PA Agree Agree Agree Agree Agree I strongly agree with this recommendation. Agree 31318 08/23/06 PA Agree The inexcusably high administrative waste in our private insurance costs (for profit)system do not improve health outcomes. EU nations manage health care for all with significantly better outcomes than does the US. Why do we pay more and receive inferior care? No response Agree Patients' medical records privacy is of essential importance. There should be a national law such as passed in New Hampshire to protect medical records from being SOLD! Agree Improved paliative care is imperative. New York State is the first in the nation to have substantively addressed education and training in paliative care. Why is this not a national priority? Agree "Americans fear impoverishment from medical costs more than a terrorist attack or natural disaster according to a recent poll by the Center for American Progress. Health Savings Accounts are a drop in the bucket, and so NOT meet the needs of underserved populations. " No response single payer is the most efficient means to control administrative costs. mental health must receive parity coverage; US care for the mentally ill is a disgrace. 31319 08/23/06 GA Agree we are a wealthy nation that has turned a blind eye to the millions crowding our emergency rooms who suffer acute illnesses because they cannot afford preventative care. Agree Agree Agree Agree Agree 31322 08/23/06 OR Agree "In the discussion section, CHCWG seems to support the high-deductible plans as a cost-conscious/cost control measure. You even gave as an exemple up to $30,000 deductible. How ""high"" is ""high out of pocket expenses""? I see this as only supporting the profits of insurance companies. The middle class is hurting from high health care costs as well, and high deductible plans are no real protection. " Agree "I strongly urge the CHCWG to add an open statement in support of SB 2772 (Health Partnership) to promote individual states to conduct their own health care reforms according to local needs. Community health networks are important for the ""vulnerable populations"", but do not answer the need of most families. They are but safety networks. We need a more comprehensive system for ALL Americans." Agree "Models of health care system where there is strong coordination at the national or regional level, such as ""single payer"" system -- are best at controlling costs while monitoring quality and efficiency. There should also be a statement emphazing transparency in health care policies, provider accountability to the public, and ""pay-for-performance"" practice to promote quality and efficiency" Agree Very good recommendations. Agree This should be the first recommendation of all. I do not understand why the CHCWG reshuffle the listing of its 6 recommendations when it re-issued them in July. The priority listing in the first recommendation set issued in June is much more logical. Agree "I support financing that involves EVERYONE. All businesses will have to pitch in, and all working individuals will contribute into a fund earmarked for health care, just like for Social Security." "Excellent recommendation. This ""core"" benefit should be comprehensive enough to allow most individuals and families to have affordable and accessible helath care without significant out-of-pocket expenses or buying another insurance ""gap"" plan. Alll insurance companies should be required to provide this set of ""standard core "" benefits, without cost shifting or risk selection." "I am encouraged by the CHCWG's vsion for universal and affordable health care for all Americans. I strongly believe that a system that expands ""Medicare for All"" is suitable for the US, and there should be more regulations of the private insurance companies (transparency, fair pricing, consumer protection...)" 31324 08/23/06 NY Agree Agree Agree Agree Agree Agree 31325 08/23/06 WI Disagree "I agree fully with the three bullet points and the initial rationale. However, the suggestion that a private program could solve this problem is laughable as the private providers have repeatedly proved their unwillingness or inability to cover everyone justly, adequately and affordably. A profit driven system cannot EVER provide true justice and equality. We really need a public system driven by the needs of the American people. " Disagree "* Again, this WOULD be an excellent reccomendation if it did not rely on the FOR PROFIT healthcare machine that is the PROBLEM in the first place. The underserved populations are underserved precisely because they do not provide the profit margins desired by the FOR PROFIT healthcare industry; the infrastructure does not exist because the industry could not justify the cost:profit ratio. Asking the private healthcare machine to help fix this problem is simply throwing good money after bad. Americans are already overmedicated, overburdened by insurance or healthcare costs or both BECAUSE we have a capitalist FOR PROFIT healthcare machine concerned only with its own bottom line. " Agree "This looks good on paper. The question is, ""Can you deliver?!?"" " Agree "Well, again, I agree with all of this except that I don't believe that private insurers have any incentive to ignore their bottom line and the demand for dividend gains from their stockholders and do what is best for the patient and their family." Agree "Internationally the evidence is in, this can be done and done well. But, it requires a public single payer universal healthcare system. It requires the kind of commitment that Cuba has. Their doctor training program is among the finest in the world, their infant mortality rate is FAR better than ours here in the wealthiest and most powerful nation the world has ever known. The facts clearly show that capitalist healthcare simply cannot provide healthcare justice for all Americans. " Disagree "I recommend a weighted income based system. Those living on less that 125% of the poverty line should have the lightest burden. Those that can afford it should pay a higher ""premium"" to subsidize those at the bottom of the scale. No shelters, no breaks, no dodges or loopholes for the very wealthy... everybody participates - PERIOD. " "Again, I agree with the substance and principle of this recommendation but I DO NOT believe that the FOR PROFIT healthcare industry is qualified, competent or even WILLING to make the necessary changes which would eliminate their giant sacred cash cow. " "Don't waste our time with partial fixes and FOR PROFIT schemes. IF you are going to do this, do it RIGHT. SINGLE PAYER UNIVERSAL healthcare. Study ALL of the nations that have PUBLIC healthcare systems instead of private FOR PROFIT systems like ours. Take the BEST from EACH and EVERY nation that has better healthcare numbers than we do regardless of their ideology or our current relationship with them!! DON'T SCREW THIS UP; WE ARE COUNTING ON YOU!! Thanks," 31326 08/23/06 IL Agree Coverage for all must be equitible. The same level of care for the very rich must be available for the very poor. Care must be driven by actual need not just the client's desire. Agree Integrated health care networks must be of high quality in all locations. Agree Duplication of services is a major issue. My father in law was terminal and two hospitals gave him exactly the same extremely expensive tests when results could have easily been shared from the first. Agree My aunt who recently died in Wisconsin had both home hospice care and hospital hospice care. She was a former hospice nurse and was comfortable and happy without extraordinary expense. Agree I agree except no one should be more equal than another. Care should be more than just minimally sufficient. Agree Financing should be broad in scope and envisioned by a bi-partisan citizens group. The Congress should directly develop a plan to implement their consensus without partisanship. An independent non-partisan private-public group is excellent. Health care must focus on prevention and especially the highest quality care for children. 31329 08/23/06 FL Agree "As the wealthiest nation;, at least in this hemisphere, we ought to be able to provide safe;, efficient healthcare for all of our citizen. It is morally disgraceful that we have not already done this." Agree "This sound good on paper. It feels more like ""pie in the sky"" without knowlege of how this will exactly work. I would support a concrete, practical and realistic proposal. Please no more crazy, complicated plans like the federal presciption drug plan, which may be helpful, but certainly benefits the Drug companies.Why can't the nation built on the spirit of capitalism not negotiate a better deal for everyone. This is certainly not government ""for the people"" it is government for the Drug companies." Agree "I agree. Let's build on what we have in place and make it all really, really beter for everyone." Agree "* I agree in principle, but as a healthcare worker I am aware of conflict often occuring between hospitals and hospices in the present structures. Hospices look upon palliative care programs in hospitals and sometimes push to get the patients transferred to their structures, their medical doctor and often the patient and the families are not ready for Hospice care. And the patient's doctor is not ready for this step. There are reimbursement issues for the attending doctor & doctor consultants and the hospice. Who get paid what when?" Agree "I could not agree more with this beautiful public policy statement. The devil is in the nuts and bolts of creating reality out of this concept of public policy. It is the right thing to do. It is ther just thing to do,!!!!!" Agree "This is the toughest part. Everyone involved in the patient's care wants their share. I agree whole heartedly with this statement of principle. Someone might be able to refine or improve on it, but this is the right direction. " Sounds great! Just don't leave health care descions up to insurance companies and lawyers. 31330 08/23/06 TN Agree Disagree "* I am opposed to the recommendation that would modify the FQHC concept to accommodate other providers. FQHCs are community-owned providers of health care, whereas the Working Group’s recommendation would take the community out of the picture, by removing or reducing the FQHC community board requirement. I strongly believe that the requirements of the FQHC funding are the cornerstone to the FQHC success. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition. I oppose dismantling one of the most successful federal health programs anywhere. " Agree Agree Agree Agree 31331 08/23/06 IL Agree "Good and affordable health care should be available to all Americans, and it must happen soon. This health care should include affordable medications also." Agree "There should be mandatory sessions on preventative medicine as well. If people are to participate in the benefits of a national health care policy, they should also have to take some responsibility to become as educated as possible about disease prevention." Agree There should be a lid placed on the profits health care providers can earn or special incentives to serve underserved populations. Agree As long as such end-of-life services are culturally sensitive they should be available to families to alleviate these stresses. Agree These kinds of services are already available to school age children in most urban areas. These services should be available to everyone. Agree "Please, let's start yesterday. It is already too late for hundreds of thousands of us. Let's not let our children suffer the way so many of us have." "The costs of caring for my mother at home for seven years has seriously hampered my children's college plans and my own plans for an imminent retirement. Fortunately, however, we were able to get by. We never did meet the ""spend downs"" required in our area, and did not take advantage of the in-home care options. Many other Americans, however, do not have these options. Please help them." 31332 08/23/06 NV Agree Agree Agree Agree Agree Agree 31333 08/23/06 FL Agree Healthcare truly is a RIGHT Disagree "This can foster tons of paper work, verification yada yada " Disagree Try Americare or Medicare for EVERYONE and forget the subdivions. Isn't confusion what got us here? Agree Old and young have heavy needs that should be met as best we can in providing information AND least expensive but appropriate care. Agree Present healthcare policies are disastrous in book-keeping and family destruction Agree Put it in everyday gas and sales taxes as all other countries do. We need a national health system Yesterday! Seventy-five per cent of all Americans agree. Where is the government that represents them? 31334 08/23/06 TN Agree Disagree I agree with most of your recommendations with the exception of eliminating or otherwise altering the community health center board requirement. Having community center users the majority representation on the organization board is paramount in ensuring the needs of the community are met. Not requiring this would likely lead to a for-profit or other organizational structure more interested in profits and personal income rather than actually caring for the community and underserved. Agree Agree Disagree "While I agree that everyone has a right to basic health care, I find it impossible to believe that there will ever be a concrete definition of ""basic health care"". Thus you will never be able to create and sustain a budget for this." Agree 31335 08/23/06 CO Agree Agree Agree Agree Agree "I do agree with the comment but, am very concerned about the funding behind it!" Agree "It's a huge issue and is crucial to the success of this project - however, I have no idea how to go about obtaining the financing." 31339 08/23/06 FL Agree Great ideas. Argument in should come from the perspective of the largest purchasers: corporate America. Their health care costs for employees have exploded and are reaching the the half way mark of corporate expenditures. This has resulted in more and more Americans becoming uninsured which is taxing the emergency departments and exacerbating disease management for chronically ill Americans. Agree Great ideas! No response "* Health care costs in the free market will respond when the public is empowered with information about quality and pricing. Florida has taken huge steps toward that end goal by providing websites geared to answer health care questions and provide information on choices. Florida's website MyFloridaRx.com provides citizens the chance to shop for retail prices for over 320 prescription drugs by county and/or city and then by pharmacy. Some instances have seen at 1200% difference for the same prescription in the same county. Florida also is the first state in the nation to publish infection rates by hospital and one of the first to publish mortality rates. For every hospital in Florida, average (risk adjusted) charges, length of stay, and total volume for 68 conditions and surgical procedures are published on FloridaCompareCare.gov. The next step will be a comparative health plan website due October 1, 2006, followed by a physicians data website, all using data already collected by the State. Leaders" Agree Can't be done soon enough. Agree I would echo that message! Agree "My comments were recommendations identical to the next action steps: stakeholder consensus building, through federal law, etc." These recommendations and survey are very well done. Thank you for your efforts on behalf of us all! 31340 08/23/06 AZ Agree Agree No response Agree Agree Agree Use available funds for a health care system instead of pouring millions into the invasion of other countries. 31342 08/23/06 MS Agree Agree Agree Agree Agree Agree "Please include preventative care, wellness and chiropractic services. Research shows these decrease total medical costs." 31347 08/23/06 IA Agree Health care should be available to everyone not just those who are employed or well to do. Employers should not be expected to carry the whole load. Small employers are unable to do the right thing because of the prohibitive cost. A system that treats people as equals and values each person is the moral answer. Agree "This must be adapted to local needs and resources. To apply the same guidelines to NYC and Ord, NB would be insane. Letting the Federal Government control the program under the umbrella of current programs would not be cost effective. We must reduce paper work and number of agencies, etc. to save the 40% that now goes to paperwork. " No response The programs must be streamlined and simplified or we will have a FEMA-type mess all over again. Agree "BUT, we must not rush people into end of life decisions prematurely." Agree We need health care for all but it should not become 2 or 3 tiers of care that punish the poor and pamper the wealthy. Agree "Keep it simple, base it on need, emphasize preventative care, and reward those who use but do not abuse. " Focus on in-home and local care as much as possible. We need to be realistic that individuals are also responsible for their own health and reward those who work with the system rather than just expect the system to work miracles. 31348 08/23/06 MS Agree Agree Agree Agree Agree Agree "I think chiropractic should play a major role in this overhaul, because it is more affordable and focuses on preventive and wellness care..." 31350 08/23/06 MS Agree Hardworking single parents can not afford most insurance companies. Yet they make too much money to qualify for gov. assistance. I have a son that i worry about and pray nothing happens to where we have to seek medical attention. Disagree Disagree Agree Agree Agree "If some ""minor"" areas are reconsidered and lowered than this might be a positive movement." I feel that everyone is entitled to the same treatment. One area that does not need to be excluded is Chiropractic. The natural healthcare would be able to benefit a person before the insuarnce co has to fork out alot more money on surgery and followup and future treatment. I feel that Chiropractic is very much needed to stay in the game. 31351 08/23/06 MS Agree Hardworking single parents can not afford most insurance companies. Yet they make too much money to qualify for gov. assistance. I have a son that i worry about and pray nothing happens to where we have to seek medical attention. Disagree Disagree Agree Agree Agree "If some ""minor"" areas are reconsidered and lowered than this might be a positive movement." I feel that everyone is entitled to the same treatment. One area that does not need to be excluded is Chiropractic. The natural healthcare would be able to benefit a person before the insuarnce co has to fork out alot more money on surgery and followup and future treatment. I feel that Chiropractic is very much needed to stay in the game. 31353 08/23/06 TN Agree Agree Agree "Putting evidence based healthcare into practice really works! Look at the 100,000 Lives Campaign from IHI - exceeded by 1/4 again as much. With the Fed. gvt behind a similar program - Wow! " Agree Sorely needed! Agree All documented Americans Agree Hear! Hear! 31355 08/23/06 VT Agree "I would also like a program that pays for ""high out-of-pocket medical costs for everyone, not just ""very high"" costs." Agree Agree Agree "Actions should be taken to initiate a ""Death with Dignity"" option based on the Oregon model that allows terminally ill patients to have more control over how they die." Agree Agree "I favor a government run single payer system to eliminate the 30%+ of administrative costs that currently is pocketed by HMO type middlemen who do not significantly improve health care, just increase the cost." 31358 08/23/06 TX Agree "* I would like to know the definition of ""very high"" out-of-pocket costs. I make a very good income, but my husband was unemployed and died of cancer in January. Because he had no health insurance, he could not afford specialty care. His only hospitalization, lasted 2 weeks and I am left with bills of approximately $150,000. I am, by the way, a health care provider in a federally qualified community health center and I work every day with people who are not getting the health care they need because they cannot afford it. " Agree "Please increase funding to community and rural health centers. Not only do new centers need to be developed in areas of need, but centers currently in existance need strengthening. Make sure that mental health needs are also addressed." Agree Please also make sure that those of us who work away from major academic medical centers have access to technology and emr's. Agree Agree Agree I believe that additional public funding will be necessary for the system to work properly and fairly. "Please include the use of ""mid-level"" practitioners in the choices of providers you offer (NPs, PAs, CNMs)." 31359 08/23/06 PA Agree currently one third of my salary goes to paying for health care for me. Agree national and local need to work together Agree Agree we also need to recognize that everyone eventually dies and 1 million dollars for a drug to extend life for 6 months is not a reasonable course of action. Agree Agree 31361 08/23/06 MA Agree Too many Americans are going without proper healthcare or going without basic ncessities because of health costs. I watched my elderly uncle struggle to pay his medical expenses. We always provided him a bag of groceries when we saw him. Agree "I agree with this although I do have some fear that it could become ""over managed"" too governmental to the point where the initial priorities get lost." Agree "We absolutely need more education and resources to provide preventative measures. Truly if each one of us had a healthy massage eac week, 3/4 of us probably would never get sick. But who can afford to take care of their stress in such a way?? Alternatives need to introduced and cost covered." Agree "Absolutely!! We brought my Mother home from the nursing facility 10 years ago, simply so she could pass on among loved ones in a familiar space. The help and hope we received from the hospice worker was invaluable." Agree "This is wgat we need. Smaller counties manage this, we should be able to figure this one out." Agree Obviuosly this will take money and time. We best get the best brains in finance and healthcare to work on it!! Certainly we can learn from other models. We also need to curb the freebies we hand out to non citizens. Ther is far too much financial waste going on. * My family is currently going through high medical needs. We are fortunate that we have good health coverage; however we are losing a great amount of work income from the time needed to be off to tend to the patient and his illness. We are now feeling a crunch and are in fear of the upcoming winter months and the heating season costs. I know that people without coverage go without care and die sooner. The whole system is in desperate need of overhaul. We are hard working people who live check to check....there must be an easier way. No THank you for giving me a chance to air my views. 31363 08/23/06 MA Disagree We have the technology to keep people alive. We do not have the ability to makr them better. Everyone will die. There are so many reasons this blanket statement can not be mandated. Disagree For eight years of my life I did not have health care or support from anyone. I did not expect someone to step up to support me.Why should I be expected to support people that cannot support themselves under the assumption they can work and change their circumstances? Disagree "my family was the recipient of the WIC program. It made a difference in our families' lives. It also made us accountable! Too much control will quash health care. How might you teach and implement the ways people in the ""real world"" do their jobs? Reduction of fraud and waste? Isn't that what government is all about? people do not care what things cost.. They want to get better.You are dreaming.. and this questionnaire is way too transparent.You are not helping.. you are just spending and making money." Disagree "You confuse me with your rhetoric. If you are terminally ill, do what I did with my chocolate lab. Put him down. All of us will ultimately die. Have you never suffered with a loved one who after everything else, eventually died? Open your eyes! We will all die!Hopefully with Grace and in comfort! That's all that can be hoped for! " Disagree "Good point! If they participate (ie pay into the system, then great.) By odds, some will make out, others will beat the odds. By odds, this system may work. But similar to Social Security, any good program will be quashed by the powers that be!" Disagree "So, if I'm fat, smoke cigars,but work for a living, I must pay more for the assbag who drinks cheap booze, smokes cigaretes, and buys lottery tickets, and has unprotected sex, instead of giving their five kids a healthy dinner? Good one! Where do you come off with these polls? " "The people who most need this, do not think about ""wellness, preventive services, primary care, patient education, or patient education."" Your problem lies within! " You are looking to start a non-profit so that someone's special kids have jobs! How about getting real jobs that do not tax our system and country? 31365 08/23/06 CA Agree absolutely!! Agree Agree Agree Agree PLEASE!!!!!I beg you! Agree "there is so much waste in the current system, the new system should end up being much more affordable. Americans should not have to pay a lot for healthcare. If the system works, it will be affordable. It's as simple as that. I've seen it work in Canada and I know it is possible." "* The conditions that should be treated should very much include a humanitarian component. For example, I knew of a patient at an HMO with a severely disfigured face from an accident who was denied plastic surgery because he did not meet the medical need for it, their critiera. It was obvious that he should not be denied that. that is inhuman. the guidelines must include the obvious also. They won't be too expensive. It's mismanagement that makes things so expensive not the actual care. The new system has to be run properly." "The government has been working hard to convince Americans that the Canadian system is not working right. That is not true. My mother just had a triple bypass with comprehensive after care and she paid zero. she got it as soon as she needed it. We should envy the Canadian system...the American system is so dysfunctional, it is very sad." 31366 08/23/06 CA Agree Agree Agree Agree Agree Agree 31367 08/23/06 CA Agree "We should have a single-payer system, publicly supported so that everybody is equally entitled to good health care and the system is supported by the government., " Disagree "Similar goals will be served by establishing a single-payer system, although not quite in the same way. " Disagree All this will be easier with a single-payer health care system. Agree A single-payer system will provide equal access to such services and thus encourage provision of them. Agree "A single-payer system is the only equitable, affordable way to put this recommendation into practice. " Agree "It is incorrect to say that no specific health-care financing mechanism is optimal. A single-payer system tremendously lowers the overhead, provides much greater efficiency than our wasteful multi-payer system, enables monitoring of best practices and fraud, and could cover all Americans without spending additional monies. " Every American should receive high-quality benefits across a broad spectrum. Inclusion of dental benefits is particularly important. "It is time to take the profit-making out of insurance, which by its nature regarding health care adds no benefit and great insecurity and additional cost. All Americans should be insured by government in a single-payer system, whether administered by states or federal government." 31368 08/23/06 PA Agree We need to keep government lobbyists away from representatives and money out of their pockets so that everyone can enjoy health care w/o having to worry about excessive deductables and copays. Agree I think the individual states would do better to identify the needy areas and then report to the federal government about a network for Federally Qualified Heath Ctr. Agree Early intervention and education are a must! Agree Agree "Make sure that ""Money talks and others walk"" doesn't happen. John Q. Public can get the same attention as the President." Agree Everyone should pay a fair share but a sum that will not be a financial burden to an individual or family. New doctors should be involved after graduating and not allowed into private practice unless they provide assistance in a pool of physicians for a period of time in this national health care at a much lower but still paying position. 31369 08/23/06 MS Agree Agree Agree Agree Agree Agree "In this country, we SUBSIDIZE the oil industry, yet we can't provide BASIC health care for our citizens is deplorable. As a baby boomer, I plan to become an activist and WILL contact every representative both state and national." 31370 08/23/06 TX Agree Agree Agree Agree Agree Agree "tO DENY HEALTH CARE TO THE NEEDY IS NOT ONLY INHUMANE, BUT MOST LIKELY WOULD COST THE NATION MORE MONEY IN THE LONG RUN. TO STOP INFECTUOUS DISEASES BEFORE THEY SPREAD, TO FIND CURES, TO AVOID THE EXPENSE OF TREATMENT FOR ADVANCED STAGES OF DISEASE, AND THE ALLEVIATION OF HUMAN SUFFERING TO THEMSELVES AND THEIR FAMILIES AND FRIENDS SHOULD BE STANDARD PROCEDURE IN A MODERN CIVILIZATION. " 31374 08/23/06 IL Agree "I agree that we need a national program. I think that the only efficient and fair way to do this is to establish a national publicly funded health care program. Private or private/public plans will not lower costs, due to the duplication of paperwork and bureauocracies throughout the private sector. This is not a situation where private enterprise is very efficient,or, if they are, they become efficient by cutting out those in need who cost them the most." Disagree "As stated above, I don't agree that public/private networks really work well in health care. One national system would be more efficient." Agree Agree Agree Agree "I think that if experts and politicians did a better job of explaining to people how much we pay in hidden costs now due to the inefficiency of our current 'system,'many more people would be persuaded that any upfront costs would be worth the long range benefits of better preventive care for all." It is particularly important that mental health should be given equal weight with physical and dental health. 31375 08/24/06 FL Agree "Presently, individuals without health insurance must pay different rates than those of the insured for services such as MRIs, lab work, presciption drugs, etc. Please find a way to ensure that individuals without group coverage are billed at similiar rates as those of the insured." Agree Agree "Quality of health care should be the TOP PRIORITY. Additionally, annual professional training on patient relations should be mandated for all health care providers (medical/clerical/administrative). No one should avoid seeking medical care because of rudeness, indifference, patronization, and/or fear. I would also suggest that the most advanced technological security measures be used when implementing any electronic medical records system." Agree "I believe that all patients, not just those requiring palliative care, hospice care, or other end-of-life services should have access to a PATIENT ADVOCATE that assist the patient with their individualized health care. The PATIENT ADVOCATE should be paid by either private insurace companines and/or federal/sate/local funding." Agree Disagree "If more of an emphasis was placed on prevention rather than intervention, I believe the cost of care for preventable illnesses and conditions would be drastically reduced." The core package must also include vision health. "I cannot emphasize how important is is to have a PATIENT ADVOCATE for individuals with chronic illnesses and diseases. The patient advocate should be well educated in the medical, legal, and financial branches of health care." 31376 08/24/06 TN Agree Private only Disagree Waters down the FQHC. Might as well recommend For Profit FQHC's. Disagree Agree Should include allowing nursinghomes to count sitters and non nurses in staffing ratios. Agree Agree 31382 08/24/06 ME No response No response No response No response No response No response "Overall the recommendations are far too complicated and would prove very difficult to put into practice. We need to start slow and simple. Why not just extend Medicare to everyone? It is simple, uses an existing bureacracy, is a known institution, and people who currently have it, like it. " 31383 08/24/06 IN Agree No one left outside the hospital sick should be a matter of nation pride Agree Only a federal supported agency can insure equal policy nation wide Agree no need to re-invent the wheel just fix the flat and re-inflate Agree The manner in which a person dies should provide dignity for them and their family. Agree As someone buying my own family health care the high cost keeps me from getting all the coverage I want. Agree "Health care should not cost an indiviual family any more than someone working for a large company. We are all custmors of the provider. This whole issue needs to move forward with great speed not as an election/re-election tool or any other leaverage tool, peoples lives are at stake not money, power, or postition." of course. America is the most advanced country in the world yet we have people die for lack of health care. This should not be a legacy pasted on to future generations. We have the means to make a change and we must make the change. 31389 08/24/06 OK Agree Agree Agree Agree Agree Agree Remove discrimination restrictions from employer plans. Create a more flexible program for employers to offer multiple plans to meet the employee's ability to pay as well as be affordable for the employer to contribute. 31391 08/24/06 FL Agree "I think everybody should receive the same benefit. In USA if you worked all your life, saved a little for your golden years, own a home and paid taxes your benefits at the end, when you are sick, are less than someone that never worked, never saved a penny and never paid taxes on a property. That is very unfair. I believe the goverment need to redifine ""poor people"". " Disagree "The more you eliminate ""middle man"" in the health system is better. Really the person facing the patient is the one that need to make the decision. It is very difficult to provide a service to a patient and someone at the other end of the country is who decides what he/she needs and or can get, according to the insurance benefit he/she has." Agree Patient-centered care is a wonderful term. I sure hope it is implemented. Agree Agree No response 31392 08/24/06 CO Agree And would amend this to be PUBLIC. The privatization of public goods (like health care and education) means that they will be undersupplied and overpriced. No response No response Agree And again would emphasize the need to focus on PUBLIC rather than private provision. Agree Agree "* Health care should be among the benefits we receive for our current taxes. The income tax system (for the most part) achieves a distribution of costs that is fair, whith more wealthy citizens paying more than the poor. The distribution of services should then be equal, with no additional ""means test."" If additional taxes are implemented to fund health care they should be weighted more heavily on goods or activities which tend to increase the health care needs of the users (cigarettes, alcohol, unhealthy foods, ATVs, motorcycles, big-screen TVs, etc.)" This set of core health services should also include access to the FULL range of reproductive and family planning medicines and medical procedures for everyone. 31395 08/24/06 WI Agree see below Agree see below Agree see below Agree see below Agree see below Agree "* It seems highly unlikely that the politicians will come up with a national health plan, much less a national health policy, in the near future. If the politicians will not do this, I propose that the citizens themselves put a plan in draft form and propose the legislation. While this may sound far-fetched, it may not take too much to rally support and ultimately create a public outcry for “a citizens’ health plan.” The following proposal for a citizens’ health plan obviously needs a lot of “tweaking” and we can let the bureaucrats work out some of the details. I should say at the outset, regarding the skeptics or those who would oppose such an idea, that this thinking is a complete political about-face even for myself over the past several years! There is hope. A national health plan should have universal coverage, universal claim forms (think how much time and grief this would save alone!), and be comprehensive. Specifically, the plan should include inpatient and outpatient medical " see above I am a Family Physician 31398 08/24/06 TN Agree Disagree "* I actually think most of these recommendations are excellent ideas; however, I must object to the recommendation to “expand and modify the FQHC concept to accommodate” other providers. FQHCs are community-owned providers of health care, but this recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. Our community board plays a huge part in the success of our FQHC because the patients feel they have a voice in the operation of ""their"" clinics, and I feel that removing this element simply to make it easier for other organizations who do not want to go through this onerous process will not ultimately result in better care, but will instead ""water down"" a very successful concept into something less effective." Agree Agree Agree "I favor Health Savings accounts as the means to do this. Although universal coverage is a lofty goal, I don't think it is realistic but HSA's (with government contributions for those with legitimate financial needs) could actually happen." Agree 31399 08/24/06 TN Agree We feel that everyone is entitled to quality health care coverage and have strived for 28-years to provide these services to the residents of East Tennessee. We have worked hard and will continue to do so. FQHC- Community Health Centers are structured in a manner that connects the community together. The involvement of the majority of board members as users of the centers is what makes CHCs unique. Disagree "* Most of the Working Group's Interim Recommendations are good and deserve support. However, its recommendation to ""expand and modify the FQHC concept to accommodate"" other providers is wrong-headed and should be removed. FQHCs are community-owned providers of health care, whereas the Working Group's recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition, justifying it the same way that FQHCs had to - not try to get that support in a back-door fashion by destroying one of the most successful federal health programs anywhere. Please don't jeopardize one of the most beneficial federal health care programs ever developed to obtain the goal that we are all most interested in, that of providing quality health care to everyone. " Agree Agree Agree Agree "Together we can accomplish these goals and strive to provide quality health care to everyone, but in the meantime don't destroy what has proven to work. Don't let your good intentions blur your vision of what FQHCs are all about-the communities we serve." 31404 08/24/06 WA Agree "This is 2006 in America - we need to insure medical coverage for all Americans - without the threat of losing their homes, businesses or contact with the rest of the world." Agree "Without covering the whole healthcare system, any one area could cause the whole thing to crash. Prescription drugs and the way drug companies price / cost new drugs alone could crash any system - at the same time, new treatment options should be easy to access throughout any healthcare system - not wait on different ""interested"" parties to be able to respond lest they lose revenue. " Agree I am a bit reluctant on this one - I'm reminded that different people blind folded and touching different parts of an elephant report wildly different descriptions. We need to promote good health care practice. We need to be vigilant about who is making the decisions about what to promote and when. Agree So many horror stories from the current generation of people going through this now--79 million baby boomers starting to join into this flow - We need to havethis handled so the quality of people's lives during this phase of the lives is as high as possible. Agree "* If we have healthcare for everyone - we have healthcare for everyone. The financial part of that gets handled without regard to the financial situation of the participant. Taxes pay for this. Coverage needs to be there whether you are so poor you don't pay taxes or so rich you don't pay taxes, and everyone in-between. And finally, the tax paid shouldn't be allowed to bankrupt the taxpayer. One program suggests copays or deductibles starting as low as $4,000 per year on top of the taxes - In just a few years that deductible expense would represent more than two months of my annual income, on top of the taxes. This is not acceptable." Disagree Health care for everyone means healthcare for everyone. The barriers to living a healthy life are so many - to keep financial ones in place seems entirely ludicrous. "Cradle to grave - preventative health care, and fix-it when its not good healthcare, and end-of-life healthcare. All of it, all of the time --- if you leave anything out of the system you'll create black markets, provide better service for some and worse for others. Opting out should always be a choice, but not at the cost of the system. " "* I believe Americans should have cradle to grave health care. I believe that Americans should have the food they need to stay alive and healthy. I belive that Americans should have a healthy, secure and weatherproof place to live. We are the richest country to ever exist. We owe ourselves these things. We owe the people who have served to build this country these things both in the past and now. For some to get rich on the suffering of others is not good business, it is a shame. Rather than fight wars in other countries let us fight poverty, hunger, poor healthcare - and anything else that hurts our citizens. " 31405 08/24/06 MS Agree No response Agree "All these programs should cover all Aspect of chiropracic services. Ex. Exams, X-rays, all therapies and tech." Agree Agree All chiropractic services should be covered! Agree "Chiropractic services should be included. Including office visits, exams, X-rays, all therapies." 31407 08/24/06 MS Agree I do agree with these recommendations and I also think chiropratic care is essential to include in any healthcare plan! My husband and I are small business owners and health care has always been a financial burden for us........ Agree Agree Agree Agree There has been several times over the past years that we have had to go without healthcare for ourselves and our children because we could not pay the premiums. Agree I personally have found chiropratic care to help me tremendously and I know others would too. Keep chiropratic care in our Health care plan! 31408 08/24/06 MS Agree Agree Agree Agree Agree Disagree "Core benefits package should include coverage for chiropractic care as well as natural medicine (use of vitamins, supplements, etc.)" 31410 08/24/06 OR Agree Disallowing bankrupcy in cases of high medical costs goes against this recommendation. That law also needs to be changed. Agree Agree Agree Agree Agree "Drugs that prevent heart attacks, diabetes complications and other chronic conditions should not be outrageously expensive. Drug companies should not be spending money on advertising; if drug companies charge high prices to promote their research, why aren't they using all their profits in that area instead of advertising on tv, radio, newspapers, internet, etc. It's all about the profit and not the people." I worked 15 years in one school district in order to have group health benefits when I retired until I reached 65. This year the insurance provider raised the rates of retired members by 300% even though their costs decreased. We have no negotiating powers or representation in this increase. My only recourse is return to work; start annuitizing my 401K and pay increased income taxes on the withdrawal; find less adequate insurance at a lower cost; wait until Medicare covers me in 4 years. 31411 08/24/06 OH Agree Agree Agree Agree Agree Agree 31412 08/24/06 MS Agree I currently do not have health insurance because I cannot afford it. I need help. Thanks for your help. Agree Agree Agree Agree Agree 31413 08/24/06 MI Agree Agree I agree with this as long as it doesnt diminish already existing CHCs. There are other models of community base primary care such as Nurse Managed Centers where Nurse Practitioners and Nurse Midwives provide high quality to underserved populations at a very affordable cost. Agree "It is important to maximally and appropriately utilize all primary care health care professionals in creating models of care that work. To date, many Nurse Practitioners are denied reimbursement by some health insurers making if difficult to maximize the providers available. For example, although Medicaid does reimburse Nurse Practitioners (NPs), many Medicaid Managed Care Orgs refuse to credential NPs as primary care providers. This has a major impact on access to care." Agree Agree Agree 31414 08/24/06 OH Agree I believe that only a national health care plan can provide a reasonable and just system for the greatest number of citizens. Agree The safety net approach is acceptable for a stop gap measure until a permanent and just system can be put in place. Agree Agree this phase of life's journey deserves and requires sensible medical assistance for the dying and their families and friends. Agree "I see this as the major domestic issue. It is one of the basic, foundational institutions found in the most progressive parts of the world. Without it we as a nation will continue to squander our resources and deny the just services required by the poor and working class." Agree "* I want to see a sizeable and reasonable tax on cigarettes; about $4.00 per pack, with increasing amounts over time. We need to have a consequence to the users of tobacco which begins to represent the actual cost to our society. Next, we need an additional tax of about $1.00 per gallon of gasoline, again to more reasonably reflect the cost in health care to our society from pollution and accidents. We need to target the worst offenders; tax the sale of SUVs and light trucks at about 10% of the sale price, plus a 1% tax on each mpg of the vehicle below 30 mpg. " Reality reality reality. 31416 08/24/06 MS Disagree Tere are no guarantees in life. I think everyone should have access to emergency medical attention but it should not be mandated by the government. Disagree "I am against any proposal that we require the establishment of a new government agency. Our government cannot manage anything in a cost effective manner. Just look at the way money was squandered by FEMA after hurricane Katrina destroyed the Mississippi gulf coast and flooed New Orleans. With the track record our government has at managing things (ie FEMA, Medicare, and Medicaid) I am against giving them another opportunity to manage anything , especially health care." Disagree "* The federal government programs already in place are the most wasteful in existance. Medicare and medicaid are going broke all over the country and you want to recommend to make these programs bigger!!! If we cannot provide care for our seniors and poor how in the world do you expect to do it for everybody. I can tell you how. You will do just like the government is doing now. Raise deductables, reduce payments to providers, increase co pays to the patients, raise premiums, and when that is not enough you will raise taxes. The government needs to stay out of health care except for maybe policing fraud and waste" Disagree I agree that this is a very hard time for the families of the terminally ill patient as well as the patient. I believe that everything should be done to make the patient comfortable. I do not believe that it is the responsibility of the government to pay for it. It is the responsibility of the family. If they are poor then their church and private organizations should try to help. Disagree I think that everyone should have access to emergency care. I do not think that it should be public policy. Once again the government has proven it cannot manage health care for its senior citizens or poor. Why in the world do you think it can do it on a broader scale. Agree "* ABSOLUTELY NOT!!!! Every country that has gone to Nationalized health care has failed. I traveled working all over Canada for 10 months in a 2 year period. I talked extensively to Canadian citizens during this time and never had anybody tell me they had a good health care system. They talked of long waits and limited care unless you were an emergency case. They told me they paid over 55% income taxes (average people not rich people. THey pay much more), to pay for this reduced care. It cannot be done cost effectively by the government. They shoul stay out of it." "* As long as it is independant non partisan. Traditionally the health care industry has been run by the AMA and the drug companies. They have tried to monopolize health care. Many americans do not want drugs and surgery if their is an alternative. It is mandatory that americans be given drugless nos surgical alternatives. For example, Chiropractic care has proven safer, more effective, and less expensive than traditional medical care. Even with these studies proving this, many insurance plans try to limit or exclude it mainly because of the influence of the AMA over many years. Exercise and diet can manage everything from type II diabetes to anxiety disorders but it is passed over in most cases in favor of drugs. This is obviously done for profit reasons. I believe 5 or 6 of the top ten drugs sold are for anxiety or depression. I can provide any references needed. " "* Our health care system is the best in the world. Yes it has some problems to be fixed, but that should be done in the private sector with vey slight government regulation. The liberals in this country are trying to socialize our entire constitutional republic. Health care is just one area. Some people in this country do not have health insurance because they cannot afford it. Many others do not have it bacause they have chosen to drive nicer cars, live in nicer homes, smoke cigarettes, drink alcohol and go on vacations instead of paying for insurance. It is not the responsibility of the government to pay for this. In fact, nowhere in the constitution does it say that this is the function of the government. Health care is not a right, it is a choice. The government should stay out of it. " 31421 08/24/06 MN Agree "I believe we should finance universal health care with a single paying entity, funded primarily by income taxes and other progressive taxes." Agree Agree Agree Agree Agree "* Again, I favor single-payer funding paid for by income tax. So-called ""sin-tax"" revenues, such as from cigarette taxes, work only for as long as people continue to smoke, despite the added expense. The purpose of cigarette tax is not (and should not be) to fund universally desirable services without having to raise other taxes, but to discourage smoking; and, of course, if we successfully discourage smoking, then revenue from the cigarette tax is also reduced. This is not a good long-term source of funding. We should never impose sales taxes on things that we regard as non-luxury items, unless we want to encourage people to buy more energy-efficient or durable products. We might impose ""sin taxes"" on inefficient, polluting cars, for example. But here again, the aim of these taxes is also to discourage a certain kind of consumption, and if a sales tax successfully reduces a particular kind of consumption, then it also reduces its own revenue. The fairest and most reliable of all taxes are income tax " "* I believe strongly that health insurance should not be a for-profit industry. It should be a non-profit industry. So much duplication of services and work spent figuring out how not to pay for services, in the name of profit, is all a waste of money and should be eliminated. I am concerned that some appointees of your ""non-partisan"" panel will be disciples of the cult of the profit motive, which I emphatically reject. I applaud your aim to include dental health and mental health in universal insurance. Preventive dental care makes expensive and painful oral surgery less often necessary, and preventive mental health care makes us all safer. If we fail to provide mental health care for everybody who needs it, then we all suffer, especially the victims of mental illness and their families. " "I would add that we also should provide free treatment for every drug addict who requests it. Drug addiction may begin with moral weakness, but it progresses into a physical disease that must be treated medically. It is a waste of money to punish people who need doctors, not jail, and it makes no sense to wait until a drug addict commits a violent crime and lands in prison before we offer this person free treatment." 31422 08/24/06 CA Agree Universal healthcare in the U.S. is possible and necessary. Healthcare should not be a commodity or run by profit-making entitites. All Americans can be covered through a publicly run single-payer approach. Agree "If a unified single-payer system is put in place, all populations will be served. Obviously needs assessment and appropriate responsiveness will determine which services are more or less needed in different communities." Agree "There is tremendous waste now in the administration of claims, eligibility inquiries, gate-keeping of doctor request, etc., by insurance companies. A lot of the money employers and employees pay for premiums goes to administration instead of healthcare. A single-payer system would eliminate the waste and make efficient use of our hard-earned money. More people would have better healthcare. It's that simple." Agree Agree Agree "What's fair about insurance companies--unnecessary third-party intermediaries dedicated to their own profits--being in control of our healthcare system? If our government collects all the money now supposedly being paid for healthcare and ""insures"" the American public, we will have an effective, streamlined system, with tremendous savings on discount buying, where we the people and the medical professionals decide what kind of healthcare we'll have. That's doable and fair. " "Healthy individuals make up a healthy nation. And the reverse is true, too." 31423 08/24/06 CA Agree "* While I presently have great coverage [Medicare plus a USAA Company supplement] it is unacceptable that so many of our fellow citizens have none. Requiring employer mandates is unacceptable as this places US employers at a competitive disadvantage compared to foreign employers. Having all persons in the same covered ""risk pool"" would prevent the sorts of ""gaming"" indulged in by insurance carriers--I recall this all too well from my years as a practicing physician! I strongly endorse a single payer health plan for all persons in the US. It is shameful this has not yet been provided for as many supposedly lesser nations have already done! " Disagree This plan does not appear to cover all equally and would be a poor substitute fr a universal single payer health care pkan for all. Agree "For the US Health Care System to work properly, I feel everyone must be covered in the same ""risk pool,"" in the same plan." Agree This would be good ideas only if part of a true universal health care plan covering everyone(medicare for all). Agree "This recommendation is only acceptable if part of A ""Medicare for all"" law." Agree "It was unfortunate that our ""peace dividend"" of the last decades was foolishly spent on a new war. I the US took its appropriate place in the family of nations, it could fulfill its reponsibility to provide for the health of its citizens. " "These would be excellent if part of a universal ""Medicare for All"" plan!" I strongly favor a universal single payer health plan for all in the US. 31425 08/24/06 MI Agree "Health care should not suffer because someone can't afford it. People's lives are destroyed paying for health care cost. Homes and lost, indivuals have filed for bankruptcy due to paying for health care for loved one with fatal illnesses. You shouldn't become homeless because you couldn't pay astronomical health care bills." Agree There needs to be accountability for these companies to ensure proper care is given. Contracts should not just go to political allies of those in power. Agree "No one should get wealthy on the backs of those who are underinsured, uninsured or on the lower economic scale. The care should be the same no matter how poor or rich you are. " Agree These are very stressful times for family members and friends. All resources should be available to assist them. Agree "High-quality for everyone. Everyone has a right to good health care. Be treated with dignity and respect. Be treated As a person, not as a health care plan that falls short " Agree "All the money that is wasted on pork barrel legislation, war in Iraq, silly research, over priced items that money could be used to finance health care. Getting the Health Care and Pharmecutical to rein in the outlandish prices. Those strategies need to be looked into." At every level there should be adequate health care and dental care. A fair market prescription plan. 31426 08/24/06 IL Disagree "* I disagree with the recommendation to a point. As a citizen I do believe that health care should be made affordable and that no one in America should be left in a state in which health care costs consume their living. However, I believe that individuals should take responsibility and that society and communities should pull together to help each other out to prevent and promote wellness on a health care continuum. I do not believe that society should provide such a great discount for protection in low income individuals and families. I do believe that some financial protection should be given to low-income families. If indeed we provided a great amount of financial protection to low-income persons, we would be do injustice by not giving those persons an incentive to better themselves. When reflecting on history, this mindset of getting something for next to nothing only persists from generation to generation and individuals need to take responsibility. We should help low-income individuals, but not" Disagree "* Again, as American we need to take responsibility. It is not the federal governments responsibility to provide care. Society and communities need to stand up and support one another. We should take an active role in our communities by increasing knowlegde regarding health care illness and how to prevent these occurrences. Churches and local businesses should take part in helping those low-income families and vulnerable populations. Health care providers within a community should dedicate providing health care not only to those within a city, but outreaching those in a rural area. Federal money should be distributed to churches, health care clinics, and outreach programs in purpose of providing care to the community. " Disagree "* Again, I support that individuals should take responsibility and not rely on the federal government programs for assistance. I do agree that by providing funding to health care clinics and inceasing the health information technology with special emphasis on their implementation in teaching hospitals and clinics we will promote wellness across the health care continuum and take part in primary prevention. Money should be allocated to communities and clinics in thoughts of increasing knowlegde base and providing care to those that are unable to access care. In our current health care system, we are already in crisis regarding the Medicare plan and the inevitable bankruptcy our country is facing. Therefore, with this knowlegde regarding our countries current status and the impending bankruptcy of the program, by continuing and pouring more money into this federally funded health care program we are setting ourselves up for failure. " Agree Disagree "* Again, as individuals we should take responsibity for ourselves and those surrounding us. I agree that the health care costs are very expensive and the cost should be cut. However, health care is not considered a right. Society should unite and communities should work together to care our people. Society should not become dependent on the the federal government for financial assistance. If society becomes dependent on the money allocated by the government, then there is no incentive for the American person to take part in the growth of our nation and we as a country would start to decline in advancement of our technology instead of flourish. Our country depends on the exchange of money and money within the system. Without society contributing in market and depending on the government for money, then we would be preventing advancement in technology and promoting instability. " Agree None. "I agree under the discussion area that not all individuals would need the same care. This womb to tomb care that is being promoted does not seem to be any different than providing basic health care for all. However, in providing the most basic and simple care in promoting and preventing health, illness may be prevented and health care costs cut. " 31428 08/24/06 CA Agree Agree Agree Agree No response Agree There are people dying needlessly and many others sick because of this broken system of healthcare. We must have single payer Healthcare for All immediately. Thank you. 31429 08/24/06 MN Agree "I believe the U.S. needs universal health care with a single payer such as Medicare. We are wasting millions of dollars by having many health insurance companies do the administrative work. We are also wasting dollars and lives by having thousands of people without health care, mostly because they can't afford to buy it. Many end up in emergency rooms in hospitals which is very expensive." Agree Agree Agree No response Agree 31430 08/24/06 MS Disagree "Healthcare is not a right, it is a responsibility." Disagree "The most cost inefficient way to provide healthcare is through the federal government. Medicare and Medicare are not recognized for their quality, access, or cost effectiveness yet they are the model for government managed healthcare." Disagree "* Current efforts do not yeild the referenced results. CMS programs such as ""pay for performance"" are not measuring ""quality"" with clinical objectivity but rather measure subjective indices such as ""satisfaction"" and ""cost-efficiency (cost per clinic)"" which can be substantially biased by locale, patient population, and bias. HIPAA and other integration of common data languages have driven up cost and created a cottage industry of businesses selling a myriad of solutions that still do integrate information. Fraud and waste law has been used to control markets and target individuals attempting to comply with extremely complex laws that require near monthly re-interpretations and OIG opinion letters to the point that physicians operate their businesses in a defensive posture raising the cost of the delivery of care. Consumers are being given data and statistics without the means to filter the information into usable bytes and, as such, institutions and practices with commonly held acclaim for superior health" Agree Hospice care has been low on the scale of priority. Legislation needs to be in place to protect those providing these critical end-of-life decision services from unnecessary lawsuits from grieving families. Disagree "* Healthcare is not a societal right; it is a personal responsibility. In every country where healthcare has been given stature as a right and obligation of the government, the general access has worsened, costs have been driven up while quality driven down. Further, fewer bright individuals consider healthcare as a career field because of the declining economics and choose other, well-paying fields, creating yet more shortages in critical fields. Further, in most every case, the society ends up creating a two tiered system of healthcare in which those who can afford it get the quality care with access and those how can't must put up with the government system." Disagree "* Our current tax system and funding for healthcare constantly shifts money, often linearly related to the political season. One quarter CMS announces drastic fee reductions, the next quarter they change the plan. As such, the pain of an inefficient system continually gets shifted further into the future and our children are the ones who will be paying for our mistakes of today. We cannot afford to continue to raise taxes for social programs without fiscal resonsibility. Adding more social rights sounds good on the surface but at the core will only add more weight to shoulders of the tax-payer and our general economy will suffer. The solution won't be found in creating more programs or the government creating deeper safety nets for citizens who refuse to be responsible and save their money or invest in healthcare solutions. It is not possible to legislate conscious. Certainly it is our societal obligation to help those in true need but few will argue that the vast majority of those who personally prof" "* Conceptually sound but practically impossible. The system if far to complex to believe that citizen overseers could have the expertise to manage medicine. The best example is the demise of the ""managed care"" services across most marketplaces. Healthcare delivery is phenomenally complex. It is simplistic to believe that citizen groups can develop consensus on treatment plans for even the most common health problems when experts with decades of clinical experience often cannot concur on best-practices and standards of care." "* Having worked in healthcare on both the clinical and business sides for three decades, it is with fear that I and my collegue look over the horizon. Most of my peers are looking for means to leave medicine and many in response to just the measures as outlined above. As reimbursements are reduced and it becomes a battle to get paid only what is due by contract from 3rd party payers it makes little sense to see programs endorcing predominantly government-based healthcare delivery services since most physicians view Medicare and Medicaid to be two of the least efficient delivery systems in our country. Couple this with a highly litigious society and I am not surprised that we are seeing fewer of our youth choosing medicine as a career field. " 31431 08/24/06 NC Agree "cover people and families working here, whether or not they are documented; should be a public national program" Agree no need for public-private advisory group -- just an appointed group answerable to Congress (and the American people) Agree Please do not just pay lip-service to quality of care! I notice that patient-centered care and health education are at the bottom of this list and do not merit a recommendation apart from efficiency. Agree agree; no comment Agree "yes, all Americans and all people living and working here, regardless of immigration status" Agree progressive income taxation should provide needed funds "Core health care includes access to a full range of family-planning services, including abortion and emergency contraception." 31435 08/24/06 NJ Agree "* I agree with the recommendations for my mother is elderly and frail, we are spending all of her resources on end of life care. My father worked all of his life and never took vacations. Her main asset is the house they lived in for over 50 years. My father is deceased now, and his pension benefits were cut in half once he passed. The reality is a very sobering fact that people, including myself, are afraid to get sick, because one catastrophic illness could bankrupt you. The stress alone from being sick is substantial, but to couple that with financial burdens, dealing with insurance companies, who can deny your care is just overwhelming. Something needs to be done in this county and soon. " Agree Agree Agree I worked in the hospice field and encountered many older physicians who just could not provide the proper care for the dying. They were afraid to order morphine in the event of an overdose. Palliative care should be on the forefront and people need to know what their end of life choices are. Agree Agree 31440 08/24/06 CA Agree We all should have healthcare. It is essential in keeping the quality of life at it's highest level. One of the most important ways in doing this is making sure everybody has healthcare coverage. Agree Agree Agree Agree Agree 31441 08/24/06 TN Agree Disagree Agree Agree Agree Agree 31446 08/24/06 CA Agree I would prefer to see this be a public program as the private sector has already failed its responsibilities and the public sector has a proven record with medicare and tricare. Agree Agree Agree Agree Agree "Financing should be based on progressive taxes and contributions with high-income and ""high net-worth"" individuals paying a larger percentage. Conversely, the working poor should pay something, but a much lower percentage of their income." 31451 08/24/06 GA Agree Agree Agree Agree Agree Agree 31452 08/24/06 OH Agree This is a must. Agree "Fed. govt. must lead and provide funding as needed. but it must not mandate unfunded programs (such as No Child Left Behind). All recommendations need to be based on current and credible research around best practices. This will take time, but will avoid waste." Agree All above are imperative. Curbing the extraordinary amount of waste should be a priority and should be monitored carefully. Patients are overbilled for items and for services. This causes great harm to the poor and underinsured and unfairly augments insurance costs for the rest of Americans. Agree My own experience with the end-of-life issues of family members convinced me of the need for such restructuring to support programs and make training available for all care providers. Agree "Let's remove the ""haves and have nots"" from the equation starting with health care coverage for all. America can do this." Agree I agree. "If dental, what about vision? Both are really aspects of physical health. As a clinical counselor who treats persons with mental/emotional disorders, I would say ""mental/emotional""." "It is really encouraging that this study and efforts are going forward. I find it deplorable that so many Americans are denied adequate health care. Let the President know that this is a HUGE life issue. I think that we have not espoused a ""culture of life"" during the G. Bush presidency." 31455 08/24/06 CA Agree * The only prospect for achieving universal health care with tolerable cost is a single payer system. Only a single payer will significantly reduce the mestastasized administrative costs that float the current insurance system. Only a single payer system will permit our doctors to focus primarily on medical practice rather than on billing codes and insurance intricacies. Only a single payer system will free American business of the anti-competitive burden of health care costs. Only a single payer system will permit the medical profession to practice robust preventive medicine rather than ameliorating medical crisis because the medical insurance industry judges the former unjustified. The practices regarding diabetes are a dreadful example: thousands for amputations rather than hundreds for prevention. Agree " See comments above, stating the necessity for a single payer healthcare system to achieve real savings and improved health for all." Agree All of these laudable goals will be achieved sooner and less expensively with a single payer system. Agree These efforts too will be better chieved with a single payer system. Agree The real solution is obvious. Billions are wasted in the current system on its administrative costs. We need a single payer system. Agree Only the most efficient financing system will afford the needed care to all. That is a government-administered single payer system. 31457 08/24/06 CA Agree "A single payer health care system would reduce the total cost of medical care, would remove the burden of cost from individuals of every income group, and would guarantee a level of health care for all Americans." Disagree "* I both agree and disagree with the above recommendation, which may funnel money into bureaucracy and could drain money from the provision of health care services. I would recommend a single payer system that allows patients to go to existing medical service providers. However, I also support health care for all. I would also recommend training more doctors and nurses, because sometime in the near future, I think the demand for medical care will outstrip the ability of doctors and nurses to treat all of the patients. This is a part of the economy which will be expanding, especially given the aging baby boomer population." Disagree "* If single payer health care were initiated, all of the programs listed above could be reduced or eliminated, taking money away from bureaucracy, and making more money available for health care services. Also, I take exception to ""health care systems built around evidence-based best practices."" People should have the option to choose homeopathy, herbalism, acupuncture, or Ayurvedic medicine, if that is what they desire. These complementary forms of medicine are often cheaper, less invasive, and less polluting (fewer syringes and other medical paraphernalia)." Agree No additional comment. Agree "Americans should have access to equal health care, regardless of ability to pay. I would not offer financial assistance to help pay for the health care, but rather a health care system available to all. To keep down expenses, I would not offer optional cosmetic surgeries within this system, and I would have a hard look at treatment that merely extends life for a year or two, without a possibility of cure. These services should be available, but at the individual's expense." Agree "Too much money currently goes into the processing of claims for health care by insurance companies. Single payer would eliminate that. If you are suggesting that people pay premiums for added health care benefits, yes, the people who can, will fork over the money, but once again, what about the people who cannot afford health care? If you are thinking of taxing the rich, go for it." "* I agree with part of the statements, disagree with others. Yes, the health needs you listed should be covered. I take issue with what you call ""evidence-based science."" This sounds like AMA-talk for only covering conventional, western medicice, to the exlusion of comlementary medicine. In my opinion, it would be a BIG MISTAKE to exclude complementary medicine. If herbalism, homeopathy, acupuncture, etc., were as well-financed as western medicine is, who knows what medical miracles complementary medicine could perform?" "No, thank you." 31458 08/24/06 MI Agree "PLEASE, Help the Woman that have had and have Breast Cancer, and Everyone that have suffered from Cancer! PLEASE ENFORCE NEW LAWS TO PROTECT US FROM BEING DISCRIMINATED AGAINST FOR CURRENT AND FUTURE EMPLOYMENT! HELP!" Agree Agree Agree Agree Agree Thank You for the opportunity to speak out for many woman that have lost good jobs over the years because a company finds out that we have or have had Breast Cancer and they get rid of us! I HAVE BEEN LET GO FROM GOOD JOBS FOR YEARS NOW BECAUSE OF MY BREAST CANCER (which was over 8-years ago)! PLEASE HELP US! Someone has to help Cancer Victims too! 31461 08/24/06 CA No response No response No response No response Agree No response 31464 08/24/06 OH Disagree "* Having a one-size fits all policy for every individual makes no sense! I think that we must examine the socialized health care systems abroad to understand if it's truly the system we want to subject Americans to. I work for a surgeon who has extensively travelled Europe. Waiting 6 months for a cancer surgery is routine in many of these countries. This is only a small aspect of their system, but speaks volumes for how patients are treated, which is truly appalling. If a budget only allows for x amount of procedures a month and there are 10 individuals more than the budget allows, the 10 patients simply wait and in some instances die while waiting. I'm not sure how such a system can be construed as compassionate." Disagree "The problem is government. Government does not work and it does not care. By de-regulating and removing all subsidies, this will allow a free market in medicine to flourish, which will provide an abundance of affordable solutions to the average medical malady, which in turn will benefit the low-income consumer. " Disagree "* Asking the government to make health care more efficient, cost-effective, and at the same time provide high quality care is completely unrealistic. This is the same government that is nearly 9 trillion dollars in debt and has roughly 60 trillion in unfunded future liabilities. Only in a free market in medicine, will there be these types of benefits. A free market in medicine(i.e. one in which the government does not subsidize, regulate, or license) will not be perfect, but will be far superior to a socialized system." Disagree "I agree that end-of-life care is important, but disagree with community funding. Charity care is important and should be stressed to help those dealing with end-of-life issues." Disagree "* It is not realistic to expect that a socialized system could deliver high-quality care. One only needs to examine many of the European models to understand this. Yes, we can provide mediocre care to everyone, or we can create a free market in medicine to dramatically decrease the amount of individuals who have no access to health care. A free market in medicine will create an abundance of competing solutions and treatments for all maladies thereby helping all individuals. No where on this web page is there a serious discussion of how such a system could be payed for." Disagree "Financing should be up to the discretion of the individual!!! That is THE optimal mechanism. Only in a free market of health care will there be an abundance of health care options. A socialized system is a one size fits all solution, which does not take the health care needs of the individual in to consideration. Only the individual knows best. Government is an uncaring entity which could not possibly comprehend the 300 million indivual health care needs." "How could such a group represent all 300 million individual Americans! It's outrageous and simply presumptious!! Health care decisions should be left to the individual. If private groups want to aid individuals, so be it, but do not subject the entire populace to a infitisimal small group of individuals who's goal is to socialize health care." Please consider having free-market(i.e. objective) economists in your group to consider the costs of the various health care systems. 31465 08/24/06 MN Agree wealfair to the pill pushers and wall street are screwing working class and retired american's. Agree Agree Agree Agree Agree the bush administration is destroying retirement for too many american workers. 31466 08/24/06 WA Disagree "I disagree with the phrase ""private or public."" I favor a publicly financed, single-payer system of health care coverage, with a core benefit package and some limits on provision of very high cost procedures (to be determined by a group such as the one discussed in your final recommendation)." Agree I Agree Reduction of fraud and waste is much easier in a single-payer system. Agree "Death is a natural part of life and it is not the responsibility of medical professionals to prolong life by any means whatsoever in all cases. Patients should have the right to request and obtain palliative care only and assistance in dying (""right to die"")." Agree Agree "The optmal health care financing mechanism is not-for-profit. Public funding (through taxation) is the most efficient and equitable way to go, the best any nation has come up with so far (as comparative statistics show). Let's get to that method as quickly and directly as possible." 31468 08/24/06 CA Agree Agree Agree Agree Agree Agree "* Lets face it the costs of not doing enough are astronomical to the very fabric of our society ,loss of productivity, alienation of disadvantaged portions of society with concommittant non participation in it [society that is] art education commerce community should not become equated with an ability to have them as commodities in ones life. this stuff should be up there with freedom of speech we are only as strong as our weakest link and we need to see that a healthy society is one that values all its members simply for their humanity .We all need to feel good about ourselves which we cant do alone in isolation. So regarding financing lets make it more than just about money in the short term ,we are investing in the health of our nation which is not safe in the hands of for profit enterprise without vigilant and active public oversight both to expand the scope of what is healthcare and to ensure an actively competitive marketplace for all providers. I cant think of a subject that could better exemplify " A core benefit package needs to include access to information from an early age ie nutition /sex /exercise phsyiology education mandatory in our schools . It has to have a prevention is superior to cure bias! Good Luck may the force be with you. 31470 08/25/06 CA Agree "These basic principals, UNIVERSAL,PROTECTION, and INCLUSIVENESS are the basis for SB 480 Khuel in the California Legislature. I support these concepts. I would have to know more about your proposed Public-Private group before I could think of supporting that proposal." No response I would have to know more about this Public/Private group idea before supporting it. Who is the public referred to? How would they be selected? Who is the Private sector in this scenerio and how are they to be selected? Would these groups truly represent the best interests of healthcare consumers? Could this simply be a means by which to twart the growing public support for an american version of the single-payer concept? Agree "I agree with the concept that federal funds for health care programs would be best spent to support single payer type systems, but not to shore up the existing for profit HMO systems." No response The problem with your proposals is the lack of specificity of the role of the Public and private sectors of your proposals. I feel sure that a single payer system would include Hospice care such as you suggest. We already have one in our community. Agree This is exactly what we are supporting in SB480 Kheul in the California Legislature. No response Universality and affordability are key concepts for arestructured and revitalized health care system in america. "I would specifically include eye care and glasses. Your suggested inclusion of ""citizens but not limited to patients, providers, and payers seems to lead a lage gap making possible the same players 'insurance companies and HMO's' who are bringing about the present destruction of our health care system which we are struggling to reform will continue sopping up profits to the destruction of health care and leaving millions of americans without protection " I suggest you clarify specifically who the players will include as well as what sectors will not be allowed to corrupt your health care reform efforts. 31472 08/25/06 CA Agree "everyone deserves health care and getting it, especially for preventative care, saves money and promotes good health and productivity of the people" Agree Agree this will actually help businesses by reducing costs needed for employee insurance Agree This will improve the quality of life for the aged and again reduce costs Agree "yes, everyone should participate and contribute when they have the resources" Agree "financing at all levels, by the individual, employer, and state are needed. Such a system should be much more efficient than all of the bureauacracy we now have with HMOs" People should get what they need and not things they do not need - again making the system more cost efficient "If properly presented to the business community, including large companies, I believe they will realize that they will save money with the plan presented. There is a reason that the US companies spend so much more on health care than other countries that have universal health care " 31473 08/25/06 CA Agree "Focus on public healthcare only if lifestyle changes can be implemented: better nutrition and exercise, especially in the schools where children develop lifelong good or unhealthy habits. " Agree Agree Agree Agree Agree "How about calling it ""excess tax"" rather than a sin tax so that those who are using more natural resources which ultimately contribute to poor health can foot the bill for the negative effects of their self indulgence. This could apply to both businesses and individuals." Bring Pilates exercise methods to the schools. Get better coaches who care less about winning and more about healthy development of growing bodies; about having fun while being physically active so that as children grow they want to be active and continue through their lives. 31474 08/25/06 NJ Agree Agree Agree Agree Agree Agree 31476 08/25/06 CA Disagree "* The majority of respondents favored a national health program which is ""financed by taxpayers, in which all Americans would get their health insurance."" This implies a program which is public, not private. In order to be egalitarian, which also was a value that participants seemed to favor, health care should be paid for primarily through a progressive tax structure with minimal out-of-pocket costs for anyone -- no deductibles, no premiums, co-pays of $5. In this way, everyone would be protected against ""very high out-of -pocket costs"". People with higher incomes would pay more into the system through taxes; low income individuals and families would pay little or no taxes so there would be no need to provide financial protection for them specifically." Disagree Making sure that people living in rural and underserved areas have access to high quality health care is important. However I disagree with the notion of having a separate safety net health care system for low income people. Everyone should be included in mainstream health care. Disagree "This recommendation also keeps in place our fragmented health care with one program for the elderly, another for the poor,etc. The greatest efficiency could be acheived by having everyone included in one risk pool and having national health insurance. If private health insurers are eliminated we could have expenditures on administration more like Medicare at 2-3% instead of the 30% spent by private insurers on administration, advertising,etc. " No response Disagree "* If this is the common message that you heard, why does the Working Group insist on recommmending a fragmented system where there is a separate, lower-tier for low income people? People are asking for a health care system where everyone participates, regardless of their financial resources or health status,with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care. Why insist on talking about core health care services? People want comprehensive health care services. This is not catastrophic care; this is comprehensive care! " Disagree "* Why is there no mention of the great number of participants who consider a single payer system preferable? Yes, the financing strategies should be based on principles of fairness, efficiency, and shared responsibility and should draw on dedicated revenue streams such as income taxes or surcharges, ""sin taxes"", business or payroll taxes, or value-added taxes. However enrollee contributions could exclude some low income people and means testing is a cumbersome and expensive process. Once again, the Working Group mentions catastrophic health care expenditures and impoverishment of individuals as a result of getting the health care they need. If health care is paid for through taxes, why would there potentially be catastrophic health care expenditures and impoverishment? It would be paid for by taxes. As I mentioned above, the greatest savings could be acheived by eliminating private insurers. " "I primarily disagree with calling this a ""core"" benefit package. It seems that this recommendation would include a comprehensive package of benefits which I support. If the ""identification of high cost and core benefits"" means that core benefits are included and high cost benefits are not, I would disagree. This recommendation is unclear. If the Working Group means that all medically necessary treatments would be covered to address a person's physical, mental and dental health, then I agree." "I think it is crucial that the Working Group recommend a specific date, for example 2012, by which a national health plan which is financed by taxes, in which all Americans would get their health insurance should be implemented. I also hope the Working Group listens to what the American public has said to them during this process and makes final recommendations which are truly in the spirit of what the majority of participants have asked for. " 31479 08/25/06 IL Agree "We need real health care and it is time to get rid of the ""Looney Tune Psychiatrists"". Much of it is a ""Shell Game"" and cold-blooded killer activity. It has nothing to do with care, help, or medicine. Much of it is ""Racketeering"" and using the so-called mental health industry for illegal activity including homicide. They think they can rob ""Victims of Violent Crime"" and the Elderly of his/her money and commit ""Ultimate Identity Theft"". " No response No response No response No response Disagree "* What is the word mental doing beside the word health. Mental illness runs rampant in the mental hell industry. The lunatics are attending the asylum. They destroy many lives and extort thousands and thousands if no millions of dollars involving their own insanity. They are the most useless form of doctors. They do not deal with reality, only Ideology and Propaganda and they are not experts. The psychotropic drugs are being used for illegal purposes and homicidal activity. They have knowing lyied about the psychotropic drugs for years. Enough money has been thrown down the toilet and sewer. Many are into cruel, inhumane, degrading treatment and punishment. They defraud the records and cook the books in order to try to make the ends jusity the means. They call false emergencies for abusers and perpetrators. Allow him/her to sign committment papers or false petitions. They they kidnap or abduct the ""Victim of Violent Crime"" and he/she does not even know the hell of what is taking place. Mob Actio" "It is time to send the psychiatrists back to Nazi Germany where our government brought them here from. It is also time for the Nuremberg Tribunals and that the corrupt psychiatrist for his/her ""Unspeakable Crimes Against Humanity"". " 31480 08/25/06 CA Disagree The system should be public only. Private health care won't keep costs reasonable. Disagree "We need public health care for all like Canada's. At the current health care prices, even middle class people cannot afford care. We can do better." Disagree We need universal health care that incorporates all of these practices. Agree We need good end-of-life choices. Agree We need this in the form of Canadian-like single-payer health care. Agree "We need universal, single-payer health care. It should be free to all citizens." 31483 08/25/06 OH Agree Agree Agree Make sure all medical records are effectively protected. Agree Agree Amen! Agree The more you make the more you pay! 31484 08/25/06 TN Disagree Don't want higher taxes for another government program. Please freeze all new government programs. Disagree I want the federal government to stop becoming involved in every issue in America. The private sector will take care of the problem. Agree Agree Disagree "I don't want the federal governtment to socialize, and screw up, health care like they do everything else." Disagree "No new taxes for anything. No new revenue from any source. If healthcare was important to people, they will spend their money on it. Yes, even low income people." "No womb to the tomb healthcare. This is supposed to be America, not a communist country. Stop trying to take control of peoples' lives." I don't want the federal government to take control of healthcare. It will become socialized and the quality will be reduced. Canada has socialized medicine and the Canadians come here for their healthcare... because our system is better just as it is. 31485 08/25/06 TN Agree Agree Agree Agree Agree Agree 31486 08/25/06 TN Agree Agree Agree Agree Agree Agree 31487 08/25/06 FL Agree Costs are out of control and corporate America is controlling our health care system. We need to provide eqality and equity in our national health care. It is a basic human right. Agree It would reach those most in need. At least ideally! Agree Agree Agree Agree "Drug companies and cost of prescriptions are out of control. Also Doctors prescribe too freely and too many medicaions. We are a ""pilled"" society. Limits on drugs and suppliers will cut costs. Insurance companies also have too much control. and government entities spend too much on administsrtion. Cut costs in these areas and the finances will be much easier to deal with." 31488 08/25/06 MS Agree "* make it to where any medical student that accepts government financial aide is required to serve in clinis established by the government for these americans/low income people to come to. Have a 2 year agreement set aside for these students so that they work for the government and get paid by the government a set salary for those 2 years. Then they can go to work where ever they choose. The only one's that are winning in the ""medical"" situation is the insurance companies. They make sure that they have their enrollees only go to doctors that participate in their ""programs"" or are penalized with large deductibles and out of pocket cost. If the doctor doesn't want to ""participate"" then they loose business and are then forced to accept the low reimbursement that the insurance pays for procedures. THE INSURANCE COMPANIES ARE THE ONES THAT ARE REGULATING EVERYTHING. THEY ARE THE ONES THAT NEED TO BE TARGETED....CHECK AND SEE WHAT THE CEO OF BCBS AND UNITED HEALTHCARE AND OTHER TOP INSURANCE COMPANIES BONUS" Disagree "ALL THAT YOU WILL BE DOING IS PAYING LARGE SALARIES TO PEOPLE THAT SIT AROUND EACH DAY AND LOOK AT ""FORUMS"" THAT HAVE COSTED AMERICANS TAX MONEY TO HAVE AND TAKE YEARS OF ""REVIEWING"" AND NOTHING EVER COME OF IT. " Disagree "* AGAIN, YOU WILL PAY HIGH DOLLARS FOR PEOPLE TO ""IMPLEMENT"" THESE PROCEDURES AND THEY WILL NEVER ACTUALLY GET OFF THE GROUND AND MANY MILLIONS OF DOLLARS WILL BE SPENT ON SOMETHING THAT IS NOT BEING USED. MY DAD GOES TO THE VA...HE IS ON A LIMITED INCOME AND HAS TO HAVE HELP WITH HIS MEDS THAT HE TAKES. I HAVE SEEN THE WAY THESE VETERANS ARE TREATED AND IT MAKES ME SICK TO MY STOMACH. BECAUSE IT IS A FEDERAL RUN FACILITY, EMPLOYEES KNOW THAT THEY CAN TREAT THE PATIENTS ANY WAY THEY WANT AND GET AWAY WITH IT BECAUSE IT TAKES AN ACT OF CONGRESS FOR THEM TO LOOSE THEIR JOB. YOU NEED TO LOOK INTO THAT BEFORE YOU TRY AND CHANGE THE OTHER THINGS...." Agree Disagree "* I HAVE WORKED IN THE MEDICAL FIELD FOR OVER 20 YEARS. I HAVE A BIG PROBLEM WITH PEOPLE THAT ABUSE THE SYSTEM!!!! I HAVE SEEN 20SOMETHINGS COME INTO OUR OFFICE THAT ARE HEALTHY AND ABLE TO WORK, BUT WANT TO BE ON THE GOVERNMENT ""TIT"" AND SIT AT HOME AND DRAW A CHECK AND GET FOOD STAMPS AND BE LAZY. THESE PEOPLE DO NOT DESERVE TO HAVE THE SAME ACCESS TO HEALTH CARE THAT OTHER HARDWORKING/TRULY DISABLED AMERICANS HAVE. GET UP OFF YOUR LAZY BUTTS AND WORK. IT'S NOT UP TO ME TO WORK MY TAIL OFF FOR THESE PEOPLE. I HAVE BACK PROBLEMS AND OTHER HEALTH PROBLEMS, BUT I GET UP AND GO TO WORK EACH DAY SO THAT I CAN HAVE HEALTH INSURANCE FOR ME AND MY FAMILY. IF A ""HEALTHY"" AMERICAN CHOOSES TO SIT ON THEIR BUTTS AND NOT WORK, THEN THEY ARE NOT ENTITLED TO GOOD HEALTH CARE. THAT IS WHAT IS WRONG WITH OUR COUNTRY TODAY, WE ARE ALLOWING PEOPLE TO SIT ON THEIR BUTTS AND LIVE OFF THE GOVERNMENT WHEN THERE ARE PLENTY OF JOBS OUT THERE TO BE HAD. BUT IT IS HARD LABOR AND THEY THINK THEY ARE TOO GOOD TO HAVE TO DO IT" Disagree "ALL PUBLIC ASSISTANCE PROGRAMS ARE A JOKE. THE PEOPLE THAT REALLY NEED THE HELP ARE USUALLY THE ONES THAT ""DON'T MEET THE OUTLINED CRITERIA"". AND THE ONES THAT, AGAIN, SIT ON THEIR BUTTS AND DO NOTHING ARE THE ONES THAT END UP WITH THE ""HELP"". " "HERE AGAIN, IS THIS GOING TO BE A PANEL THAT VOLUNTEER THEIR TIME. OR IS THIS GOING TO BE A PANEL THAT GETS MONETARY COMPENSATION. IT APPEARS THAT THE PLAN IS TO SPEND MORE MONEY ON PANELS THAN HEALTHCARE. " "* THE PROBLEM WITH OUR HEALTHCARE SYSTEM IS NOT THE DOCTORS, NURSES, AND OTHER EMPLOYEES. THE PROBLEM COMES FROM THE GOVERNMENT ALLOWING INSURANCE COMPANIES TO TELL ENROLLEES AND THE HEALTHCARE INDUSTRY THAT IF YOU DON'T ACCEPT WHAT WE DEEM ""IN LINE"" PAYMENTS FOR SERVICES RENDERED THEN ALL WILL BE PENTALIZED. THEIR PREMIUMS CONTINUE TO RISE AND THE DEDUCTIBLES AND OUT OF POCKET FOR THE PATIENT GOES UP AS WELL AS WHAT IS TAKEN OUT OF THEIR CHECK EACH MONTH TO COVER THE OUTRAGES PREMIUMS. YOU KEEP PAYING MORE FOR LESS. THE INSURANCE COMPANIES HAVE TO BE REELED IN AND GUIDELINES SET FOR THEM. START MAKING CHANGES WITH THE INSURANCE COMPANIES, THEN GO FROM THERE." 31491 08/25/06 MS Disagree "* There is no more of a ""right"" to equal access to healthcare than there is that everyone have the same house or car. There is no right to a car or even transportation, for that matter. The basic needs of food and shelter--and health care--should and ARE presently guaranteed to all. A person with a life threatening condition cannot be denied healh care anymore than they can be denied shelter. Granted the level of minimal shelter the GOVERNMENT provides is not what most Americans would find acceptable--but neither would the healthcare that was ""guaranteed"" either--not if it was affrdable. The country cannot afford to elevate access to health care to the level that those willing to spend the most can afford. The net result would inevitably be that the new general standard would be lower." Disagree Since when has the federal government been able to provide a more cost effective service than similar private sectors? Any perceivable savings would be gobbled up in an ever expanding bureaucracy. I've seen the military health care system--is is NOT what the US public would stand for. One need only to look to FEMA to see the US government is neither able nor should be tasked to coordinate such a national service. Disagree " ""Medicare, Medicaid, Community Health Centers, TRICARE, and the Veterans’ Health Administration""--one can't possibly believe these systems are something the private sector would want to emmulate. These organizations are being held up as models to control ""fraud and waste""?" Disagree "Persons at the end of their life would most likely be in the Medicare system already, so if there is a complaint with the quality of end of life service now, it rests with the system that is being touted as the fix." Disagree "* That is an overly broad statement woitout defining the ""core health services."" This country cannot afford to elevate access to health care to that which those with better resources can afford. The net effect of generalizing the system, would be to dismantle the higher echelon US healthcare services which are indisputably the finest in the world. Lokk at public education--does the US enjoy the world-wide reputation in education that we do in healthcare? Not even close! Those with the resources mostly eschew the failed public system--though they still have to pay (with taxes)for the blighted mess." Disagree "I wouldn't buy into this without specifics on financing. ""No specific systme is optimal""? I'd really like to know how the most indebted nation in world history is going to finance a service with a budget 300+% larger than the conglomerate cost of the military(at wartime) before I'd even be willing to consider this." "That is far too broad to endorse without specifying this ""core"" and how these services would be funded." "Yeah--FEMA, FEMA, FEMA!!!!" 31493 08/25/06 CA Disagree "* I disagree. The majority of respondents favored a national health program, which is “financed by taxpayers, in which all Americans would get their health insurance” -- period. This is a program that pays for all medical costs for everyone, and does not provide only ""protection against very high out-of-pocket medical costs."" It implies a program which is public, not private. A program financed by taxes would not require premiums, co-pays, and deductibles for financing and therefore out-of-pocket costs could be minimal. This makes “financial protection for low-income individuals” unnecessary. " Agree No response No response Agree "I agree if what is meant by the recommendation is a universal system of single-payer nationalized health care (NOT health ""insurance"") like the national programs of western Europe and other developed nations. " Disagree "The greatest efficiency in financing health care would be achieved by eliminating private health insurers where 30% goes to administration, advertising, and profit and replacing them with a single payer like Medicare, with only 2-3% spent on administration. " "There was a clear preference among respondents for a fully comprehensive benefit package. A core benefit package should cover all treatments deemed medically necessary by an individual’s health care providers to address physical, mental, and dental health. " "* If the political resistance to creating a national single-payer health care system in the United States prevents our achieving such a system, at a minimum the Medicare system should slowly be extended downward from age 65 and upward from the earliest ages. Also a Pre-Medicare Mid-Life Complete Physical Exam, paid for by the Medicare program, should be made available (and publicized) to every American for each person's utilization at a time of their choosing during the age 40-to-age 50 period. See my Citizens Health Care ""Gregory Wright Blog,"" at www.americansdiscusshealth.org/blog/89. " 31494 08/25/06 NJ Agree Agree Agree Agree Agree Agree 31496 08/25/06 MS Agree Agree Agree Agree Agree Agree "chiropractic care should be included in this ""core"" benefit package." 31498 08/25/06 NJ Agree America should provide the basic health care for all its citizens. Agree We need to establish facilities across the nation to provide basic health care to also inclue jperiods of national disasters. Agree All health care facilities should be intergrated to prove optimal health care delievery to all citizens. Agree considerations muct be given on how care is delivered to those individual whose family must work and are not available to help provide care for their family members. Agree Agree "A totally new system must be devised which should inclue money from: Health plans, Motor vehicles and worker's compensation." 31499 08/25/06 TN Agree Disagree I don not disagree wholly with this program. My main concern is the national healthcare record. The potential for negative consequences is greater thatn the benefits. I do agree with electronic health care records and the ability to quickly and effeciently obtain information but pooling all information into one healthcare database Disagree Agree Agree Agree * I believe a revision of all financial funding by the government needs to examined. I would like the government to take a serious look at a flat tax. I would be willing to pay more of a percentage of my income knowing that the tax is evenly distributed and governmnet spending is reported on a monthly or quarterly basis. Health care facilities are making this transition in reporting as a government edict and I think it will provide for a more educated and aware public regarding healthcare choices. The government should be just as responsible to its people the priority and emphasis needs to be placed on preventive services-prescription drugs-primary care-psychological and behavioral care-pt educvation and management of care-acute care. Psych/behavioal and addiction care should recieve the ssame if not more emphasis in the new program. We are finding in scientific research that the link between these issues and acute and chronic disease states are linked. 31500 08/25/06 MS Disagree Disagree Disagree Disagree Disagree Disagree The government should stay out of people's lives as much as possible. 31503 08/25/06 KY Agree "Desire individuals to be free to choose own doctors What about those who fall ""between the cracks"" in this scenario? Need national database so don't over-immunize, especially among migrants, immigrants, etc." Agree Desire to keep ethical aspects unique to each institution. Network okay as long as it is used for intended purpose. Individual care and their understanding of it must be priority Concern about too much paperwork or technology effort over patient care. Agree "Must be accountable to public in terms of money spent per person, etc. Emphasize reduction of fraud and waste in administration and clinical practice" Agree Rural areas are a concern especially the need to network and have people in urban settings aware and knowledgeable of what is happening in the surrounding rural counties for services. One person to coordinate all services rather than one person for each service. Agree Those who can afford healthcare should be asked to pay something like a sliding scale based on income. Agree Seems appropriate All institutions to remain unique in their values on beginning of life and end of life issues. The above data was discussed with twelve other people and submitted as group comments. I coordinated that dialogue. 31504 08/25/06 MS Agree "I feel health care should be for everyone that WORKS! Even those that are poor should peform some form of ""work"" to help off set the cost." Agree This sounds like a great idea as long as ALL forms of the health care are represented. Agree Agree Agree It becomes a matter of pride when one works for what he receives. If every AMERICAN worked for the same goal we would have the best of health care!! Agree "As I have mentioned on a previous comment, it is important that ALL work for the better of our health care. Even the poorest should have to work to off set the cost. Giving services away makes them less valuable and demeaning. " "* If I understand the core health services, it will include and not limit Chiropractic care. If we see the destruction of Katrina and all the support for the health care the Chirpractic community contributed, it would be ashame to exclude them from the total health of this country. In a recent article about rebuilding New Orleans it mentioned all the help the Chiropractic community has and is doing to help ALL the workers who are doing the manual labor. As long as Chiropractic care is included, I would agree with the above statement." I hope for the Over-All health of this great country that certain health care providers are NOT excluded from this form of a health care system. 31506 08/25/06 TN Agree Please do whatever it takes to support this proposal. Many thanks. Agree Agree Agree Agree Agree 31507 08/25/06 AL Agree Agree Agree Agree Agree Agree "If it is important enough to us, we seem to always ""find"" money, be it for a war that costs billions every month, or for putting a man on the moon. The health of all Americans should be important enough, as well. I, for one, am fine with using tax money for this purpose, even if it means paying in more taxes. However it is financed, I will support this ideal, both personally and with my vote." "It is a shame that the United States does not take care of it's people. We should take a page from the books of the other developed nations that do have programs like this in place. Personally, healthcare has been a struggle for my family. Recently, my husband's employer doubled the amount withheld from employees checks for insurance, due to increased cost. " 31508 08/25/06 TN Disagree I believe that there should be catastrophic coverage for everyone; high out-of-pocket costs is not the same. Agree Agree Agree Disagree I believe this should only be for US citizens. Disagree "In my experience, it is very difficult to define a core set of health services in a group setting. Think this has to be cost driven in some way, or it could bankrupt the government. No public service has ever cut out services." 31509 08/25/06 OH No response Agree "This is long overdue. YES, I support integrated community health networks" Agree YES! do it! Agree This is the right thing to do. Agree Do it NOW! Agree It's about time this is happening. 31510 08/25/06 MS Agree There is a growing need for protecting and providing for all Americans. Cost however is prohibitive. I am for trying to accomplish your ideals. Agree My biggest concern is getting too much control for the government. I am not sure how to be efficient in this while providing the care. Disagree "At this point, I am afraid that we are talking about more beaurocracy." Disagree This is too big for me to agree with without discussion. Agree Agree "When talking about core benefits, I believe chiropractic is important. A majority of patients have not have had chiropractic services and don't realize the vital role chiropractors play in health. Those who have benefited would definitely see the necessity to have Chiropractic as a core benefit. " "This subject is important, but very complicated. I appreciate your work. I am cautious as we move forward toward these goals." 31513 08/25/06 PA Agree Health care is an important concern and should be addressed by government. Agree Agree Agree Hospice choice is very important. Agree Agree Use a substantial portion of our defense and war-related budgets to ensure health care. Reduce defense and war spending. Respecting healthcare choices at the end of life is very important. 31514 08/25/06 CO Disagree "* I think this recommendation is very loosely worded and don't believe a National program solves the problem. I'm not sure how you define 'all Americans'. Are you referring to all citizens, registered citizens, people with ssn numbers, etc. I also think that 'very high' out of pocket costs and 'financial protection' is ambiguous. The first is extremely variable depending on peoples financial scenarios. Does financial protection mean 'free', discounted, rebates, etc? I agree there is a problem with high costs but this recommendation is a bandaid on the wrong end of the problem. " Disagree "The federal governmnet does not have a track record of solving healthcare problems very efficiently. I'd like them to work to establish guidelines, but not be driving specific solutions. " Agree Agree Disagree "Same comments as recommendation number one. What is the definition of ""American"", ""participates""? Does that mean ""everyone"" living in America will help ""pay"" for a system that supports everyone equally? Part of the problem is uninsured (by choice), use services today which drives costs for those who do buy. " Disagree "I would assume that 'most people you heard from' were not the people that have financial barriers to buying healthcare/insurance. If you look at the uninsured are they willing to make 'additional financial investments"". If so, then perhaps we are on the right track. Core benefits that are for all Americans should be paid for by all Americans." "I think that the overall objective is good, but there are many holes in the recommendations. They are too broad and not specific. The ambiguity will limit the effectiveness and the actions needed to implement the recommendations." 31520 08/25/06 MN Agree I agree in principal but we need to be able to contol costs too. I would support a universal MINIMUM coverage but the high out of pocket expense protection must be evaluated according to some ability of the government to pay. The Oregon plan of the early 90's was a good one but it forced folks to make difficult choices. Agree Agree Agree Agree "Again, we need to define what is a benefit and what would require additional funds from the individual" Agree Somehow the patient needs to be responsible for the cost. Get the third party payer out of the room trying to manage the provider-patient relationship. 31521 08/25/06 MS Agree Agree Agree Agree "This is a good first step, but needs to be developed further." Agree With the addition that everyone should pay something. Agree "Everyone needs to participate in paying for this system since everyone wants to utilize it. Understanding that everyone's contribution should be based on their financial ability, then the fairest tax is sales tax. If you spend one dollar or one million dollars a percentage is allocated to healthcare." 31522 08/25/06 NY Agree I really think we as a country need to have core healthcare at the latest 2012. We need to really start working towards this goal because soon only the uber-rich will be able to afford healthcare. Pharmacutical companies do not need lobbyists in Washington. The amount of money pharmacutical companies are making off of the elderly and really sick for their medication is just criminal. Agree Agree Agree Agree Agree 31524 08/25/06 OH Agree Long overdue. I agree Health care professional for 45 years in Nursing practice Mothers and Newborn populations. Agree Agree Agree Agree Agree 31527 08/25/06 OH Agree "If we are interested in a safer world, we should put time and money into inclusiving protecting the human rights of each person especially those who a poor and victims of violence and war." Agree We need to be true to the qote on the Statue of Liberty in providing health care for each person. Agree Agree Agree All is the key word--at present we have an in group with many options and the ignored. This is a terroist type situation. Agree Those who have more wweath should consider it a priviledge to assist those who are without such resource. The group needs to include persons for all areas and economic groups so each groups needs ar represented. 31530 08/25/06 IA Agree "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " Agree "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " Disagree "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " Agree Agree "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " Disagree "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " "Too complicated. Follow, economist and co-director of the Center for Economic and Policy Research, Dean Baker's suggestion: ""The goverment could simply open the Medicare system on a voluntary basis to any employer or individual who wanted to sign up. The Medicare program could charge standard insurance rates based on age, and compete with existing private sector plans."" The Conservative Nanny State, page 99. " 31531 08/25/06 CA Agree I propose a single payer system. Disagree I propose a single payer system Agree I propose a single payer system. Agree I propose a single payer system. Agree I propose a single payer system. Agree I propose a single payer system. I propose a single payer system. 31532 08/25/06 MS Disagree "* While this is a well-worded concept, likely with good intentions, I believe it would serve to erode quality healthcare in the U.S. The reason the U.S. remains on the pinnacle of medical care with a system envied by other countries, is the lack of socialization. I have seen patients cross over from Canada after a Stroke to obtain our health care (I mean within hours of the stroke). I have experience with the German system of healthcare, with the three major providers, and all citizens, save the very rich, required to participate. These systems and their shortcomings speak for themselves. When I need my hip replaced, or my brain MRI, I do not want to wait for permission, or for a number. I have no experience of people lacking healthcare coverage, with Medicare, Medicaid, and the pro bono care provided by conscientious physicians. Yesterday a local hospital provided me with five leukocyte-antigen blood filters for a patient without any health care coverage, for free. It demanded a phone call from me. " Disagree See above. Agree Disagree See above. Disagree See above. Disagree See above. See above. "* I live in the poorest state of the 50 states. My state, by income, provides more for charity than any other state. Our people make less, and give more. And our health care system works better than most, because we have so little ""managed care"". Most people give, just like during Katrina, and they leave the government for governing. If you do not know the role of private giving during Katrina in Mississippi, you should inform yourselves. Katrina made landfall in Mississippi, not New Orleans. But we do have a different way of doing things here... Yes, lower personal income, and more charitable giving. Think about it." 31534 08/25/06 MS Disagree financial responsibility for healthcare is the responsibility of the individual and their family. The governments role should be that of providing a spartan safety net for the minority of Americans who can't afford care(eg Medicaid). Disagree "Once again, ""uninsured"" does not equal ""vulnerable"". Some Americans with the ability to pay for health insurance opt not to. It is not my responsibility as a tax payer to providecommunity health networks, especially on a federal level." Disagree "* ""Using federally-funded health programs ... will promote"" should likely read, ""Using federally-funded health programs ... will force"". The govenment should be cautious in its use of its programs used to care for the elderly(Medicare) and poor(Medicaid) to change healthcare. Reimbursements to physicians from federally funded programs have dropped precipitously over the last 15 years. Many physicians already limit the number of Medicare patients they treat. Some, especially dermatologists in my community, don't participate in Medicare. Using these pitifully funded programs to promote change will unlikely be successful and may lead to a mass exodus of providers from Medicare participation, especially in fields with short supply and high demand, such as neurosurgery." Disagree Disagree Universal coverage will lead to universal low quality care and access to care. Disagree "Medicare is a disaster. There is no means testing. Therefore, regardless of income, those 65 and older recieve essentially a blank check from working Americans. This is an entitlement program that has proven impossible to stop. Expanding the federal government's involvement in healthcare will inevitably lead to further entitlements(eg prescription drug plan) that our country can't afford." "All of these programs sound like giant and expensive steps towards socialism. This is a country, built largely on idividual responsibilities and ambition. I'm concerned that all of the steps above which involve increasing federal involvement in healthcare will lead to a less efficient, more expensive and lower quality health care system for all. Just look a the Medicare disaster." 31537 08/25/06 TN Agree THIS WILL BE THE GREATEST EVENT THAT EVER HAPPEN IN AMERICA. Agree Agree Agree Agree Agree 31538 08/25/06 MA No response No response No response No response No response No response "I noticed that the majority of the people who attended the Community Forums is predominately ""white"". What steps can be put into place to increase the racial/ethnic diversity of the participants?" 31540 08/25/06 TX Agree I think that no U.S. citizen should be without medical insurance. Ever citizen needs to have medical protection for their health. Agree Agree Agree Agree Agree 31543 08/25/06 IL Agree Agree Agree Agree Agree Agree 31544 08/25/06 WA Agree "* I agree with this recommendation. Further, I support a single payer system to avoid billing abuses. I also support the notion that any physician trained in a medical facility that receives any government funding must serve in the public sector for a fixed term prior to opting out to see private patients only. Pharmacies must be a part of this nationalized system, to control drug costs. Care will necessarily be rationed. There should be particular focus and expenditure on neo-natal and early childhood care, with rationing of care in the last months of life, often the most expensive to society. " Agree "I agree, in particular the FQHC concept: many health issues can be addressed by complementary providers and devolved practitioners (nurse practitioners, for example or alternative therapies with proven results). " Agree "European countries, for example, have successful preventative health care programs--an ounce of prevention is better than a cure. In this country, urgent resources ought to be dedicated to early childhood nutrition education and a form of unearned income credit applied as a supplement to help disadvantaged families provide better nutrition to their young. " Agree "Rather than grow a new industry to service the weight of boomers, it makes sense to review end of life care directives to physicians; here too there needs to be rationing--more money dedicated to the beginning years of life and less to the end. " Agree "This is beyond doubt--not merely from a humanitarian point of view but from a pragmatic one. Studies show that a majority of the homeless are on the streets because of debt, and this debt has primarily resulted from medical costs they could not meet.This destabilizes society and wastes potentially productive lives. " Agree Deduct from earnings in a progressive levy. "* Many HMOs already have a core plan in place--GP, preventative screenings depending on age/ethnicity/family history, and all referrals done through the GP. GPs should neither be rewarded monetarily for the number of tests they order, nor be restrained by the system from recommending necessary follow up tests. Here the watchword would be conservative care--without the incentive to order a procedure, the patient might recover with rest, diet, exercise. It's the doctor's job to recognize when that would not be enough, and not the cost controllers to second guess them. " "America needs to ensure a healthy and educated population to compete with emerging economies in the East. Presently, over half the population is overweight or obese and our education system, for the many as opposed to the few elite, is woefully inadequate to the task. " 31545 08/25/06 GA Agree Agree Agree Agree Agree Agree 31551 08/25/06 FL No response No response No response No response No response Agree "If citizens can effect change, they should also be in charge of it. Too much government with false representation going on already. It is a disastrous situation, but I am more in favor of less fear mongering and more access on a positive outlook on life without constant crisis." "Plese explore health insurance for catastrophic illness with health savings accounts (how, I don't know) and more community health centers and clinics with people working in them who actually care. We are in this together and need to take more personal responsibility - either in establishing a means to pay for health care, or even more important, just quit running to the hospital for things that a few aspirin and some aloe vera plants can take care of." 31552 08/25/06 OH Agree Agree Agree Agree Agree Agree Health Care and Education should be a right not a privilege for the rich. 31553 08/25/06 NJ Agree "Health care coverage is not only good for us as individuals, it will be good for businesses." Agree Agree Agree Agree "We are an advanced nation. We should be able to go the doctor when we need, not wait to save up enough money to go." Agree 31554 08/25/06 CA Agree "I think the US should adopt a universal health care system like Canada's. It is sad that the ""richest"" country in the world does not provide this basic human need/right to it's citizens." Agree "I think the US should adopt a universal health care system like Canada's. It is sad that the ""richest"" country in the world does not provide this basic human need/right to it's citizens." Agree Agree Agree "I think the US should adopt a universal health care system like Canada's. It is sad that the ""richest"" country in the world does not provide this basic human need/right to it's citizens." Agree "I think the US should adopt a universal health care system like Canada's. It is sad that the ""richest"" country in the world does not provide this basic human need/right to it's citizens." 31556 08/25/06 OH Agree Agree Agree Agree Agree Agree 31563 08/25/06 MO Agree "I think this recommendation is a good idea. Health care should be provided for all persons in this country. It should not be a privilege for those Americans that can afford the always rising high cost of health care. Health care, rather, should be provided for persons of all classes in this country." Agree "Yes, even the uninsured and persons living in underserved areas deserve basic access to health care." Agree Health care costs need to be controlled in this country and this recommendation sounds like an excellent start. Agree Palliative and hospice care is an excellent service that should be available if individuals choose to do so. Agree "This is an excellent recommendation. All Americans should have access to basic health care services. It is sad that in this technologically advanced country there are still individuals who do have access or are unable to afford such basic health care services. However, careful attention must be paid to assure the system is not abused. " Agree "Financing health care for all Americans is an important point that must be addressed. I certainly agree that financing strategies should be based on principles of fairness, efficiency, and shared responsibility." This also sounds like a very good idea! I think it is important that all Americans be able to receive BASIC health care needs. I think the core benefits will have to be clearly and thoroughly explained in the benefit package. I commend you all for all of the hard work you have put into this thus far. Good luck with the process! I will be interested to see how things turn out! 31564 08/25/06 WV Agree "We need one, national program to reduce the enormous waste in the current, very complicated system." Disagree "I think it's time to set up a public system that covers basic costs for all of us. A small private system for the rich could exist outside this system, but need not be integrated with it." No response "This proposal uses so many vague, abstract terms that I can't figure out what it would actually mean in practice." Agree "If we are to have both universal access to care and increased taxes to pay for it, there needs to be savings. Some would come from eliminating the enormous waste in the current system, including the costs of having an unnecessary industry (insurance) between users and providers. But some could also come from a frank national look at death and how we want to deal with it, and an end to the waste of resources in keeping people alive, but miserable, for a few more months." Agree "It would be cheaper to provide health care than health care COVERAGE. One payer--the federal government, would eliminate the disincentive to hiring caused by our mistaken system of employer-provided coverage. It would also probably be cheaper to have all providers on salary and eliminate the absurdly high percentage of hours going into billing." No response We could easily pay for this without raising taxes--a; we have to do is reduce the amount of money we spend developing new ways to kill people. We should also invest in public education to encourage healthier habits. It's not clear to me what the purpose of this is. "I am a case manager in a community mental health facility. I spend at least 80% of my time on paperwork, justifying what I actually do for my clients, and with endless new rules and restictions in the name of ""accountability,"" this keeps getting worse. The system we have is surely the worst possible one!" 31565 08/25/06 OH Agree "No one should ever have to lose their home, their retirement savings, college savings for their children, or be forced into bankruptcy because they or a family member got hit with an expensive illness. " Agree Agree Agree Agree Agree "* 1. Don't be afraid of a single-payer system if that what it's going to bring needed efficiencies to the system. Paperwork and administrative overhead costs in our private insurance system is three times the same costs in Medicare, for example. Money should be spent on care not paperwork. The same can be said for HMO profits and executive compensation packages-- affordable healthcare for all is far more important. 2. The government should be allowed to negotiate drug prices to bring prescription costs down. Again, affordable healthcare for all is more important than private sector profit margins. " 31573 08/25/06 MA Agree I strongly agree with this recommendation. Agree Agree Agree Agree Agree I agree strongly with all above recommendtions. 31574 08/25/06 OK Agree Health Insurance Premiums must be affordable and pressure should be placed on Drug Companies to lower the cost of prescription medication! Agree The monitoring of best practices must be realistic and streamlined in order to minimize the providers time spent on documentation resulting in increased time spent with clients/patients. Agree "Again, the risk is that bureaucratic government agencies often foster increased paper work and redundency of information. Many talented providers leave the profession to unreasonable paperwork expectations!" Agree None Agree No comment. Agree 31577 08/25/06 CA Agree Health care is a basic right. Agree Better integration would save costs because people would get health information and treatment before conditions became chronic. Agree Health education is the best prevention. Agree Agree "Lack of access to health care is a drain on all sectors--business, schools, & govt." Agree 31581 08/26/06 OR Agree It is an excellent coverage of health care for all people living in the U.S. Disagree I don't think the government will be very cooperative and I wouldn't trust them to develop a fair program for all people's health care needs Agree Yes. This would be an effective system if one can get the government to promote it and vote to pass such a system. Agree Yes. I definitely agree with this recommendation. But it covers only a specific targeted group who are at the end of their life. Agree Amen!! This is the way it should be. This covers it all. Agree Not as strong as some previous recommendations I like that this includes also dental health! I'm very appreciative that you have taken it upon yourselves to do this. Thank you and I hope one of these recommendations are successful. We are one of the few so called enlightened countries that doesn't offer health care for all its citizens 31583 08/26/06 WA Agree Agree Agree Agree Agree Agree Health education should be a key part of any healthcare plan. Teaching people how to live a healthy lifestyle is so important in preventing illness and aiding healing. This one area that could save billions if not trillions of dollars over time. 31586 08/26/06 WA Agree Agree Agree Agree Agree Agree 31594 08/26/06 CT Agree "The current ""system"" is strongly biased towards those who are in the privledged sector of society. This sector is influenced heavily by race, gender, and family histories which stretch back for generations. It has created an injust situation that must be fixed." Agree "Yes, there needs to be a comprehensive, national approach to solving this problem. Leaving it to individual communities will mean it gets fixed in the wealthy/privledged communities, and gets worse in the underprivledged communities." Agree "The current insurance/corporate based system of billing (copays, covered amount, uncovered amount, adjustments, etc..) has created a fraudlent system where the true cost of healthcare is impossible to see. And it leaves those outside the insurance/corporate system facing unrealistically high costs. Needs fixing." Agree Everyone deserves to face death with dignity. This is a part of healthcare that has received inadequate attention and I applaud that it is being included. Agree "This is a fundamental right. Every person has inherent worth and dignity, regardless of their financial status, and we should treat them as such." Agree "There is more than adequate wealth in this country to fund a basic healthcare network, it is just a matter of what the national priorities are. It should be funded at the national level through taxes, probably corporate/business taxes." The issue of healthcare is a fundamental justice issue which must be resolved in this country. 31597 08/26/06 WA Disagree "The Seattle hearing on Feb 25th stated overwhelmingly that preventative, primary, pallative, and high cost emergency care ALL should be covered for everyone. Low income and high income individuals should have the same health care available. Please read the site reports!" Agree "A nation-wide, comprehensive network to assure service for all, and to monitor quality and costs is very valuable. But this is not a safety-net. If everyone has the right to equal care, this network is structured to cover everyone." Agree Yes. Agree Yes. Disagree "Participants at the Seattle meeting on Feb 25th did not want ""core"" health care services for low-income and those needing subsidies, with wealthier people buying additonal services. Everyone needs full-coverage with emphasis on preventative and on-going care as the best way to reduce catastrophic crises and costs." Agree "We need to get away from employer-based financing since it denies portability in so many cases, and causes lack of coverage for so many people." Yes "The Interim Report included this recommendation: “Guarantee financial protection against very high health care costs.” There follows a complicated plan of insurance companies getting something called “reinsurance” for people who have high costs. Then comes a list of Policies A, B, and C with subsidies for low income folks. Where does this come from? Only one person out of 300 at the Seattle session on Feb 25th was worried about insurance companies’ profits." 31598 08/26/06 WA Agree This is not a radical concept but something the rest of the industrialized world implemented decades ago. Agree Agree These goals make sense for any health care system. Agree Agree As one of the most powerful nations in the world we should be able to implement a strategy that cares for the health of our citizens. No response 31602 08/26/06 PA Agree Agree Agree Agree Agree Agree 31604 08/26/06 IL Agree I HAVE health insurance and I cannot afford to go to the doctor! I had pneumonia in January and I am still paying the bills. Agree Agree Agree Agree Agree 31605 08/26/06 NC No response Disagree The FQHC governing board requirements are necessary to ensure adequate community input into developing the local community health care delivery system. No response No response No response No response 31610 08/26/06 CO No response No response No response No response No response No response "* The experiences of other countries should be our number one teacher. We need a financing mechanism where the whole country is the risk pool, where for-profit companies play no role in providing the necessary health care we need, where we publicly fund the system, and where we set a cap - e.g. 17% of GDP - on total health care expenditure. We would need to prioritize which care fits within the cap as fiscal responsiblity is very important. The resistance would be huge from the vested interests especially in the private health care industry but I see no solution to providing decent health care at reasonable cost as long as for-profit companies play a big role. They divert hundreds of billions of dollars into their corporate pockets. And their management inefficiencies and fragmentations introduce huge waste through their lack of country-wide planning for resources and provision of services." 31612 08/26/06 NC Agree "SURELY the richest country in the world can provide at least some kind of effective health care system for its citizens. At the very VERY LEAST, we should have a system that would prevent anyone from becoming impoverished or destitute due to unbearably high medical costs." Agree Agree Agree Absolutely! Agree How could a nation as rich as ours do anything less? Agree "Our elected representatives should go out into the real world and listen not just to those fortunate enough to have good health care insurance, but to those millions and millions of persons who have inadequate health insurance or no insurance at all. " 31618 08/26/06 VA Agree Good idea Agree I agree Agree I agree Agree Agree Agree 31625 08/26/06 OH Agree "* MAKE THIS AN OFFICIAL PART OF THE RECORD. EMAILED TO YOU AUGUST 25, 2006 Your recommendations must also include thge following patient right of access to medical care, specifically, that hospitals amd medical centers must be prohibited by law(s) and/or by regulation(s) of the United States Government, from banning any patient from medical care, in retaliation against the patient for making a complaint about or questioning his or her medical care. The Cleveland Clibic in Cleveland Ohio is known to sometimnes retaliate against patiients who complain or ask questions, by banning them. No lw prohibits the Cleveland Climic, or other hospitals, from that nasty, unethcial practice of banning patients in retaliation. The Cleveland Clinic has been known to ban patients from the all the approximately dozen hospitals and medical clinics it owns in Greater Cleveland, in retaliation for any legitimate complaints or questions by a patient. The Cleveland Clinic would probably lie and deny it. Apparently the hospit" No response No response No response No response No response 31626 08/26/06 MI Agree "Having good health care for all Americans is cheaper in the long run, as preventive medicine is less costly than curing a disease." Agree "Many alternative medicines should be available, as many alternatives are as good or better than traditional practices and often far less costly." Agree "There is evidence of many mistakes made by Medicare in billing, which coses a waste of money. Doctors should be making the decisions for which therapy is appropriate for each patient. The medical model is outdated, there are many factors in play affecting each persons health. Diseases, medications and therapy affect each person differently. There are few blanket treatments." Agree It is everyone's right to have a quality of life that they can attain through whatever method is appropriate for them. Agree No response 31630 08/26/06 GA Agree "* I agree with this recommendation, however, if health care is a right, then I believe that as a citizen of this country each individual must be held accountable for the behaviors that affect health. In addition, after reading the American Nurses Associations additions to the recommendations, I have one disagreement. They fully support the changing of ""health care for Americans"" to health care ""for citizens and residents""(illegal immigrants). This recommendation I do not agree with not because as a health care professional, I do not care about illegal immigrants' health, but because the scope of the illegal immigrant problem must be contained not encouraged. I do not believe that our country could economically bear the burden of providing health care for ""free"" to anyone who wishes to come to America. I am disappointed that this was a recommendation by the ANA, and feel strongly that the wording should not change as originally stated by the Citzens Healthcare Working Group." No response No response No response No response No response 31631 08/26/06 MO Agree Health care is a social good that is too important to leave to an imperfect market; keep solutions public as much as possible. Agree "Quality health care should be available to all regardless of income, location, etc." Agree Prevention! Consumer-focused info! Fraud/waste reduction! Excellent! Agree "This seems to be a very humane benefit that any industrialized nation should expect and provide and it seems to me that it has been neglected so far. This seems to be a good, fair start." Agree "Strongly agree. An individual's health and access to preventative, acute, etc. care should not depend on their income, class, zip code, employment status, etc. Once again, a social good vital to the strength of our society that is too important to be left to an imperfect market system." Agree I'm troubled that it seems to be assumed that health care costs need to be as high as they are and further assumed that they will keep rising. How do our costs compare to other industrialized nations? The high cost itself seems to be systemic problem. "Be sure that most weight on medical decisions is with medical professionals, not those who sign the check. Also, I assume that vision is also covered; thought it was odd to highlight dental and not vision." "I applaud your apparently open process and recommedations that seemingly come from the results of that process. It doesn't seem like ""more of the same"" and hope this is the start of true reform that will protect and support all of our citizens." 31638 08/26/06 CA Disagree "Comprehensive insurance should cover ALL medical costs, not just very high or catastrophic costs. Health insurance, unlike othere kinds which may never be needed (fire, accident, etc) will sooner or later be needed by evereyone. If the risk pool includes everyone, there is more than enough money to give every American high quality, reliable, and affordable insurance." Disagree " Initially, the Fed. Govt. could look at current state efforts toward universal coverage and facilitate those that in tune with the public's opinions re expanding health care coverage. Improving Medicare and using it as a model might be most useful. " Disagree "Movement towards a national healthcare plan financed fairly by taxpayers would be more efficient than patching up the existing system, which is so wasteful and inefficient at reaching the goal of universal coverage with a single superior benefits package available to all.. This is what the public clearly wants." Agree Agree Agree "The most efficient financing is eliminate private insurance companies whose success is more often profits at the expense of health care. Standards for care, formularies, reimbursement rates for providers, etc. should not be made by for-profit companies. Twenty to 30% overhead compared to ;ess than 5% for Medicare speaks volumes." "Core benefits should be fully comprehensive--covering all necessary treatments for medical, dental, vision, mental health needs. " "* The following article pretty much sums up my views on health care coverage--our California effort is remarkable and even if the Governor does not sign it, history will have been made. The business community is rapidly realizing that it is better off paying their fair share and getting out of the health care business altogether. Businesses that cover their employees' health care costs are at a competitive disadvantange re those that don't. I and many others hope you add a timetable for the government to act. Thank you for all your hard work, concern and efforts to make this a democratic process. I hope your final recommendations include the clear preferences for a universal, government funded, privately delivered system similar to the Conyers bill and to SB 840 in California. California Dreamin’—of Single-Payer Health Insurance Katrina vanden Heuvel BLOG | Posted 08/22/2006 @ 11:13am (She is Editor & Publisher of The Nation magazine) What will happen to me if I get sick or injured and ca" 31639 08/26/06 NJ Agree Agree Agree Agree Agree Agree 31640 08/26/06 OH Agree As a registered nurse specializing in cancer care I see patients who didn't receive care early in their disease because they could not afford it or did not have health insurance. Currently the uninsured are the only ones paying full price for their health care. Insurance companies are able to negotiate prices and deep discounts on supplies ect with health care providers. Agree Agree "Many consumers have no ideas what quality is. Consumers receive surveys that ask about the lobby, food, decor and little about the care they received. I know that consumers have difficulty knowing who is delivering care to them even after being told. I would like to see a choice of health care providers. Not all health care needs to be delivered by a medical doctor. " Agree Agree This will not be easy. I believe we should begin letting everyone know the hidden costs of not having core health care. Agree 31643 08/26/06 CA Disagree "I agree in part, but the point of covering all Americans in a National Health plan is missed here. A single payer plan is the most effective to guarantee coverage for all, not just protecting low income folks, but all of us. Heath care should not be something we have to beg for. Presently most of the uninsured are working people who either have no plan, can afford no plan, or are only working part time." Agree "Again, this does not go far enough. This dances around the issues that are most important. We really need to come into the industrialized word, not live in the 19th century!!" Disagree "These programs are fine, but there should be a single payer plan to cover everyone. This will encourage working by partially disabled and poor people who are presently better off living on the edge of poverty than not receiving medical care, particularly if they have any conditions that require constant medications or treatments." Agree Agree "And do not forget that single payer is the most efficient and cost effective system, IF administered well." Agree Expansion of the Medicare single payer system to encompass all would be the most seamless - with refinements of course. "In part i agree, but do not believe it should be limited to CITIZENS." 31644 08/26/06 UT Agree it is also a diar need for american business to be able to compete Agree Agree Agree Agree Agree 31651 08/27/06 VA No response Disagree I oppose modifying the Federal health centers program. Other provides to vulnerable populations should either comply with thecommunity nature of the health center program or other programs should be created specifically for circumstances of these other providers. No response No response No response No response 31655 08/27/06 DE Agree "I agree with universal healthcare, but believe it should be a public funded endeavor. The last thing we need is another private insurance company making billions of dollars in profit." Agree Agree Disagree "There are so many ""for profit"" hospice companies right now. The last bullet point seems to be a way for these companies to get more ""funding"" to increase their profits even more. I do not feel more money needs to go into this system- it seems to have adequate funding already." Agree Agree 31656 08/27/06 MI Agree Agree Agree Agree Agree Agree 31659 08/27/06 NY Agree Disagree The community board requirement for FQHCs ensures that the community health center is responsive to the community that it serves. It is a requirement that is not onerous to meet and will continue to maintain the committment of FQHCs to the patients that they serve. Agree No response No response No response 31660 08/27/06 LA Agree Disagree "* I disagree that community health center governing board requirements should be modified to allow FQHC without consumer majority boards. I work with both consumer and non-consumer boards of organizations providing community based health care. Non-consumer boards tend to be dominated by larger or geographic interest than those of the direct community that is to be served. While that may be acceptable in many circumstances. It is not consistent with the theme of FQHCs that are governed by and representative of the community. This feature makes them very responsive to the interests of the community and not likely to be absorbed by boards that may be distant by culture, ethinicity, interests or geographic interests." Agree Agree Agree Agree 31661 08/27/06 MD Agree Disagree "Modifying the Federally Qualified Health Center Model is the wrong strategy and would unravel the only good idea going on in public health. Health Centers are governed by their patients, who don't just pay, but have a say in their health care delivery. You can't find that anywhere else in the health care system-- don't take it away." Agree Agree "hospice works well so long as it is supported-- but more resources are needed so that terminally ill patients have support and comfort, as well as their families." Agree the message of having a health care system in which every one participates seems to run counter to your very wrong headed suggestion to modify the federally qualified health center model. Agree i don't mind paying higher taxes to support health care-- i do mind my tax dollars paying for the war in Iraq. 31662 08/27/06 IN Agree "Coverage must include on-going treatment after a catastrophic medical event. Therapies must be covered long term. My family was told that insurance does not cover long term therapies because ""studies prove"" that treatment ""only"" the first few months after an event such as stroke is effective and ""worth while."" This is false and our loved one suffered terribly by the decision of our insurance company to ""cut off"" additional care. The ""system"" did not work for us. " Agree "We have found that as more money is spent on awareness and prevention, less money is spent on survivors. An example is stroke awareness and prevention. There are thousands of stroke survivors in the US who do not receive help after the first few months and are being told the powers that be have determined that available resources should be spent for education instead of treatment." Agree see above Agree Agree Agree "* My family experienced a catastrophic medical event that wiped out all of our assets and resources because, although our family member survived because of excellent emergency room care, within 8 months our insurance company declined to cover any more rehab or therapy. It seems criminal to us that a life is saved at any expense only to have the means to regaining a productive life become an impossibility without help. Why bother to save a life at any cost if there is no hope for receiving the meds and therapies that restore quality of life after the first year?" Spiritual and emotional health are also included in a definition of well being. 31664 08/27/06 MI Disagree "* Hello -- I see the words ""national program"" and ""federal government"" at the core of these recommendations. I respectfully submit that to these eyes there has been a direct relationship between the increased involvement of the federal government in health care over the past thirty years and the decline in quality of our country's health care over that period. As in so many areas, government involvment is not the solution. These Interim Rrecommendations, if implemented, will, in my opinion, only make health care problems worse. Rather, consider the following: One way to encourage more efficiency in indigent health care would be to allow a tax credit (not diduction) for charitable contributions to provide care for indigents. Tax credits (not deductions) would be a huge incentive to higher bracket taxpayers and would make sense for taxpayers in all brackets. Another thought is to make every effort to get the middle-man out of the process. Third Party Administrators are an anachronism of World War" Disagree See first recommendation. Disagree See first recommendation. Disagree See first recommendation. Disagree See first recommendation Disagree See first recommendation. See first recommendation See first recommendation. 31666 08/27/06 MI Agree Agree Agree Agree Agree Agree We need universal health care funded through our taxes-this shoukd be available to all citizens. 31667 08/27/06 VA Agree Disagree I strongly urge the Working Group to reject Recommendation #2. It is dissappointing to learn that the Citizen's Working Groupd would propose such a drastic change. The Health Centers program has been highly successful for 40 years due to the patient majority community board requirement. Please do not recommend taking the community and patients out of community health centers - patient majority governing boards are crucial to the continued success of the program. Thank You! No response No response No response No response 31668 08/27/06 DC No response Disagree Waiving the governing board requirement of the FQHC program will drastically change the quality and effectiveness of the health centers program - the largest network of safety net primary care in the nation. I strongly disagree with this recommendation and I urge the working group to disregard this recommendation. No response No response No response No response 31669 08/27/06 MO Agree "I agree that all people should have access to health care. As a nurse, I know that the cost of some hospital procedures are very inflated. I think that institutions that provide services should be required to validate their costs." Agree I agree with this recommendation. I believe that as an incentive for local communities who provide improved access to health care for the vulnerable populations there should be a benefit for the community that is able to maintain adequate health care accessibility to the people. Agree "I agree with this recommendation. I am concerned about the security with using an electronic medical record system. I agree with consumer usable information about health care services, but who is going to provide information with an unbiased approach?" Agree "I agree with this recommendation. More and more we are seeing health care teaching facilities incorporating Cultural Diversity classes in the curriculum. America is known as the melting pot and the people of the United States cannot, nor should they be, lumped into one way of doing things for all." Agree "I agree that all Americans have affordable health care. I disagree that there should one specific core of health care services. If the services that are provided are so many, how can that be cost effective? I think a better way of handling core services is to plan several core packages that will include different services for different age groups and let individuals choose which core they prefer. " Disagree "While the idea of providing health care for all Americans, there are still going to be people who will fall through the cracks. Is it reasonable to ask for someone to pay, even nominally, for health services when he/she can't afford to feed his/her children? Is it reasonable to ask those who have worked hard to make it through life to pay for people who make no effort to support themselves?" "Eliminate the ""core"" benefit package. Provide several ""core"" packages based on the age and gender of individuals. Why should the elderly be provided with benefits that include pediatric immunizations, and men be provided with prenatal care? " 31670 08/27/06 NY Agree It is totally contrary to American claims of global leadership for this nation to have a health care system with third-rate access for its citizens. Agree Access to quality health care for ALL Americans should be the goal. Agree "I agree, although how this will be achieved is a huge challenge." Agree "It is crucial to sever the linkage between employment and health care coverage, both for economic competitiveness and universal access reasons." Agree "Perhaps this should be the first recommendation, since it underlies the other five." Agree "In devising such a system, decision-makers in the legislative--and executive--branches of govenment will need to put advancing the public good above the benefits currently accruing to ""players"" in the health care marketplace. This will require clarity of vision and courage--qualities currently scarce among decision-makers in Washington." "Hard to do, but necessary." "I'm glad you've done this work of measuring public opinion on this crucial issue, but I share the skepticism widespread among my colleagues and friends that the powerful (and wealthy) economic interests that benefit from the current patchwork program will (once again) make changing the system virtually impossible." 31671 08/27/06 DC Agree "I believe that health care is a right and should be available for all citizens of our country. I feel ashamed that we have so many people who don't have access to care because they are uninsured. Freedom is a right we cherish, but fear of financial devastation as a result of an illness is not freedom. From my perspective as a taxpayer, based on studies that show cost savings as a result of access to preventive care, I see no reason to deny that access to anyone. " Disagree "* I don't agree that the Federally Qualified Health Center model be changed to accomodate other community-based providers. This would allow other organizations who don't have a user-majority board to have access to 330 dollars. As a board member at a health center in Washington, DC, I've seen first-hand the importance of having a majority of users of the health center on our board. Users have a different perspective that is essential to understanding how patients perceive the program. Non-users, while valuable because of their knowldege, don't have the insight gained by actually being served by the center. " Agree "Here again my support for this recommendation comes from the perspective that access to quality health care, of course not access to poor quality care, is a right of our citizens. Also as a taxpayer, I expect dollars to be used to provide the greatest benefit. The recommendation supports those values." Agree This is the only way to go if a citizen values freedom. We don't fight wars to be told that we can only access certain services if we have the money to pay for them. The definition of freedom is broader than having access to markets of goods. Agree This is what freedom is all about. Agree Yes. 31672 08/27/06 IL No response Disagree "As a health center CEO, I cannot underscore the importance of the concept of our consumer board model. This ensures we are delivering the appropriate care to the appropriate population and provides invaluable, immediate feedback to health center management." No response No response No response No response 31673 08/27/06 GA Agree Agree Agree Agree Agree No response 31674 08/27/06 WI No response Disagree Strong belief that the documented success of FCHFC's owes much to the dedication of community minded Board Members....Thanks for your consideration.. No response No response No response No response 31678 08/27/06 MI Agree "Stop nation-building in Iraq and focus on Americans. Our health, our schools, our infrastructures are crumbling - we need a voice in Washington to help Americans NOW. " Agree Agree No response No response No response 31690 08/27/06 NM Agree "This is not rocket science. EVERY other ""developed"" country in the world, and a fair number of ""under developed"" countries as well, have solved this problem that our fixation on private insurance is keeping us from the obvious solution. I support single-payer universal health care on the Canadian, European, ... model. Why is this so hard to understand?" Disagree "Forget this bureaucracy. Single payer! (Do you know that social security has miniscule overhead costs, computed as a fraction of the funds handled? It is just about the most efficient program in America, far more efficient than anything in the private sector!)" Disagree "Forget this bureaucracy. Single payer! (Do you know that social security has miniscule overhead costs, computed as a fraction of the funds handled? It is just about the most efficient program in America, far more efficient than anything in the private sector!)" Agree Incorporate into single-payer system. Agree "And how do we do this? Single payer health care, like every other developed country." Agree "If we discarded our current wasteful system in favor of single payer, we could save $100 BILLION dollars a year AND cover all the currently uninsured. This IS NOT ROCKET SCIENCE!!" "How many times do we have to tell you that SINGLE PAYER UNIVERSAL HEALTH CARE must be the gold standard against which you compare all other recommendations. Do this honestly and there will be NO CONTEST! But every government panel, like yours, just omits this option from day one. INCLUDE IT!!!" 31694 08/27/06 MI Agree How can this country be considered the home of the free when we are enslaved by our own bodies? Just because someone is low income doesn't mean that he/she doesn't have the right to free health care. Agree Agree Agree Agree "* I have been a college student for 5 years and had no medical insurance ever since I turned 18. This was a nightmare as I incurred astronomically high medical costs for even routine procedures such as bi-yearly dental cleanings, annual pap smears, office fees for colds/throat infections, etc. I know many other students who have suffered majorly during their college years too because of no health insurance. How can the USA not offer health insurance when Canada does to its citizens? This is pathetic and an outrage. " Agree "This should include things such as vision, hearing aids, chiropractic visits, podiatric visits, etc. No major part of the body should be neglected thus forcing the patient to suffer because their ailment isn't covered. So eyes, ears, backs, and feet should count just as much as any other body part. " 31698 08/27/06 ND Agree "I believe it essential that all residents of the United States, which includes immigrants and migrant workers are included in this recommendation. As long as they are in this country, usually working for meager wages, health care should be provided as a means to prevent worsening of illnesses which usually occurs because of the sick person's unwillingness to care due to the high cost. " Agree "Yes, a federal agency to oversee it's involvement in the health care and a strong coordination with the local community would be extremely vital. I believe in putting more emphasis on the local community; implementing and watching how each progam works, getting immediate feedback and close interaction with directors." Agree "Yes, I agree that there should be a fluid connection between all agencies, hospitals and patients. The case for referrals and access to specialists needs to have a high priority. Where a patient needs special treatment, the channels to accomidate that should be wide open, to find and recieve the best treatment available. " Agree This needs concern for the delicate attention that people dying and their loved ones need. Agree "We are the richest country yet we have high infant mortality rates and other bad areas regarding health care. I believe we also need to extend this to immigrants. A good chunk of industry runs on undocumented workers that have no benefits in jobs that are strenuous and sometimes dangerous. Much of the money they make they send back home which leaves them with little to spend on such ""luxuries"" like health care." Agree "* Everyone needs to look at a health care as a right, not a privelege or a luxury. It's neccesary for a decent community and way of life. Just as the 40 hour work week wasn't a ""right"" around until 1950 or so, health care has been seen in corporate America as an incentive that can be added to a benefit package to entice prospective employees. In lieu of that perspective, it usually was added or dropped depending on how much profit the company was making. Making money has always been the bottom line and Congress certainly ensures that that continues. " 31707 08/28/06 FL Disagree "We need a national health care program and it definitely should not be private. The Medicare program is administered well, and can be duplicated. Health care costs are too high because of private insurance companies." Disagree This recommendation requires too many layers and time spent determining eligibility. We need national health insurance. Disagree See previous comments Disagree See previous comments. Agree "The US is far behind other developed nations in our health care program administration. We need more than stop gap measures...a health care overhaul is needed. This process continues the ""patch it up and go on the same way as before"" model." Disagree Universal coverage should be the goal and those who have more are capable of paying more to subsidize the care of those who have limited income. "Just another stop gap measure. A major overhaul of the system is needed. My concern is WHOSE ""evidence based science"" they will rely on. This government doesn't seem to believe in science anymore." 31709 08/28/06 IL Agree "* These recommendations if implemenntd would certainly help, so I have said that I agree. They do not, however, go far enough. I believe that medical and dental care should be taken completely out of the hands of the private sector. Health care should be a not-for-profit business. We need a single-payer system that cuts through the paper work waste and provides for all out of our taxes. Our taxes should go to health care, not war. There is plenty of money for this if we stop our wars and preparations for war." Agree I said that I agreeded because this is better than what we have now. But what we really need is a single payer system available to all. Agree I agree with this because it is better than what we have now. But we really need a single-payer system that is free to all. Agree I said that I agree because this is better than what we have now. But all health care provision should be public. Agree I said that I agree because this is better than what we have now. But I believe that all health care should be free to everyone. Agree Shut down the military and we will have plenty of money for universal coverage. "I do not think this goes far enough, but agree that it is a better-than-nothing transition." "Demand a change in priorities in the national budget. People earning over $100,000 a year should pay more in taxes, and the military budget should be cut. No more imperialistic wars." 31710 08/28/06 TX Agree we definitly need this! I myself am 49 years old and I am the sole caretaker of my 24 year old disabled son. I am not able to work so therefore I have no health ins. I cannot afford private ins. I believe this is a vital area. Agree Agree Agree Agree Agree "if i became ill with cancer, what would i do?" 31712 08/28/06 MO Agree Agree Agree Agree Agree Agree 31713 08/28/06 FL Agree Agree Agree Agree Agree Agree 31714 08/28/06 MT Agree "I have, to ddate, the best health care a person can have. I am retired military, over 65. With exception to payment for medicare I pay nothing. What I don't have and need is dental insurance." Disagree "The feds are not able to do this , make this a state program with federal funding" Agree "Maybe, I still feel that if anyone can screw up a good system its the feds." Agree Agree Agree Don't mess with mine. The financial arrangement that I have is great. 31715 08/28/06 TN Agree all healthcare companies and for profit hospitals should be required to participate or face penalites. a non -partisian group should be created to grant eligibility without previous healthcare or health record. Agree "i agree with the comments as stated, the federal goverment should have the financial burden . " Agree "yes, the VA should support its own with federal tax dollars" Agree No response Agree The same tax dollars that are used to support the space program should be reallocated. The ceo and cfo of all major healthcare compainies should be tasked with being involved. 31718 08/28/06 FL Agree not only law makers should have good medical. Agree Agree Agree Agree needs mor help with those who have lost limbs Agree we should start taking care of the u. s. first instad of Iraq 31720 08/28/06 IA Agree Agree Agree Agree Agree Agree "If we can afford wars, space exploration, and the high cost of government benefits for its elected officials how can we not afford fundemental health care for the individuals paying for all of the above?" 31721 08/28/06 MN Agree reduce&control drug prices Agree Agree Agree Agree Agree 31722 08/28/06 NJ Agree Agree Agree Agree Agree Agree 31723 08/28/06 NC Agree We need something done in this country about Medical Insurance for all Americans we are paying a high price for Insurance and Hospital bills.People can't afford to go too a doctor or Hospital we need too wake up American. Agree Agree Agree Agree Agree 31726 08/28/06 VA Agree Agree Agree Agree Agree Agree 31727 08/28/06 ND Agree We should have a national health care system like all of the other industrialized nations. Set it up simular to Social Security and cover everyone. Agree Having a national heallth care system would solve most of these areas. Agree Let the federal govnerment negotiate the price of prescription drugs for medicare and medicaid just like the Veterans administration does for its members. Agree Agree This is a very good plan. I hope to see it implimented. Agree "I agee, but I hope it is sooner than later." I just hope it goes into effect as soon as possible. I think this are good recomendations. Universal health care is the only way to go. And make everyone pay according to their financial ability. 31728 08/28/06 NH Agree Developing a national healthcare plan/program as is established in countries such as Germany may prove to be highly beneficial to the overall health of our country Agree Agree Disagree Agree Agree "I do not support the idea of supporting those who are not willing to work because they fair better on the welfare system. In order for this to be fair for everyone, there must be strict to non-existance of welfare. Or at least revamp the current system to weed out ""lifers""." 31730 08/28/06 WA Agree "* However, a single-payer system is preferable in that adminstrative are more easily tracked and controlled. Along with this, as a healthcare provider, I feel a massive overhaul of resuscitation policy is integral. That is, not everyone should have CPR and most premature babies should not be revived. High emphasis should be placed on hospice type programs. Transplant program criteria should be tightened. The cost for post-transplant care is incredible for very little quality or length-of-life return. Universal healthcare with all participants contributing will increase the resource pool and reduce taxpayer burden." Agree "A set of basic healthcare standards for universal coverage to focus on primary care and preventive care. Basic health standards would not include transplants, custodial care for catastrophic illness e:g long term ventilators for paralytic illness, and medical brain injury (like strokes)" Agree "The above mentioned programs are generally very good. The problem lies in trying to save everybody instead of triage. Some patients are simply not viable, and should kept comfortable as they die with dignity." Agree This reflects my above comments Agree A set of basic services with extraordinary services available to those who can afford them or have some particularly extraordinary societal significance. Agree "A universal healthcare, single-payer system would remove hideous salaries from the equation. The current third-party payer system does not hold practitioners or administrators responsible for waste or unbalanced compensation. Billing systems increase overhead for physicians who truly want cost-effective medicine. " Already outlined in the comments 31732 08/28/06 WA No response Disagree Do not modify the FQHC program. No response No response No response No response 31733 08/28/06 IA Disagree No response No response Agree This recomendation should be #1 on the list. Moving it to position five indicates that the Working Group finds it to be less important. No response No response 31735 08/28/06 TN No response No response No response No response Agree "This so called great nation should, no must provide health care to all. A ""christian"" nation would jump at the chance to provide such care. Apparently, this is not the case with this nation. Most of us are too busy trying to accumulate more wealth for ourselves and to h--- with our fellow man. " No response 31737 08/28/06 OR Agree "It's been said, ""once you have your health, you have everything,"" but when times get tough, health care is the first on the cutting block. The US government needs to rethink their priorities, and make universal healthcare a priority! " Agree "Expansion of school-based health centers is also needed. However, the federal government needs to fund any mandates!" Agree No limitations should be imposed on any of these federally-funded health programs. Agree This is an important component in the continuum of healthcare. Agree "Healthcare access should be a right, a given. Afffordability is key for services, treatments, and especially pharmaceuticals!" Agree "I agree funding should be a shared responsibility, with the exception of the low-income, disabled, and chronically ill. Medicaid should serve these populations. I disagree with using ""sin taxes"" as our nation's number one health problem is obesity and it would be hard to tax all the ""sinful foods"" that contribute to this." "Core benefits should also include catastrophic health circumstances that may arise on one's life (e.g., Multiple Sclerosis and diabetes)" "Healthcare costs must be contained not only for low-income people, but for all,to prevent economic hardship individually and nationally." 31738 08/28/06 SC Agree I very much agree. We take care of other countries. Let's start taking care of our own people. Agree Amen Agree Amen Agree Amen Agree Amen Agree Amen Amen "Take care of the USA citzens first,Then other counties." 31740 08/28/06 IN Agree "The problem is the government will be involved. If the government is involved, there is a high risk of errors, lack of oversight, and fraud. Suddenly, since the government is paying the bill, what was a $80.00 procedure is now a $200.00 procedure ($400.00 hammers anyone?). Nobody in government questions it. Americans get ripped off again. I agree with the general idea, but getting it to work in practice is another matter. " Agree "If it is done properly and oversight is maintained, and it does not become just another bloated and ineffective beaurocracy, then yes, I agree. FEMA in theory is supposed to work, but in practice, well..." Agree "Again, it sound good. Just make it work! Reducing fraud and waste would be nice for a change." Agree "This all sounds good in theory. If you ahven't noticed yet, I am skeptical." Agree Disagree "Why not trim the fat that already exists across the board? Sure, it all takes time, but why not start now? Congress could take a pay cut to help pay for it. They have all the healthcare they need. If they really care about the American people as they say, let them take the hit. And the President too. And what about the end-of-fiscla-year money that gets wasted in the military every year? I've seen it and it is outrageous. " "I am not so crazy, pardon the pun, about including mental health coverage. Honestly, I think mental health is terribly important but I do not really want my tax dollars paying for someone who ""needs"" to see a therapist every week for the rest of his or her life. Maybe I am being myopic or cruel, but I think some people will abuse that and go to a therapist when there really is little or no need." 31741 08/28/06 VT Agree Agree Agree Agree Agree Agree Insurance & drug companies need to give up some of thrir profits. Malpractice insurance needs to be less of an influance on the price of service. Find a way to reduce the cost of educating our Doctors and encourage them to provide services to all. We need mor primary care doctors. 31744 08/28/06 FL Agree "i wholly agree with the above recommendation, however it should include guarantees in the form of social programs that highlight early on effective measures, behaviors and lifestyle choices that enhance and make vibrant an individuals health, ultimately serving to minimize health compromise or crises...." Agree "i agree and would suggest to also include severe punishment of those that would abuse any such system established for the welfare of all....in other words, ENFORCE the law and prevent abuses and violations that decimate and make ineffectual the health care system overall from concept to delivery... " Agree i am in total support and agreement with a 'dignity in death' approach any individual would desire nearing the end of life... Disagree No response Disagree 31745 08/28/06 AR No response Disagree It is important CHCs remain community oriented and based. This is an important component of CHC we need to maitain. No response No response No response No response 31746 08/28/06 CT Disagree "Every time the gov. establishes a new health care program my private plan takes away it's benefits and defaults to the gov. plan which is not as good as mine was!! For example: Medicare Part D, all this did was dump me and my wife in with all the ""prescription uninsured"". Now we are in the ""donuthole"" where we would not had been had a better job been done in preparation for implementation of this dumb Part D. All this did distribute the problem to every one!! " Disagree "Ditto my last comments! Do something for the people who need it, not those covered already." Agree Disagree Ditto my earlier comments! Disagree Not if it means I get we get lumped into something that is not as good as what I have today! Disagree We Are against all gov. meddling any further! "Sounds good, but, will just be another redistribution health care costs to cover those who cannot afford it. " Gov. stay out of our lives!! 31748 08/28/06 NY Agree "* While the goals above are good, they are not sufficient: we can and must do more. We know what to do and how to do it: all that has been missing is the political will. What passes for a health care system in the US is a disgrace--and a costly one. We pay more per capita than almost all developed countries--and get less per capita for the privilege. Among other wastes, 10-20% of payments to private insurers go to administrative overhead, as opposed to care. Why? Because we continue to rely on a fatally flawed ""employer-based"" health care coverage system, and we do this even though we have in place another system that provides good coverage and good physician choice, in which only 3% of funds used for administrative costs. That system is Medicare, and the answer to the question of how to establish a national health care program is Medicare-for-all. (I do not include in this recommendation expansion of Part D; while a drug program should be available, it should not be one that primarily benef" Agree "* Most of the Working Group’s Interim Recommendations are good and deserve support. However, its recommendation to “expand and modify the FQHC concept to accommodate” other providers is wrong-headed and should be removed. FQHCs are community-owned providers of health care, whereas the Working Group’s recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition, justifying it the same way that FQHCs had to – not try to get that support in a back-door fashion by destroying one of the most successful federal health programs anywhere. To the best of anyone's recollection, modification of FQHC statutes was not a part of the discussion or recommendations made at those meetings, and I would like to know why and how such a recommendation was developed and " Agree Agree Agree See my comments to the first recommendation above re instituting Medicare-for-all. Disagree "Per my comments to the first recommendation, above, a first step that could be taken now in the transition to a system that includes all Americans is to allow Americans under 65 to buy into Medicare." No more study groups are needed. They just waste time. Medicare is the model. Adopt it now. 31750 08/28/06 AZ Agree Agree Agree Agree Agree Agree 31751 08/28/06 OH Agree "* There are too many people that are dying way too soon because of the cost of medical coverage today. Dealing with Cancer, I see first hand what happens to people with no insurance coverage or very little insurance coverage. The politicians need to quit taking money from the medical and drug people and require that people with no coverage to be able to afford the help they need instead of the medical profession sticking it to them because they have no voice or and insurance company to lobby for them. There is something major wrong when a drug company is constantly advertizing on TV for a drug and then charging $6000 for one shot. It is a very tough thing for Cancer patients to watch when they know they can't afford such a thing." Agree We need to be able to network and get coverage at an affordable cost so people can get quality treatment. Agree Agree People need to be able to use these quality services when that time comes to deal with that time when life is coming to an end and they can choose to die with dignity. Agree Everyone should be able to have affordable health coverage. I know what I pay on the open market today and most people on a fixed income have a real problem handling such a situation. I believe it is time our politicians pay there fair share and have no better coverage than they provide for the american public that is paying the bills. Many politicians are millionaires and are one of the biggest welfare drags on our economy and it needs to change. Agree "I pay in excess of $10,000 for health care coverage for my wife and myself today and I believe every politician in this country needs to pay for there health care coverage just like I do. After all they are the people that allowed companies to drop health care coverage because it does not affect there coverage. People that can afford to pay need to pay there fair share just as I do." 31752 08/28/06 SC Agree Agree Agree Agree Agree Agree 31754 08/28/06 WA Agree I have used other countries care system and they are excellant Agree Agree I have seen and lived in health care systems that lack in some areas. Agree Agree please insure that they are US citizens Agree 31756 08/28/06 OH Agree the key here is all Americans...citizens of the United States only Agree We have in the past gave financial and medical aid to other countries...its time to give to the citizens of the United States Agree Agree Agree Agree i agree with the concept but i really would limit the government to financial aid and have a commission made-up of non political medical individuals in each state. 31757 08/28/06 CA Disagree "* Before taking any action, the committee needs to look into the areas outside of the major metropolitan areas. Rural communties often lack sufficient doctors and facilites. That will have to be taken care of before throwing more money into the system. I am disabled and on Medicare and TriCare For Life. I face rejection from various medical providers because of the level of payment being made to them. That should not be allowed. Low income status does not make it impossible to acquire medical insurance. Not staying on a job that provides benefits causes that. Make it less attractive to be chronically unemployed! Medicare Part D is a mess! It allows everyone on Medicare a basic level of assistance, but it often falls far short of the needs, expecially since the drug companies have increased their prices to cover what is lost via Part D. Prescription assistance plans are available through the drug companies, so why not let the public know about them and reduce the prescription bill that way?" Agree "Stop the duplication of effort by each of the above recommended groups. Move point number four to point number 1. Take care of the human needs first, then worry about how to manage it. Do not eliminate non-traditional sources of care. Many of us benefit more from those than from tradional sources." No response "No to point 1. The AMA and other professional associations have controlled health care in this country for far too long. If their methods were the ""best"" then fewer people who be dying from things that can be cured. Integrated health care systems may work nicely in cities, but they do not help those of us who live in rural communities, nor do they provide much for those who are less able to travel to a source of care. " No response "* Point number 1 could be accomplished without addition funding. This is the computer age! Our medical information is already shared with insurance companies and other interested groups. Cultural information is something that the patient should be communicating to the doctors and others. Training in medical schools needs to be returned to the kind of care that doctors used to give. Doctors need to be taught to listen to their patients first -- ahead of the labs and supposed ""experts"". Most of us have lived with our bodies far longer than most doctors have been in practice. We know more about ourselves than the doctors will ever know. A medical school degree does not make one a doctor. The Hospice system works, but is rarely funded adequately, nor is there always space available for those who need it. Work on that." No response "* No, it should not be a matter of national policy. It should remain as it is. Lower income groups should have plans available to them, but forcing a huge financial strain onto those who are going to foot the bill is wrong. We pay more than we should now! Health problems are a risk for everyone. How does one prepare for a disaster? I have ""adequate"" insurance for health care. The end of life situation is something that all of us will face. Plan early, or keep a .45 close at hand. No one is forced to extend their life by artificial means, which is what most ""end of life"" situations turn into, after all. Allow us to choose when we will die along with the option to be kept alive and ""stored"" somewhere." No response "No! Absolutely not! this paves the way for increasing all of those little tax sources, but provides no restrictions on how they are used. I don't want to pay more taxes! Investments in health care technology happen anyway and are a huge deductibel expese to hospitals, clinics, etc. Why throw that burden onto the taxpayers? Are you seriously expecting the taxpaying public to subsidize the medical care industry any further than we already do? Get serious!" "Get a grip! Many of us seek alternative care because we cannot afford the supposed ""expert"" care available now. Traditional methods do not always work. Leave room for alternatives and stop letting the AMA and insurance companies to determine who gets what." "* There is no right to health insurance. Changing our health care system to look like the organized medical systems in other countries won't make it better. It will further insure that those with money can get what they want while those less financially able get the left overs. I don't want methods used on me that are ""approved"" if they are ineffective, which is what is going to happen with this plan because I am covered under two govenment-provided plans. I am still a citizen and I have the right to choose what I want. The government does not have the right to control the care I receive or from whom it is received,." 31759 08/28/06 IN Agree Agree Agree Agree Agree Agree 31763 08/28/06 TX Agree LEGAL United States Citizens Agree LEGAL Unnited States citizens only Agree Agree Agree LEGAL United States Citizens Agree 31764 08/28/06 TX Agree Out of pocket expenses have become outrageous. Agree Agree Physician practices with their own Imaging modalities need to be eliminated - self referrals to increase their revenues should be outlawed. Agree Agree Agree 31765 08/28/06 CA Agree "Our current Health Care system is out of control. Even those individuals that have health insurance/coverage it doesn't cover all costs associated with routine & preventive care. Those w/o health coverage, it's financial disaster." Agree Agree Agree Agree Agree 31766 08/28/06 TX Agree Agree Agree Agree Agree Agree "* I did not see your definition of ""American"". If we quit providing free medical care for illegal immigrants, we could very easily repair our healthcare system for our legal citizens. I work in a hospital that is providing increasingly more free health care month after month. We can't do that forever and keep pur doors open. If more and more hospitals are closing because of this, then we will soon be like the third world countries that these illegals are coming from. With all the diseases they are bringing with them, that may happen sooner than any of us want to realize." 31768 08/28/06 GA Agree Provided that quality of life is improved. Continued high cost health treatment without possibility of some measure of normalcy for patients simply runs up medical facility/caregiver costs. Agree Provide it encompasses US citizens and legal imigrants/visitors (in an emergency)only. Agree Agree Agree "Again, providing for US citizens and legal imigrants (visitors in an emergency)only." Agree "Go to ""flat-tax"" for income taxes and identify line item within that venue to fund health care based on incomes. No regressive taxes to fund health care." Core benefits already promised to veterans should be the basis for those already entitled; additional level of higher cost coverage to be available at US citizen's option. "Emergency room treatment for those uninsured persons, regardless of citizenship status, should be local government responsibility in partnership with local health activity/company. Bonafide emergencies only! flu shots and over-the-counter remedies not for ERs." 31771 08/28/06 NC Agree Agree Agree Agree Agree Agree 31773 08/28/06 NE Agree "I can not even afford to go to the doctor at all and at my age, nearing 50 years of age, I really need to. I know I am not alone. Many people young and old share in my plight. We have many concerns! Donna C. Matthews" Agree We must do this. Just a month ago my sister passed away from a fatal heart attack and this was totally un-neccesary. Agree Agree Agree Agree "Financing is absolutely neccesary for many americans because the low-income, the elderly, and those who have serious health problems can not afford the high cost of medical services!" 31774 08/28/06 na Agree Create a basic payment scale for Medical providers. Many providers charge exorbitant out of pocket fees for initial visits. Here in the Virgin Islands there is no regulation that prohibits physicians for double billing; this occurs quite often. Agree "I also believe that the use of Mid-level practitioners who are highly skilled and have the proper certifying credentials should be encouraged. The studies done by the ANCC, ACNP and other show that use of Nurse Practitioners decrease the cost and health care as well as ensure that low-cost effective health care is delivered to those who are most in need. " Agree "Again, standardize care practices can help to decrease the incidence of many of the most common diseases. Best use practices should be encouraged." Agree This is a crucial issue. Incentives to health care providers who wish to train in hospice related issues is important. I believe increased funding will help to encourage qualified workers in this arena. Agree Access of Care should also include identifying the constraints which prohibit people from getting the care they need. I know of many working poor who can not afford to go to a doctor and they do not have insurance. Americans should not be denied health care for any reason. Agree "I believe that while many can contribute, there will be many who cannot contribute because there salaries are so low. If we ensure that there will be a fee based on a sliding scale showed be tried. Also, this recommendations should be sent via regular mail to ensure that all populations of our coutry have equal access to inputting there comments and concerns." "Have the homeless and mentally ill populations been considered? How will we reach them? Will there be any agencies who will specifically target these populations? If so, how will we collect the data that deals with this population of people as they are transient. " 31775 08/28/06 CO Agree Agree Disagree Agree Disagree Disagree 31777 08/28/06 NY Disagree "There should be a public baseline program cobering All americans. Private, supplemental, insurance could be allowed, but the program should be inclusive for all and publically funded." Disagree "* Again, the concept should be a public baseline with private supplement. HHS should be the lead agency and decisions should be made on the basis of science and funding, not ""political"" consicerations so prevalent in the ""faith-based"" governmennt of today. This means the standards of care and practice of the physician dhould include necessary funding for abortions, stem cell research, birth control and other scientifically appropriate courses of treatment. This recommendation sounds to me as very politicized and serving the giant private health care business community and not the people in need." Agree "* Thus seems like a worthy goal. However, recent history shows that extreme care must be taken with any health information system. Generally this flows from the HIPAA legislation and will require the Federal Government to standardize several definitions across various jurisdictions. It will require steady, professional leadership and commitment and will, in my opinion, only be ultimately possible in a singlr-payer publically funded Federal program. Close attention must be paid to fata security (see the Veteran.s Administration data thefts for the reasons why). The basic goals of the HIPAA legislation and some sort of national identity card will be necessary." Agree "A worthy goal, but it should be a public first with privat supplement program. The necessary integration and standardizatio will come about anly with a well administered singlwee payer system." Agree "With this as the first, primary and controlling premise the only viable way to fulfill it would be a public baseline program with private supplement. This basicall extends the right to ""life"" as envisioned by Jefferson in the Declaration of Independence." Agree "* I firmly believe that fianancing needs to be through a Federal baseline program for all americans and tat we shoulkd begin moving in thaty direction immediately. One of the principles of provaye insures is to minimize their risk by elim8inating those most needy. The reasining here is not to be cruel, but rather to maximize returns to investors. The premise of any rational program of health care is to include everyone and have everyone pay into the program and thereby increase the risk that someone in the insusured ranks will have to avail themselves fo the benefits. Leaving a scattered multi-payer system which allows some providers to ""cream"" the pool of risk, puts us where we are right now, all right maybe slightly better. The single-payer ystem prevalent in many industrialized countries today, coupled with a scirntificapproach to public health education, rather than our current values-based approach (abstinence, just-say-no etc.), coupled with the comprehensive Health Information system to allow continui" A worthy goal and one we need to undertake 10 years ago. "* Generally the goals are fine although they reflect, in my opinion, a pre-determined bias toward a system which I feel is inherently unworkable because the base motive tend toward profit ratther than health care. I feel that the coporate insurers and various other political groups will wok to torpedo these efforts like they did the proposal of the first Clinton Administration (I belive most of the goals listed here, were also listed there). The core question in all of this is the will of the American people and their government to ensure the primary goal of health care for all americans is provided. Jawboning and the ""bully-pulpit"" only go so far. If we can afford a billion dollars a week to kill people in war, we should be able to redirect that effort toward health care and use our better natures of diplomacy and entrpeneurship to be able to use the market economy to be able to learn to live with others on the planet and take care of ourselves at home. The rue way to ""win"" the war onterror (as if there re" 31778 08/28/06 MO Agree "I agree with this because many americans go without coverage. If they don't seek medical treatment do to no coverage, then the long range expense will be associated to them losing what they have worked so hard for or costing the government much more expense by them going on public aid. There should be a sliding scale based upon income levels for health care cost." Agree Networking and not segrogation is the answer. Treat all equal. Agree Makes since to me. Agree Treat all equal. Agree I believe all should be covered. But if a person is capable of working they should have to work to help conserve the cost and pay based on income. Even if they have to volunteer to some degree. Agree The financing should be monitored and audited like any business entity. One must also consider the liabilities and also to whom pays for them in figuring out the system. 31779 08/28/06 OR Agree "I am a 100% disabled veteran and I cannot afford to provide my family with any health care because it is cost prohibitive. We subsist solely on my VA pay, as I cannot find any work because of my disability. At least try to help the veterans if you help any one." Agree "I agree as long as it's for Americans and not every illegal that can sneak over our borders, thus draining the system and leaving nothing for us Americans. " Disagree "I've seen first hand what cost control does to a VA hospital: you end up with people waiting so long in the emergency room that their wounds start to heal. Maybe that sounds good to Washington, and elected officials can pat themselves on the back saying how ""efficient"" the VA is. But there are VETERANS suffering AGAIN for this country, only this time it isn't our country's enemies inflicting the pain, it's our own people, and that makes the pain worse." Agree "Dying with dignity should not be cost prohibitive in a so-called ""civilized"" society." Agree "* I agree, we have a wealthy enough society that that policy can be put into place. How about rolling back some of those tax breaks for the wealthy that are making those six figure incomes, make them pay their fair share. That would help with this policy. Another way would be to keep the medical profession from gouging a person. How do people know they are even being charged fairly for their health care? There isn't a sign or a poster with their prices, nor is there a fee schedule online for any hospital's services. They seem to just come up with the numbers based on the doctor's yacht or mansion payments it appears." Agree Roll back the tax cuts for the wealthy. Take the money from the greed pirates like the Mr. Skilling's and Mr. Lay's of this country and put those billions towards the country's health. Dump the foreign war penchant. If you want to war with another country nuke them. Who's going to argue? And it won't cost trillions of dollars and thousands of lives. "* A core benefit package ideally would include dental and vision as well as basic health services. It would have just the things covered that make life less painful and better to enjoy. It would not include vanity service such as fat reduction surgeries or botox treatments. As fgar as mental health goes, I believe that there are in place already many state agencies taking care of that, and that could be annexed into the system being formed. There is a need for mental health, but it is not as great as the need to have a tooth pulled or cavity filled or and appendix removed or your beginning of life shots. We now have to re-eradicate childhood diseases because of the absolute torrential flood of illegal immigrants pouring into the country non-stop, bringing with them all the disease we got rid of long ago. The core benefits package should not be written in stone, either. There are cases where an individual may really need something tat isn't covered. So, a board of review should also be in place as well as an " "* First and foremost the Disabled Veterans of this country should come first. The reason is obvious. We facilitated the means by which this country remains free. We should be given the very best health care that is available. We should be treated with the dignity and respect that we deserve because of our supreme sacrifice. Anything less is a shame on our nation, and sooner or later this country will pay for the shameful way Disabled Veterans are treated. Great strides have been made in the last twenty years, but there is a long way yet to go. I hope America can find it in her soul to help those who gave so much, the Disabled Veteran, a better life." 31780 08/28/06 VA Agree "* At the heart of all the recommendations in this proposal and those following is the need for the health care industry - pharmaceutical manufacturers, hospitals, medical device manufacturers and others in the health care industry to lower their charges/prices. The net effect of all of this set of recommendations and a plethora of other studies and congressional investigations is an effort to feed an industry that has an ever increasing appetite for profit. They justify their ever increasing costs with a circular reasoning about each elements ever increasing costs put upon them by the element above them." Disagree This will lead to a layering of red tape and hoops to jump through as one goes from federal to state to county to city etc. bureaucracy. A layering of employees will only increase costs. An interface between federal to state to direct caregivers is all that is necessary. Agree "* I agree in part. As a veteran, I feel there should be no integration of Tricare into a grand melding of health care programs. Being over 65 I pay for Medicare A&B and have a back up of Tricare to cover expenses medicare doesn't. This alliance should be left alone. Messing with it will only either increase my costs or water down provided services. I committed 20 years of my life to my country. For that they promised health care for the balance of my life -free. That has already gone down the tubes for retirees. I must pay for what services I do get unless I travel 200 miles to the nearest military facility. And then I am low priority for care barring and emergency. Don't mess with the Tricare/Medicare alliance. I earned it." Agree Don't study it to death (pun intended). Agree This should have been the first recommendation and is the foundation (mission statement)for all following recommendations. Agree Income tax returns pinpoint income levels. Patient out of pocket expenses should be predicated on income. At the lowest levels services should be free. At the highest levels full costs should be out of pocket. "* This deserves intense study. The present plague of obesity will lead to future health problems. We nibble at prevention by removing junk foods from school cafeterias and vending machines. The junk food industry pledges to stop using trans fats etc. Fast food advertisers procalim ""I am full"" as an enticement to eat more of their junk. Education and perhaps legislation is needed to keep people from eating the jumk and keep the junkers from selling the junk. There is money to be made from selling healthy foods. " "Take a long hard look at the health care industry. Their exorbitant costs are not justified. high end medical technology justifies its costs on supply and demand. You're just not going to sell a lot of MRI machines. That, however, dos not justify charging 300 patients $3000.00 each for using the machine. If taxpayers can pay farmers not to raise crops, taxpayers can subsidize the costs of such medical technology - not the patients." 31783 08/28/06 GA Agree "I was disabled at the age of 38 years old. I am now 51. I have two heart prosthesis and unable to work. My medicine was expensive and the doctors gave me some samples but that did not last long. I have to go to the doctors every two months and it is a burden to have to pay high costs for medicine, a way to the doctor's office, and needing help from time to time. " Agree "It seems to me that the people up north, Washington, New York, etc. receive better accommondations to paying for health care, preventive measures, and medications. They know so much more than the people down south,in the rural areas like Twiggs County, Jones County etc....Start getting someone who knows about the rural south, and see what accommondations they need" Agree Agree Agree Agree "When these things are implemented, there should be someone watching over the people who are trained to know what help Americans need. Some people use the money and access to them and their families. They are cheating in the system also." "Finally, someone includes dental health with physical health. I am a civil servant retired, and with the health insurance that I pay for, does not pay anything for dental benefits. Being a heart patient, I have to get my teeth checked often, even my children get limited care." 31785 08/28/06 NV Agree Disagree "this leaves an opening for illegals to get free health care, if for U.S.natives or naturalized peoples it would be acceptable." Agree Agree Agree Agree 31786 08/28/06 NY Agree Disagree "* The third bullet should be removed. Due to the realities of race and socioeconomic status, this recommendation removes the decision making and the voice from the people and communities in which the FQHC's serve. This recommendation only serves to alienate the community and lead to inevitable failure to include race, gender, culture and socioeconomic status. If other providers want federal recognition and support, and they have no interest in meeting current FQHC requirements, then they should seek independent legislative recognition, justifying it the same way that FQHCs had to - not try to get that support in a back-door approach by destroying one the most successful federal health programs anywhere. Why and how was such a recommendation developed and included in the Interim Recommendation when it was not addressed in the community meetings. Once again, this is displaying poor management practices and going against the notion of best practices. " No response No response Agree No response 31787 08/28/06 FL Agree I would like to see a single payer system in the USA. Agree I would not want this effort to be a half measure that diverts attention from establishing a single payer system in the USA. Agree I would not want this effort to be a half measure that diverts attention from establishing a single payer system in the USA. Agree I would not want this effort to be a half measure that diverts attention from establishing a single payer system in the USA. Agree I would like to see a single payer health care system in the USA. Agree "I would be willing to pay more taxes for a single payer system, however, that should not be necessary given we spend about 13% of GNP on the current system and other Western decomcracies with a single payer system pay about 9%." There needs to be a strong commitment to prevention in the system that educates Americans about their personal responsibility in maintaining optimum health. 31788 08/28/06 MI Agree we must provide health care for all americans.all health concerns should be affordable to everyone.please dont forget dental. Agree Agree Agree Agree Agree lets not get too complicated and lets get going quickley on this matter.maybe you can get all Dr. give a fair discount to low income and then let the Dr. deduct his discount from his taxes so he wont lose any money.or maybe each Dr. and dentist could also commit to work for free 2 days a month in there own offices for Americans who dont have any money.preventive care would also cost the govt. a lot less money 31789 08/28/06 FL Agree "As a retiree, I am very concerned about the high cost of health care. My retirement annuity is reduced each month to pay for the health care coverage for myself and husband cutting into very much needed income. Then once used, I am out of pocket for the deductible and still have to pay for what the insurance company doesn't. Something has to happen soon as expenses continue to rise. " Agree Agree Agree Agree Agree 31791 08/28/06 TX Agree I fully agree that all Americans should have access to health care regardless of their income level and willing to pay if we can for those that can not afford it. Please let us do something now and not wait ten years for it to happen. Charles Culbertson Agree Please lets do it and not let party sides get in the way as most of the time it does.We need this and lets get it done now. Agree Let us all get togeather and do it for the sake of the american people . Agree Please help Agree Please Please do not wait 10 years to do something Agree "I agree with this, now let us get the professional people that can do it and do it fast with out a lot of beckering with different parties fighting each other as always happens and causing delays or never getting it done." 31794 08/28/06 CA Agree Agree Agree Agree Agree Agree 31796 08/28/06 NY Agree "America as a nation has an abundance of resources. Yet there are people within our beloved country that cannot afford to pay for healthcare. We should share our resources to provide healthcare for the marginalized individuals who need it most - the poor, the elderly, and the homeless." Agree Agree Agree Agree "I think ""and justice for all"" applies here because justice in America would be the sick being taken care of by the healthy, regardless of the cost." Agree Cut defense spending. 31797 08/28/06 NC No response American citizens should all have the medicine they need at an afforable cost. Other countries take care of their peoples health why can't U.S. There should be NO health care coverage for non citizens at any age. If you are not here legally you should not share any benefits of any kind rather it be health wefare etc. Pharmicitial company's should not be allowed to gouge the public. and they are! Agree Agree Agree Agree "* As it stands now In NC to qualify for medicade, income has to be like 3X's poverty level. For instance I get $625.00 S.S. I am told I could earn about $50.00 a week. At this age I could never earn enough to pay for supplement ins. and any prescriptions so in order to have the benefits I desperetly need I have to function as best I can at below poverty level. How ever foreigners can come here and get health coverage for family etc. be given grants to start a business. Is this fair to the people born in this country??????" Agree 31798 08/28/06 CA Disagree I feel all Americans should have access to health care but this would likely lead to a government single payer government run health care system. I cannot agree with policy until I see exactly how it would be implemented. Disagree "This is an attempt to further expand the size of government and waste more money on ineffectual studies. Worse, it attempts to absorb community efforts into the federal system" Agree "The government does very little to elimate fraud wast and abuse in these programs, relatively speaking. Aggressive action is required." Agree There should be a liberal policy for providing pain medication for such patients and care givers should be allowed to prescribe adequate dosages. Disagree This would virtually establish a government controlled health care system that has proven to be a disaster in socialist countries such as Canada. Disagree "This is socialism run amuck, if not outright communism. The government must not be allowed to take over health care in the US and the imposition of confiscatory tax schemes." "This another attempt at setting up a universal, socialist heath care system." "* 1. There should be aggressive actions to eliminate fraud, waste and abuse in Medicare and other government sponsered health care. 2. How can you implement any of the above when the government is already cutting back on fair and adequate payments to doctors and hospitals? The above propositions would only make a bad situation worse, unless of course taxes were raised through the roof, which if governments solution to everything. 3. I feel adequate health care should be available to everyone, but not through a government run single payer system. Perhaps dedicated health care vouchers or adequate government insurance would be acceptable." 31799 08/28/06 IN Agree I believe it should be a right for all Americans Agree Agree "Yes, these things must be done to insure quality of our health care system" Agree Ed & Support systems must be put into place for patients and families concerning end of life care and options available Agree Agree I believe health care again should be a right for all Americans. The system starting failing when healthcare became a money maker for large corp. america. Health care is a need and should not have high profits attached to the system. Universal coverage using the Medicare Adm. fee will cut down on the cost and help control spending whle covering all americans 31800 08/28/06 NV Agree I am 63 and my wife is 68 even with good health ins a large part of our income is spent on health care. Agree Agree Agree Agree Agree 31801 08/28/06 OH Agree Disagree No response No response Agree No response 31802 08/28/06 AZ Agree Agree Agree Agree Agree Agree 31803 08/28/06 CT Agree "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." Disagree "This only takes care of a small segment of the population and shifts costs to those with private insurance: Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." Agree "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." Agree "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." Agree "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." Agree "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." "Freeze all health care costs at current levels until a comprehensive health policy can be established. Freeze provider compensation, insurance premiums, and wages of everyone associated with the health care industry -- private and public, provider and insurers." 31804 08/28/06 CO Agree ONCE REACHING RETIREMENT AGE. BENIFICIAL HEALTH CARE COST ARE ECONOMICALLY STRAPPING FOR LOW AND MIDDLE INCOME FAMILIES Agree Agree ALLOW MIDDLE AND LOW INCOME PERSONS TO HELP ADMINISTER FUNDS AND ESTABLISH POLICIES. Agree Agree Agree 31806 08/28/06 NC Disagree The national program should be public. No private participation. Disagree "The program should be entirely public, no private participation." Agree Disagree Only public participation. Agree Agree 31807 08/28/06 TX Agree "* I believe every American should have insurance coverage. I believe no matter if you are a student living on their own or an elderly person, all Americans should have insurance. I believe the cost of insurance coverage and doctor's visits are outrageous. For instance my daughter working at a advertisement firm, can not get insurance under $400.00 a month, she only makes 9.50/hr. She is forced by our American Insurance Company to not carry insurance because she can't afford insurance. Every American should be protected against out-of-pocket medical cost, medical cost has to come down and insurance cost has to come down. America the land of no insurance for it's people, that is what we have become. America, you live of die based on how much money you have for medical treatment. I believe America can not only change these policies but can also be an example for the world to see and a guidline for other countries. This can be changed. " Agree This will be a start but not an answer to the real problems. Agree Agree Agree Agree I don't believe our right to choose insurance should be based on where we work and what they offer their employee. I believe not only should every American have coverage but I also believe choosing the coverage that's right for our families should be our choice and the same for every American regardless of where we work. 31808 08/28/06 OR Agree "Other countr5ies have free health care, why not America?" Agree "These groups are already part of the health care system, Congress and the President are responsible for not letting them function like they should." Agree none Agree "Oregon has an ideal system the voters approved, but the federal government won't let it function the way it was intended too." Agree Free health care should be investigated for all. Agree "Contact those countries that have universal health coverage, and combine the best aspects of their health care system's." Oregon has research in this area. "Something neeeds to be done to lower the high cost of medications. People are dying or starving, trying to pay for costly medications. Do something NOW!!!" 31809 08/28/06 FL Agree "* If the American Government can pay for health care for people in other countries that we fought decades in a cold war; pay for their retired generals pensions; than the government should pay for all American Citizens. In addition, consolidate all Federal medical programs into one program and track those that are receiving care from multiple medical agency/programs. The consolidation could cut federal costs by over 50% and allow only one medical budget, in lieu of several programs requiring budgets for the same medical products, procedures, etcetera. In example: Budget for Medicare,Medicaid,VA,Military,Private Insurance programs partially paid for by government employees or Agencies. Consolidate, Coordinate, Communicate, Control and Certify eligibility. " Disagree To many hands in the pie; leads to a bad taste. See Comments above about CCCC&CE Agree none. Agree None Agree None. Disagree When people contribute through taxes or payments; it should be clear that any of those payments can be deducted when filing their Income for tax purposes. No more groups or agencies to be established; use existing groups and agencies; if those groups and agencies are unable to do anything! Fire Them and then get new ones through a local election process by state. Only that it is good to get imput from all sources. 31811 08/28/06 LA Agree "Adequate healthcare should be a right for US citizens, not a luxury. This is also true for others in this country who are not citizens but are in this country legally. We cannot ignore the healthcare needs of persons in this country illegally as well." Agree This would need to be done with a minimum of beaurocratic obstacles. Agree "Particularly important is the push toward healthy lifestyles. With improved access to laboratory and imaging data, providers will be able to obtain needed information without repeating studies previously done." Agree No comment. The above accurately sums up my opinion. Agree This should be public policy. Agree "Increased taxes on cigarettes and alcoholic beverages (including beer), somewhat higher taxes on the gaming industry and consider a 1% national sales tax. Also with our dependence on imported goods, a 1% health tariff should be considered." Mental health has traditionally been covered at a much lesser level than physical health. Most major mental illnesses have been shown to be caused by physiological (physical) problems. Mental health should be covered at the same level as any other illness. "The primary thrust should be health, wellness and prevention. After that, treatment of ilnesses. " 31813 08/28/06 FL Agree "* 1. NO MEMBER OF A LOBBY OR CORPORATION SHOULD BE A MEMBER OF THE GROUP PREPARING THIS PROGRAM. 2. NO POLITICIAN SHOULD BE A MEMBER OF THIS GROUP DESIGNING THIS PROGRAM. 3. THE FINAL PLAN THAT IS ASSEMBLED SHOULD BE PLACED ON A NATIONAL BALLOT AND VOTED UPON BY ALL CITIZENS ONLY, AND IF APPROVED MUST REPEAT MUST BE ACCEPTED BY THE SITTING PRESIDENT, AS THE WILL OF THE PEOPLE. 4. THE PROGRAM MUST REPEAT MUST REIN IN ALL DOCTORS, DENTISTS, HMO'S, INSURANCE COMPANIES, HOSPITALS, MEDICAL CENTERS ETC, SO THAT THEY DON'T SEE THIS NEW PROGRAM AS A NEW WAY TO RAPE THE NATION. 5. THIS IS AN IMPORTANT MILLESTONE IN AMERICAN HISTORY AND MUST BE HONEST AND SINCERE AND NOT SUBJECT TO POLITICAL 'PORK'." Agree I DO NOT BELIEVE AN HMO APPROACH IS THE ANSWER. THESE PEOPLE ARE PROGRAMED TO EXTRACT EVERY SINGLE CENT AT THE EXPENSE OF THE PATIENT. WE NEED MEDICAL PROVIDERS WHO ACTUALLY CARE ABOUT THEIR PATIENTS. THIS SHOULD BE THE GOAL OF THE ENTIRE PROGRAM Agree "* AS A VETERAN I FIND THE MANAGEMENT OF THE VETERANS ADMINISTRATION TO BE WANTING. THIS IS PROBABLY TRUE IN HMO'S ETC.. AS A FORMER CORPORATE TROUBLESHOOTER OF CORPORATE BRANCHES, I FOUND HAVING TEAMS OF 2 OR 3 PEOPLE TRAINED IN THEIR FIELD WHO TRAVEL THE NATION VISITING THEIR BRANCHES UNANNOUNCED TO DETERMINE THE QUALITY AND EFFICIENCY OF THEIR PERFORMANCE AN IMMEDIATE IMPROVEMENT TAKES PLACE. THIS IS THE SINGLE MOST IMPORTANT SUGGESTION YOU WILL RECEIVE. TROUBLESHOOTING TEAMS WOULD ONLY REPORT TO THE HEAD OF THE PROGRAM. " Agree "i BELIEVE THE IMPORTANCE OF END OF LIFE CARE FINANCING IS PROBABLY ONE OF THE MOST IMPORTANT PARTS OF THIS COVERAGE. PEOPLE SHOULD NOT HAVE TO LOSE THEIR HOME, THEIR FINANCIAL WORTH ETC. IF A MATE HAS A DRAWN OUT ""END OF LIFE"" ILLNESS" Agree "I EXPRESSLY REQUEST THAT THE TERM 'ALL AMERICANS' BE CHANGED TO ""ALL AMERICAN CITIZENS ONLY"". NO ONE OTHER THAN AMERICAN CITIZENS SHOULD BE ALLOWED INTO THIS PROGRAM BY DECLARATION OF LAW." Agree ASK WARREN BUFFETT TO HEAD UP A TEAM OF HIS CHOICE TO DEVELOP A FINANCIAL PROGRAM UNTAINTED BY POLITICIANS. DISCONTINUE THE OLYMPIC VISITATION BY PATIENTS TO DOCTOR'S OFFICES. DOCTORS AND MEDICAL MUST GIVE PATIENTS ASSURANCE THAT THEY ARE INTERESTED IN THEIR WELFARE. 31814 08/28/06 MI Disagree "I see no reason to include the two ""protection"" items. Medicare works fine for rich or poor and we should not have to worry about high-cost situations. Basic health care should be covered for all Americans, and, by the way, not just American citizens. All of us living, working, and paying taxes should be covered." Disagree "* This recommendation assumes there will remain a patchwork of city and state and corporate and non-profit groups sharing or leading the health care system. I belive we should have a single payer system. I assume there will have to be some transition period, but anything less than a single payer system will not cut the waste built into our present system. Medicare has only a fraction of administrative cost that private groups have. And the supplemental insurance offered seniors had to be forced into common offerings because it didn't work." Agree I agree but only if we get rid of the multiple providers and insurance companies now operating. Disagree "I do not want the proliferation and expense of the private payers such as we now have. If the public system is adequate, then I see no problem with letting the rich pay for whatever they want. Some may even hire a full-time private physician if they wish, but that is not part of a health care sytem for all." Disagree Skip the assistance for those who need it. Just have a system that provides quality care for all. Agree "Move towards something like the Canadian system of universal health care for all paid by our taxes. We do this for police and fire protection; let's do it for health care. And yes, we will need a transition period, but lets get rid of all the competing private operations. " "Agree, but get the insurance companies out of the system. We should have one payer with all the proper experts to settle on the core health services. " Why do we in the USA pay the most in the world for health care and score so low on so many health criteria? Because we have the most inefficient system. Let's start by looking to Canada. 31815 08/28/06 UT Agree "All of should have fair, reasonable and responsible access to health care and have protection against very high health care costs. The low income and rural populations are the most vulnerable to abuse and falling through the cracks of a large bureaucratic organization." Agree "* All existing resources and revenue streams to health care should be brought to bear. It is important though that if the Federal Qualified Health Care Center concept is adopted that medical liability should not be ignored or signed away in pre-service arbitration agreements. The medical community cannot have unregulated health care at the expense of fair and resonable medical consumerism. We've had enough of tort reform, our doctors and hospitals are to be held to a high level of professionalism and responsibility." Agree "The concept of evidence-based medical care is sound and should be supported. Consumers must have medical information about treatment costs, rates of infection, and doctor malpractice readily available to them at all levels of coverage." Agree "Providers of care, insurance carriers and all who work with patients in an end-of-life situation must be properly trained and sensitive to these unique patients with very special needs." Agree The biggest and most pressing issue of medicine today. Most folks are anxious to support a fair and resonable health care system. Agree "What must be avoided is a non-medical clerical worker defining what medical care is appropriate through the HMO to a patient. There are may revenue streams available to provide the type of health care we desire. Catastrophic health care expenses should become a thing of the past, " "A panel of experts and lay citizens should be given the task of what is fair and resonable health care covering physical, mental and dental health. This MUST not be controlled by insurance bureacrats or a governement clerk, otherwise the fair, compassionate, and responsible health care we desire will just become a burdensome, governmental agency that leaves out the poor, underpriveleged, and more vulnerable of our society" Many thanks to the hard work you have done. Keep up the good work. Let's be sure this process doesn't become politicized. 31816 08/28/06 MI Agree I do not believe the health care industry should be allowed to control a national health care system. They have proven that they are totally ineffective in controlling. A mixture of people from different interests would prove more effective. Agree " People must be able to afford this care. The uninsured have no money, thats why they do not have health insurance." Agree Agree " The costs of these services today are totally out of line with any reality, and should be controlled." Agree Agree People should never be puy into a position of choosing between health cre and other basic necessitys in life such as we have today. 31818 08/28/06 AL Agree Disagree "I am sick and tired of the ""poor"" getting better quality and free healthcare at my expense while I work my ass off to pay for what I get." Agree Agree Agree "Again, as long as I am not funding treatment for free where the so called ""poor"" (folks that don't want to work cause the liberal Democrats will take care of them) are getting better and free care." Agree 31819 08/28/06 PA Agree I would think that all Americans should have the same health care as all United State Senators and Representatives. Disagree All Americans deserve the same health care as are United Sates Senators and House Representatives. At the same cost they pay. Agree Some what agree all Americans have the right to life and liberty and health care is part of that in this day and age. Agree All person must have individual health care plans. This is the corner stone of good medical practice. Agree As I have written all Americans in this day and age have a right to health care that does not depend on being low income. Most of the highest income people all have free all inclusive health care. Agree "Sorry , but the income tax and VAT are the only way to pay for health care. This can not be a “privatized” venture. Why is the Veteran’s Administration so efficient ? Government oversight! Competitive bidding for medications and there employees." “Evidence Based” is a buzz word for low cost at any cost. What is ‘wellness’? All the above must be defined and be a known first. What is ‘preventative? Is that a pap every ten years or yearly? Flu shots for all or only those a certain age? Expert what is that? An M.D. or someone who has lost a close one to a disease? "I by no means am trying to be negative! Americans are the most productive workers on earth and can be even better with the health care burden off there backs. Business will be against health care but will in the long run be better off. Who wants an employee who can leave anytime and not have to worry about health care,but that will all flush out to be an advantage to the better businesses." 31823 08/28/06 NY Agree "I think we MUST take care of our own, if the family, itself, is not able to do so - medical personnel would better serve the public if they aimed at curing, rather than medicating/masking, and letting patients make the decision for their own 'quality of life' in life-threatening circumstances" Agree "If this would be in the form of local and accessible health care clinics, with full ranges of services, I like it" Agree Should have been in place LONG ago Agree Whatever the dying wish should be honored . . . Agree "If the government paid the doctors, drug companies, and other health care facilities, there might be more checks and balances against these 'seemingly bottomless' money pits . . . " Agree "Perhaps a 'citizens committee' of a hundred or so of the great minds and thinkers, rich or poor, as watchdogs for a dedicated funding policy that can ONLY be used for these types of health-related issues; followed by checks and balances for the fund, at every step along the way and no corporate and/or other, raiding for purposes other than those health issues stated. Persons able to do so, without it bankrupting their family, should pay . . ." "If the grievously ill-patient wishes to end life for which, in his opinion, has no possibility of recovery, and said life has no quality remaining (as a productive citizen) he should be given his choice and the facilities to do so. " "The last, though somewhat radical, will happen eventually - with skyrocketing costs keeping persons with no quality of life alive, why not sooner, rather than later" 31825 08/28/06 IA No response Disagree "I strongly disagree with this recommendation. This proposal threatens to weaken to successful health center model of care, especially the patient-majority community board. Other organizations are valuable in the safety-net, but if they want to be health centers, they should work to establish a program that works for them, instead of dismantling a system that truly provides for community and patient involvement." No response No response No response No response 31826 08/28/06 TX Agree "EVERY ONE SHOULD HAVE INSURANCE COVERAGE, REGARDLESS OF AGE AND RACE. " Agree No response "MY HUSBAND IS A 59 YR VIETNAM VETERAN AND IS HAVING A HARD TIME GETTING INSURANCE THOUGH THE VA. MEAN TIME I HAVE TO KEEP HIM INSURED THOUGH MY EMPLOYER, IF HE HAD INSURANCE WITH THE VA, I COULD SAVE A LOT O MONEY AND MY CURRENT INSURANCE WOULDN'T HAVE TO COVER HIM AND SAVE MONEY ALSO. TO ME THIS IS A WASTE. " Agree EDUCATION IS THE ANSWER. SUPPORT THE PATIENTS IN THEIR TIME OF NEED. IF Agree "IF ALL AMERICANS HAD HEALTH INSURANCE WITH PREVENTIVE MEASURES,WE WOULD NOT HAVE SO MANY SICK PEOPLE. KEEP AMERICANS HEALTLY AND INSURANCE WOULD NOT COST SO MUCH. " Agree AT INCOME TAX TIME COLLECT X AMOUNT OF MONIES THAT GOES INTO OUR HEALTH CARE. LET THE STATES HANDLE THEIR OWN UNDER ONE UMBRELLA. EVERY STATE WITH THE SAME GUIDE LINES. 31827 08/28/06 RI Agree Health Care should be freely accessible for everyone. It should not be another expense to account for. If people have to choose between premiums or no coverage they will choose no coverage- not because they want to but because the cost of living is going up and wages are stagnant. The private sector is often not equipped to handle public progams. Disagree "* In the last 10 years the Federal government has eroded, underfunded and underresourced the social ""safety net."" A net catches people who fall through the cracks. There aren't cracks in our health care system so much as giant gaping holes. I support a public/private solution that: 1)covers everyone. 2)sets strict rules for employer mandated healthcare, including cut offs on cost sharing. 3) DOES NOT count on already tapped social service programs. While the US is setting international relations policy for the world, the rest of the 1st world has us beat on health care. And they didn't do it by creating an underfunded two-tiered welfare system. This proposal sounds to me like there will be a health care system for the rich and one for the working people who cannot afford coverage. That is the wrong direction. " Agree YES Agree Agree It should be public policy that all Americans have FREE health care. Agree "Our health care system was founded on an employer based system. There was a time when if you had a job it was a 40 hour a week job with health care. Now, even though the size and profit level of large corporations are expanding, health care benefits packages are shrinking. I think through payroll tax & progressive income taxes, we can finance a health care system." Is vision care included in physical health? It would be a good idea to include. Thank you for conducting this process. 31828 08/28/06 TX Agree I agree as long as the Americans who are benifiting from this and who can work; do work. If they can work and won't I do not think they should be considered. This is part of the problem we face now. Those that can't work should be included. Agree Agree Agree Agree "I agree that all Americans should be given the chance to buy health insurance, however if they choose not too the rest of us Americans should not have to pick up the tab like we do now." Agree I have no comment concerning this other then people should be allowed to pay anyway they are able to. Paying for health care is no different then buying a house or a car. You either have it or you finance it. I don't believe that this nations health care problems lies just with the health care providers but with our governments welfare policy and with the amount of money charged by doctors and hospitals. If someone is treated and then can't or won't pay for the services then we who do have health coverage suffer. We not only pay for our services but for the charges which were never collected. There is absulty no reason for a heart operation or any other major operation to cost what it does today. 31830 08/28/06 IN Agree "I believe this will keep the prices down. Health costs go up every year, but with a program like this, they will level out." Agree Agree Agree Agree Agree "* I believe most Americans would be willing to pay a standard fee for a standard policy of health care. Currently, policies are priced by the size of the company (number of enrollees). It would be fair to have policy prices based on the coverage provided, i.e. family policies priced as family policies, individual, and have the price adjustments not based on income, but based on the type of coverage the individual is willing to fund. In other words, for myself and my husband, not old enough for medicare, working for 2 separate companies, being able to adopt one policy through the Government for one price. This would be a family policy providing major medical, office visit limits, 1 physical anually, one optical visit per year, and 2 dental check-ups per year per person. The price for such a policy should not exceed the cost of what a large corporation pays currently for this same coverage. Most Americans would be willing to pay for this type of coverage." I believe that Optometrist visits (1 per year) should also be included. 31831 08/28/06 WA Agree "It is about time that we in the US adopted a policy providing health care for ALL! The current system is broken beyond repair and needs to be replaced with a humane, universal health care system." Disagree "It cannot be implemented community by community. As we have seen in our recent and not so recent history, poorer communities get poorer service, while the wealthy communities get the best (as is schools, etc). It needs to be the same for everyone!" No response Agree Agree Agree 31835 08/28/06 IL Agree Agree Agree Agree Agree Agree 31836 08/28/06 MS Agree Agree Include alternative and conservative healthcare practices of non-invasive procedures i.e. physical therapy and chiropractic. Agree Include all practice entities including the most recently introduced such as chiropractic. Agree Agree "as long as it does not strip down or not offer coverage for less used entities such as vision, dental, physical therapy, chiropractic etc." Agree making sure physical rehabilitatoin is a widely reviewed entity for a more physical approach is the way to a healthier individual pre and post invasive medical procedures. Chiropractic is an integral part of physical rehabilitation that can greatly influence the health care industry if given a chance but only from evidence based practices that regard themselves as conservative rehabilitation specialist and working together with physical therapist and the patients primary medical doctor if they have one. 31838 08/28/06 CT Agree Agree Agree Agree Agree No response 31840 08/28/06 IN Agree Agree Agree Agree Agree Agree I am assuming this does not include illegal aliens. 31842 08/28/06 AZ Agree "I agree that no one in America should be impoverished by health care costs, and I believe it is important to establish a national PUBLIC program, using proven models by Britain, Canada or France immediately." Agree "While I support this recommendation to assure the quality of a PUBLIC universal healthcare system, I don’t think we need more study to decide what we want. We know publicly funded systems cost less and provide better results than the private system we have. We know what the American people want and deserve (as reflected in your Values and Principles section), and we have proven models on which to base our new PUBLIC system. We need to develop the political will to just do it." Agree "* We should have no underserved or uninsured populations. For years, we have allowed the myth that more involvement by government would create an unwieldy bureaucracy that will bankrupt us to impede efforts to create a health care system that works for all Americans. The evidence points to the opposite conclusion. ■ Our publicly funded Medicare system spends under 5 cents per budget dollar on administrative overhead, compared to 15 cents that the private health care system allocates to shuffling the paperwork and paying people to shift the cost to somewhere else. ■ The Veterans Administration, which functions like Britain’s socialized medical system spends less per patient, but consistently outranks private providers in patient satisfaction and quality of care. We could save a trillion dollars in 10 years by adopting a Canadian-style single-payer system — and cover all the uninsured at the same time if we would simply abandon our private health care system. The United States is the on" Agree "* I would eliminate private payers. They are part of the problem. I think you would better serve the American people if you simply recommended what other countries have demonstrated works rather than trying to accommodate the views of those who are creating the problem. ■ The drug industry says research and development cause high prices, but only 12% of its revenues are spent on R&D, while 30% are spent on marketing and administration, and 17% go to profits. ■ In the health care industry, million-dollar CEO pay packages are the rule. I think it is a waste of time to try to “reconcile contrasting views about the role of the marketplace and government, of competition and planning, and of individual and shared responsibility. This will only perpetuate the current crisis. People are feeling like their government no longer even tries to do what is in the best interest of the American people. They are too influenced by powerful industry lobbyists. Please don’t contribute to this by trying to" Agree "Successful reform must concurrently address increasing access, reducing costs, and improving quality. It must embrace both individual and shared responsibility. Individuals should be called to make healthier lifestyle choices, and society must be called to care for those unable to care for themselves." Agree "* Britain, Canada and France all have proven models that are much more cost effective than the U.S. system. In the British and Canadian models, the government pays. France has compulsory payroll contributions from employers and employees. Funds cover 75% of medical bills. The remainder comes from government, patients, and supplemental insurance. The cost per capita in Britain is $2,389, in Canada it is $2,989, and in France it is $2,902 -- significantly below the per capita cost of $5,711 in the U.S. The World Health Organization (WHO) performance rating on the overall ""bang for the buck"" for France is 4, Britain, 24, and Canada 35 -- compared to 72 for the U.S." "With a universal health care system, there would be no need for separate high-cost protection. I strongly support the set of core health services across the continuum of care throughout the lifespan that you propose in this recommendation. I would include vision as well. " "* Thank you for the time and obvious effort and concern you have invested in fulfilling your responsibility to facilitate an informed national public discussion about the choices we face in reforming our health care system. I generally support the guiding values and principles you have expressed in your Interim Recommendations. However, by stating no preference for PUBLIC funding, you are ignoring what has been demonstrated to provide better care at a lower cost. Many businesses -- despite a distaste for government involvement -- are coming to the same view. Doctors, nurses, not-for-profit hospitals, and clinics are joining the call, many specifically saying we need a single-payer system like the system in Canada. While we hear complaints about Canada’s system, a study of 10 years of Canadian opinion polling showed that Canadians are more satisfied with their health care than Americans. We have in essence, the results of a 30-year experiment comparing the merits of private vs. public health care" 31843 08/28/06 IN Agree "I fully agree. We work, pay taxes, we pay for our health Insurance , we pay for our co-pay, and we still receive a bill to pay and pay and pay...""when is our goverment going to make a afford and see what we are paying out and not recieving in!! We need someone whom is going to recomment and identify the infrastructure in out local level!!! Sincerely, Latian tax payer!" Agree " Support is the keyword!-infrastructure in our communit-Support, Support, Support-our health insurance!" Agree Promote effort by making sure the people whom is taking advantage of our system in (Health Care)-starting with the administration/clinical practice. Agree Agree Agree 31844 08/28/06 MI Agree The fact that 50 million Americans are without a health care program is inexcusable. I do not believe we should include illegal aliens (undocumented individuals) as participants in this program. Agree "We should be using the health care programs which federal employees, including Congress, enjoy as the basis for a national health care program. " Agree "Dependence on the private sector (e.g., current prescription drug coverage programs) is NOT the way to go. The federal government needs to take the lead on this. The Scandinavian countries have shown leadership in this area. " Disagree Preventive services should be emphsized and end-of-life models should be de-emphasized. Agree "All citizens should have this access. This does not include undocumented individuals, who are illegally working in the U.S. Congress needs to start first with immigration reform." Agree "I am willing to pay higher taxes in order to fund these programs for all legal U.S. citizens, even to the extent of introducing a ""means basis"" test for determining premiums. " The number of choices should be limited in order for simplicity and efficiencies to be introduced to any future system. Complexity comes with a price and the current system reflects this. Philosophical differences need to be put aside (market versus public based). 31845 08/28/06 NJ Agree Agree Agree Agree Agree Agree 31846 08/28/06 CA Agree Access to health care is a RIGHT! Agree Agree Agree "If we care for people who are dying, support their families, etc, then we don't ""need"" assisted suicide." Agree Agree "Financing will be complicated and will require additional taxes, we should not be afraid of that. " 31848 08/28/06 NC Agree "With health care costs increasing, people can not just afford to pay the cost. All american should be protected by full coverage. Like a national health care databank." Disagree Because I believe these measuremnts are alreay in place and would create additional confuse. Agree I believe in integration of health care system because it will be more effective and information can be cross related. thereby reducing waste and duplications Disagree "End of life is a hard but from my understanding, this is already being done. All available options should have been explained before they even determine that a person life is about to end." Agree All americans should have access to health care Agree "I believe that we should not place addtional burdens on citizens but should look at some support from taxes or tax exempted donations to support the system. If I can not afford to pay for health care, how can I afford to finance it?" except you should also have regular citizens or community health services Give us health care we can live with and ensure that we can use the service. 31849 08/28/06 VA Agree I recommend this for all American citizens. No American should be turned away due to lack of money or coverage. Agree "Americans should always have access to health networks. Having local networks is a no brainer, especially when you take a look at the gas prices. " Agree The federal government should take immediate and necessary actions to rectify the health care costs and qualities. We should be helping out our own Country before helping others. Agree "When one is reaching the end of life, it's hard and unimaginable to think that you and your loved ones are not getting the proper support." Agree "No one asks for medical issues, so why should they be punished for it. If convicts could get access to health care, then why can't civil Americans get it?" Agree "The cost of health should be based on income. Those who make more should pay more, just like we do in taxes." "If this basic health care took affect, I could almost gaurantee that it would prevent half the serious medical issues. We all need preventive services." 31850 08/28/06 FL Agree "* When I signed up for Universal Health care Plan as a senior citizen, I asked if it was an HMO or a PPO. I was told it was a PPO, otherwise I wouldn't have signed up for it. When I went to my regular Dr. that's been treating my foot problem, for the past several years. I find out thatit's an HMO and I have to pay in order to continue under his care. Later I find out that I could have called the Dr. to whom I was asigned and gotten a referal. In the mean time I don't feel comfortable with the physican that I was assigned to. Plus I'm aimost six (6) hundred dollars out of pocket. Thats half of my SS check." Agree Personally I feel like the Federal Government needs to get out of everyone's business and let Entrepreneurship take over. One might be surprise at how quickly things would get taken care of and how much better things would be and would work Agree However we all know that anything the government is going to do will cost 2 and 3 times what private business could do and do it better for. Agree Agree Agree What happen to vision care? 31851 08/28/06 NJ Agree Agree Agree Agree Agree Agree 31856 08/28/06 DE Agree Health care must be obtainable by all citizens of this country. Providing better health care to illegal immigrants than a poor American can get is foolish. Health care to illeagal immigrants must stop completely unless they can pay for it. AMericans must come first. The monetary savings woul probably pay for the program. Disagree "* All Americans must have equal access to health care and the current recommendations do not level the field. HMOs must not be able to limit drugs or treatment based on affordability. If a rich person can afford a needed medical treatment or drug that is effective, the poor must be allowed the same treament or drug. Once again, by not paying for the treatment of illegal aliens that will not pay their bills and provide false names and addresses to avoid paying, this money could be spent to equalize the playing field for Americans." Agree Current levels of federal funding for Veterans Hospitals have been dropping and the number of veterans needing services rises due to the current war on terror. VA Funding must be a priority else we need to get our troops out of the middle East and take them out of harm's way. Disagree "I hope that by the term ""actual needs"", the government is considering allowing senior citizens and terminally ill patients the right to die with dignity and allowing the issue of assisted suicide to be considered. Many people who are terminally ill are in great pain and want to end their own suffering. Arresting and prosecuting Dr. Kevorcian was a crime." Agree Agree "Once again, the resources taken away from Americans by exporting jobs to foreign countries and allowing illegal immigrants to sap away the funding from the health care industry is abominable. THe issues are interconnected even if the current administration says they are not." "ANy group of individuals that comprise an oversight group must be willing to do serve in such a position for no financial benefit. The current drug asistance program benefits only one group, that being the manufacturers of pharmeceuticals. By bartering a deal for themselves the drug companies are still making huge profits." This is too important an issue to be left to the likes of an incompetent administration. I pray to GOd our president has a lucid moment when considering this legislation and is not motivated by his own greed for power or furthering the New World Order. 31857 08/28/06 NY Agree "Health care should not be a business run for profit. It should be the venue which provides the care all citizens deserve. The service of providing health care should not be looked down on, but rather our right as human beings and citizens of the USA." Disagree "* You have not identified health care as a need for everyone. Yes, there are certtain populations which are in dire need, and yes they should get the help they need. But, in todays world, no one is assured of health care coverage. When middle class(??) people have their medical coverage taken from them (and this is happening at an alarming rate) they should not need to spend all their money on health care and become poor. You are missing something here. We need to take care of all our citizens, so that they don't all become poor. Universal Health Care for all is what we need in todays world. We should have that choice. It is our right, and it is the duty of our government to provide it." Disagree "* This sounds OK but it is too technical. It also makes it seem like a service for the poor. We should get away from that. We should be about the business of providing education, health care and alternative education and practices so that people who want to take better care of themselves can prevent sickness, but have the service if it becomes necessary. Likewise, those who do not want to practice prevenative measures should be provided with what they need to stay as healthy as they can. Your very model is too top-down, too beauracratic, not easily accessable.Good money would be lost in the execution of the policy instead of the care of people. You need to look to the Universal health Care models provided." Agree "Sounds good. Education is very important for end of life experiences. People should be allowed to talk about it and families should partake, and it should not be left until it is too late. From my experience, Hospice is a good practice model." Agree "Everyone participates and no one is made to feel inferior. Health care should not be a divisor of society, nor should there be two levels of care. Everyone deserves the best care that we can provide them with. If some can afford co-pays, let them pay accordingly. No one should become destitute from health care bills, and no one should be left out because they cannot pay." Disagree "Stop wars, stop wasting our tax money, make corporations pay with their bountious profits. Tax payers contribute enough to support Universal Health care. Our government needs to spend our money on us and get out of the other countries where they are spending our money destroying the lives of people. " "People who need health services should be able to partake of the kind that works for them. This should include standard medicine and alternative practices, prescriptions and herbs and supplements. Look to Europe for models here." 31858 08/28/06 CA Agree Agree Agree Agree Agree Agree 31859 08/28/06 PA Agree I am especially concerned with the very high out of pocket cost piece of this recommendation. Agree Agree "Quality and efficiency measures should align across organizations, and when possible be electronically available within an EHR. " Agree "Consider adding core curriculums to medical and nursing schools, as American culture does not readily accept death, and this recommendation will require culture change along with legislative action. In addition, consider re-evaluating accountability of practice. In England, hospice nurses can pronounce patients....I don't believe we are allowed to do that in the U.S. " Agree Isn't this a duplicate of the first recommendation? Disagree "We also need to take a hard look at the way we spend our money. For example, not every hospital in every community requires the same top of the line technology. Perhaps it is shared? Looking into specialist providers (eg, cancer centers) should also be investigated. " "Please also consider ""alternative therapies"" in your recommendation. A lot of people are spending a lot of money out of pocket for these treatments, and they should be incorporated into this plan. I am concerned that ""medical effectiveness"" could be interpreted too narrowly - consider rewording. " 31860 08/28/06 VA Agree SEND ALL ILLEGAL BACK TO THEIR HOME LAND AND SECURE BORDERS. CAP THE AMOUNT THAT PEOPLE CAN SUE. PLACE TERM LIMITS ON JUDGES. DO NOT REWARD ILLEGALS BY MAKING THEIR CHILD BORN IN THIS COUNTRY A CITIZEN. TWO WRONGS DO NOT MAKE A RIGHT. Disagree THE FEDERAL GOVERNMENT CAN NOT SECURE OUR BORDERS. THEY SCREW EVERYTHING UP THAT THEY GET INVOLVED IN. LOOK AT ALL THE ILLEGAL/FRAUD/WASTE IN NEW ORLEANS. WHAT WORKS IN NEW YORK CITY WILL BE DIFFERENT IN THE COUNTRY OF VA OR WVA BECAUSE THE PROGRAMS DO NOT EXIST. Disagree "FEDERAL GOVERNMENT IS TO FAR FROM THE LOCAL PEOPLE. FEDERAL, STATE AND LOCAL GOVERNMENT NEED TO FIND WAYS TO WORK TOGETHER TO BE EFFECTIVE TO THE PEOPLE THAT NEED HELP. I SEE GOVERNMENT PROGRAMS ABUSED BECAUSE LOCAL AGENCY DON'T HAVE THE RESOURCES OR TRAINING. " Agree THE US NEEDS TO START BEING MORE LIKE JAPAN BY USING PREVENTIVE MEDICINE TO ELIMINATE OUR GROWING MEDICAL PROBLEMS. WE NEED TO START IN KINDERGARDEN TO EDUCATE OUR CHILDREN ABOUT DIETS AND EXERCISE. WE ALL HAVE GOT FAT AND LAZY. EVERY ONE LOOSES EXCEPT THE BIG CORPORATIONS IN FOOD AND MEDICINE. Agree MAKE IT AFFORDABLE TO LEGAL AND HIGHER TO ILLEGALS. STOP LAW SUITS AND CAP MEDICINE AND REQUIRE PEOPLE TO BE MORE ACTIVE. Agree THE FEDERAL GOVERNMENT CAN START BY REDUCING THE AMOUNT OF REFINED SUGAR AND FATS THAT ARE INJECTED INTO AMERICAN FOODS. WHO IS GOING TO MONITOR THIS GROUP? MOST PROGRAMS START WITH GOOD INTENSIONS BUT GO ASTRAY AFTER GETTING BOGGED DOWN IN THE PAPER WORK. RESULTS ARE WHAT COUNTS. STANDARDS HAVE TO BE SET AND CONTINUELY MONITORED BY AN INDEPENDENT GROUP. 31863 08/28/06 OH Agree "* I have Ms.I have had it for almost 10 years but just now went on disability. I went through most of my savings waiting for my aproval. I know how expensive the medication is so I applied throught the ticket to work program for a part- time job which I got and started in March of 2006. I thought that it would at least hel with my co-pays Was I wrong. I got my Medicare in June and signed up for this ridiculous drug program.I had 2 scripts fill and hit the donut hole. My disability income is $1152.00 a month my job pays abot $420.00 a month net. How can I pay $3600.00 + in drug cost every year, plus Doctors and my general living expenses. I drive a 10year old car and live in a 30 year old Mobile Home. I worked and paid taxes all my life since I was 16 and now I can't even afford the medicine I need. I was better off with out medicare and the goverment drug program . At least then I could go directly to the pharmacuetical companies and get a diacount on my medications because I was low income." Agree I agree with these recomendation as long as the goverment dosen't turn it into another disaster like the current program. It has turned into a farce with entirely to much red tape and goverment babble and waste. Agree It sound good on paper. The current administration is not capable if implamenting a plan like this. Not smart enough and no matter what they said I wouldn't believe them nor tust them to implament the plan. No response Agree Agree health care has spiraled out of control I think a lot of it is from health care litigation and abuse of the so system we have in place. I think limits should be set on litigation and the strictest penilties imposed for fraud. the txe loop holes need to fixed so that evey one pays including the wealthy. 31864 08/28/06 OH Agree "It is very disturbing that the richest country in the world does not provide minimial health care for all its citizens, let alone full coverage for everyone. " Agree Agree Agree "After having been with several family members during their final days, I understand the absolute necessity for pallitative care and end of life services. " Agree Agree It would be wonderful it our political leaders could put aside partisan bickering and focus on providing universal health care for people of all ages and socio-economic groups. Thank you for providing a forum for this conversation. Good luck. 31865 08/28/06 MI Agree "Even for people who have jobs, many of the costs for healthcare are practically out of reach. Defining high out-of-pocket costs and what constitutes low income needs to be looked at very carefully." Disagree Why can't there be one system like Medicare / Medicaid that covers everyone? Agree Agree Agree "This needs to be done now, right now." Agree "I'm in the process of obtaining my new job, but am willing to do what I can to help the process. " "The last figures I read stated that close to half the people of our nation do not have health care, and some people working in the healthcare field do not have coverage. The United States helps people around the globe; it's past time we do something to help our own." 31866 08/28/06 VA Agree Agree Agree Agree Agree Agree "* I disagree with adding more taxes. Goodness, we are taxed enough as it is. Some state tax, federal taxes, ssn tax, medicare tax and then when we do retire we get taxed on retirement and SSN. They take taxes all the while we work to pay taxes again on the same money we are saving for retirement or social security? does not make sense to me, it seems like double taxation. Now you want to introduce new taxes? to pay for medical reform. Please don't they already take 20-30% of middle america, it is the working class and lower income that gets burdened by new taxes. How much more can we take? " 31868 08/28/06 CO Agree Agree No response the availability of charge data is critical if we are encouraging consumers to shop around and take an initiative in bringing down costs. Agree Agree No response consumers and consumer advocacy groups should be involved in the independant process to identify core benefits. 31869 08/28/06 PA Agree Agree "Our current national health insurance program, Medicare, should be open to all -- employers and individuals." Agree Agree Agree Agree Tax the industries that are making the most off the current system. 31870 08/28/06 NC Disagree "The weakness of course is that, if we don't provide first dollar care, then there will remain many of us who never get to the point of accessing health care before it is too late, and expenses are ""very high"". So focusing on on ""very high out of pocket costs"" is the wrong focus. Focus needs to be on getting people healht care, not ""coverage"". " Disagree "Focusing on integrated community networks of care for vulnerable populatinos will perpetuate the 2-clas system of care. All Americans deserve integrated, community based health care, not private, disaggregated health care for some and integrated community health networks for others. " Disagree "The federal government has the responsiblity to impose quality and efficiency on all systems of care, not just public systems. The VA is already considered high quality and efficient. Is that helping the rest of us who are the victims of corporate medicine in non-federal health care systems? Today's incentives in the medical care market are responsible for increases in pricing, not efficiency. " Agree "Can't disagree with these platitudes. too many ""shoulds"". Where are the ""musts""? Nice passive construction for the last bullet. Where ""should"" that funding come from?" Disagree "Sounds good but what's wrong with, ""Health care will be available to those who need it""? Why is the focus on financial assistance, not health care itself?" Disagree "* Shared responsibility is a wuphemism for ""blame the victim"". Don't give fat people health care. Put them on a diet. The health care system needs to be reformed regardless of ""shared responsibility"". It is not obvious that more revenues will be required. No other country in the world spends as much money as we do on health care, yet most other countrees in the developed world have better access to health care, and better health status, than we do. Let's agree that ""multiple financing sources"" are only transitional to a more efficient and effective and ffordable single financing system. " "I don't think payers (i.e., insurers)should have any role in these deliberations. Our goal should be to phase out fiscal intermediaries, not further empower them" Pay more attention to what citizens actually said in the hearings. 31872 08/28/06 TN Disagree I disagree because it doesn't provide an exclusion for the illegals from all over the world from unjustly claiming benefits. Disagree "I would agree with this recommendation, as long as it includes workable features for weeding out the non-eligables from around the world, who have been and are infiltrating into the situations mentioned above. " Disagree "I resent raising the cost of medicare, tricare and diluting VA benifits to those who have paid into social security and served militarly for years, just so free loading forigners can have free benefits." Disagree "The first statement in this recommendation seems purposely vauge, possiblly to allow for euthanasia and the like, therefore I have to disagree." Agree I agree with this recommendation as long as it pertains to real Americans and not those who claim to be Americans based on phoney credentials etc.... Disagree Perhaps some of the billons we spend on forign aid should be redistributed to the health care systems here. "The decision on core benefits (or who gets them) seems to be in the hands of a few ""experts."" It has come to my attrention through the news media that an incredibly high number of patients in various hospitals around the country have died because the ""expert"" diagnosis/decesions were incorrect. I thing these ""experts"" should have have some sound and compentent over sight. " 31873 08/28/06 VA Agree I cannot get long term insurance because I've had cancer -- even though it was stage 1 and I have a 98% chance of it never reoccurring. Agree Agree I am insured by both the FEHBP and by TRICARE. TRICARE does not interface with the FEHBP providers which makes for a lot more paperwork on my part and the providers' part. TRICARE is a completely separate system from all others. Agree Agree Agree "* TRICARE should not have increased user fees. The reason for this is that we who use TRICARE have already paid dearly for the use of federally provided health care. This was a promise that was made to me and many others of the Vietnam era. It is a right! Otherwise, everyone, and I mean EVERYONE, members of Congress, the President, Diplomats, et al, should pay for the system. Europe is full of working examples as to how to operate a system such as this. Also, keep in mind that familys, i.e., with children, use a lot more medical services than couples without children." The emphasis of any program should be on prevention. 31874 08/28/06 OR Agree Coverages for all does not mean lower health cost realized from access to health care through insurance schemes. Universal coverage through a single payor plan is the only answer that saves money Agree "Coordination is essential but if capital spent on management continues, now currently 30-35% of health care dollars, we will be unsuccessful in realizing comprehensive coverage for all." Agree * We have illness care in the U.S. Health care or Health Prevention and Disease Protection does not happen at the same standard of care expected for illness care. We need mandated basic services for all through primary care venues. More of the same will not yield better health. (See results from Healthy People 2000 and Healthy People 2010 whose data reflects that prevention is not provided consistantly to patients). Health care providers value prevention but it is not funded for reinbursement in almost all cases. PREVENTION MUST BE MANDATED AS A STANDARD OF CARE. The model for practice MUST change from DEMAND MANAGEMENT to PROSPECTIVE MANAGEMENT so each health member receives standard of care prevention services on par with illness care services. Agree Agree Agree There is more than enough literature to support a single payor plan. The problem is there is no political will to challenge capitalistic models that continue to fail * We have illness care in the U.S. Health care or Health Prevention and Disease Protection does not happen at the same standard of care expected for illness care. We need mandated basic services for all through primary care venues. More of the same will not yield better health. (See results from Healthy People 2000 and Healthy People 2010 whose data reflects that prevention is not provided consistantly to patients). Health care providers value prevention but it is not funded for reinbursement in almost all cases. PREVENTION MUST BE MANDATED AS A STANDARD OF CARE. The model for practice MUST change from DEMAND MANAGEMENT to PROSPECTIVE MANAGEMENT so each health member receives standard of care prevention services on par with illness care services. The dialogue on health issues is framed around market solutions. These have proven to work only for privilidged segiments of the population (see series from Institute of Medicine on Health Insurance). Single payor plans are the only option that yields both desired results: high quality and affordable health care for all. 31877 08/28/06 VA Agree Agree Agree Agree Agree Agree 31878 08/28/06 WA Agree "Tjho a 100% disabled Vietnam vetern. with my needs cared for by the government at a loss of a leg and an arm.I strongly agree with this with this plan. My mother was 80 yesterday and worked for the government and in the private sector. just her deductable has dropped her into a near improvished ctegory. I will I have moved her in with me and take care of her for the restnof her life, but what about the the rest of America. FIX the SYSTEM NOW." Agree Amen Agree YES! aS SOON AS POSSIBLE! Agree Agree Agree I have looked at many plans through the last few years and have to commend the person's who spent their time researching polling and putting together this plan in such a concise and understandable way. 31879 08/28/06 TN Agree "The program should be public, so that everyone has the same options. No one should be treated better because they are rich!!" Agree Agree Agree Agree "Put people on the board of directors from the lower class economic sector. At least they know where they come from, and are not as likely to cheat their fellow men. If rich people are in charge, all they see is the bottom line, or revenue!" Agree "As long as everyone gets charged the same percentage, it should be good. As it stands now, the richer you are, the less you have to pay!" "Give us little poor people a chance. We are not stupid, or afraid of making decisions." 31883 08/28/06 CT Agree If the provisions are reasonable. The countries that have a national health plan pay a very high percentage of their GNP toward that end. We can't afford that same path as we all ready have the world's highest deficit compliments of our current administration. And the citizens often have to wait for long periods of time for procedures like knee or hip replacements and even bypasses... Agree This would be good if it can stop the duplication of services and really get the services neede to the people that need them. Agree "Unfortunately, I have a hard time believing that this one will work because our gov't has already been cutting services to veterans and I fear they will do the same to the general population" Agree It is definitely needed there is no doubt about that what with reports of dumping from nursing home to nursing home currently. Agree Does this mean that there will be no exemptions (for the rich for example)? Agree See the first question's comments "As long as ""extras"" such as replacing almalgem fillings with the much safer polymers are not really an extra. Wiil there be room to ""upgrade"" the procedures if the person has the means? " "This sounds like a great way to get elected by pushing the buttons of the average person. As you have stated, this is a very complex and complicated issue with no one or easy answer but it would be very helpful if it can be structured so Corporate America pays its fair share for its part in this conundrum." 31885 08/28/06 NJ Agree Agree Agree Agree Agree Agree 31886 08/28/06 MI Agree The current system is completely unfair. The only thing it guarantees is that who have the most money will be able to afford the best care. This recommendation would eliminate the unfair advantage of wealth. Agree "Private-publish partnerships are a necessity, if we are to have a system that succeeds." Agree "Consumers need to be educated about the costs of their behaviors, e.g., the cost of treatment vs. prevention of illness, the long-term benefits of maintaining a healthy immune system, etc. They should be held accountable for their choices." Agree "Affordable, compassionate end-of-life care is one of the biggest failings of our current system. The focus should be on improving the death experience--not extending life at all costs!" Agree "Ironically, the stress of facing high costs for medical care in itself produces illness. Everyone, regardless of income, should have access to affordable health care." Agree Considerable financial resources would be freed up just by eliminating insurance companies and the wasteful claim process from the picture. Lack of attention to wellness promotion is the biggest hole in our current system. It's much less costly to maintain health than it is to be treated for illness. The American system of health care delivery is a national disgrace. Other countries with far fewer resources have figured this out--why can't we? 31888 08/28/06 WA Agree being a part the medical field I see how difficult the insurance co are making it for both the patient and the provider. I believe all americans should be able to afford health insurance to include dental and vision Agree Agree Agree Agree Agree 31889 08/28/06 FL Agree Agree Agree Agree Agree Agree We should help all americains all for one and one for all. 31890 08/28/06 NH Disagree "Someone carefully crafted the words, ""No one in America should be impoverished by health care costs."" If, instead, the author(s) had carefully said, ""No legal citizen of the United States of America should be impoverished by health care cost."", I'd be 100% in agreement. There should be none, and there are now way too many illegal immigrants/aliens ""in America"" that deserve nothing but a very quick deportation." Agree "I'd support this IF it were clear to EVERYONE that no illegal immigrant/alien in the United States of America is entitled under ANY circumstance to receive any benefit from any portion of these provisions. I'm wary of how whatever plans and programs might be crafted will be managed. If the fools (of all persuasions) in Congress play their usual partisan games and fail to place the needs of the people ahead of their own politics as they seem ever more want to do, this laudable goal will never succeed." Agree "* Every citizen of this country should be wary of any statement that includes the words ""The federal government will expand and accelerate"". I'd support this IF it were clear to EVERYONE that no illegal immigrant/alien in the United States of America is entitled under ANY circumstance to receive any benefit from any portion of these provisions. I'm wary of how whatever plans and programs might be crafted will be managed. If the fools (of all persuasions) in Congress play their usual partisan games and fail to place the needs of the people ahead of their own politics as they seem ever more want to do, this laudable goal will never succeed." Agree "I'd support this IF it were clear to EVERYONE that no illegal immigrant/alien in the United States of America is entitled under ANY circumstance to receive any benefit from any portion of these provisions. I'm wary of how whatever plans and programs might be crafted will be managed. If the fools (of all persuasions) in Congress play their usual partisan games and fail to place the needs of the people ahead of their own politics as they seem ever more want to do, this laudable goal will never succeed." Agree "I'd support this IF it were clear to EVERYONE that no illegal immigrant/alien in the United States of America is entitled under ANY circumstance to receive any benefit from any portion of these provisions. I'm wary of how whatever plans and programs might be crafted will be managed. If the fools (of all persuasions) in Congress play their usual partisan games and fail to place the needs of the people ahead of their own politics as they seem ever more want to do, this laudable goal will never succeed." Agree "* I'd support this IF it were clear to EVERYONE that no illegal immigrant/alien in the United States of America is entitled under ANY circumstance to receive any benefit from any portion of these provisions. I'm wary that the fools (of all persuasions) in Congress will play their usual partisan games and fail to place the needs of the people ahead of their own politics as they seem ever more want to do. I think the financing strategies should include serious consideration of reducing the amount of ""aid"" to those outside of our borders to offset some of the expense to our citizens. Help others but take care of ourselves first." Laudable. Good luck. "I am a retired United States Air Force officer, and have worked since military retirement for a company with superior medical benefits. My health care needs are very adequately being met. I have three adult children, one of them married with three children. None of them have, nor can they afford health insurance." 31894 08/28/06 na Disagree WE NEED A SINGLE PARTY PAYER! This could be like the current SB840 under current consideration in the Calirornia Assembly. All funds go to one agency. There will be one form for all providers.The financial aspects are cover in the Lewin Report. I can send the info to you if you want. Disagree The same comments as on the first question. Agree "We also need a single Party Payer to deal with drug companies, HMOs, eliminate ""private"" insurance and cover all citizens for all medical care." Agree "It should still be a single party payer system. If the insurance companies run it they will ""cherry pick"" and skim off too much overhead." Agree "But anything that is less than comprehensive, doesn't cover everyone and looks like the Massachusetts model is not a workable plan. " Disagree Look to California SB 840 and read the Lewin Report. We can cover everyone with no increase in total cost. Everthing shoud be covered for everyone. 31895 08/28/06 MO Agree "I don't care for socialized medicine, but something has to be done about the deplorable lack of access to medical care that many in our society experience. Medical costs are unconscionable including the costs of medicines and a lot of people can't afford proper medical care." Agree "What is the Federally Qualified Health Center concept? I haven't a clue. The overall concept appears to be satisfactory, but how much will our national debt and our taxes increase if Congress passes implementing legislation? " Agree "I completely agree, but do not degrade TRICARE and TRICARE FOR LIFE in any way or increase costs for those medical services. Our active duty military and retired military have paid their dues!" Agree Agree Agree 31897 08/28/06 MI Agree Agree Agree Agree Agree Agree 31898 08/28/06 KY Agree Our countrys health care should be front & center as well as formost on the list of priorities for any government official Agree Only to include legal national residents Agree To exclude illegal imigrants Agree Do not force life to be extened on the dying in order to drain the resources Agree To include Americans & Legal immigrants only Agree Take funding away from the war to cover this necessity Also contaceptives Hilary Clinton was not ahead of her time but this administration is certainly behind the times on this issue 31899 08/28/06 IL Agree "A large percentage of Americans who file bankruptcy are forced to do so due to medical bills. This is akin to debtor's prison, out of which an impoverished person could not recover if disabled, and yet, with our legislation, would still not be able to go on Medicaid until impoverished." Agree "We have to be careful how this aid is distributed and by whom. The privatized insurance for medication has been a disaster, causing confusion among the elderly, and often, not giving them the coverage they had expected with the new policies." Agree "Evidenced-based best practices is critical in the distribution of resources. Just one example, a Pap smear is performed routinely on women who have had hysterectomies even though it does not test for anything but cervical cancer. Insurance still pays for this test on these women, but conversely, a rectal exam for blood, which should be routine is not done because insurance will not pay. This may miss certain pathologies while spending resources on tests that do nothing." Agree "* Patient's right to choose end of life care, where they want to die, and how they want to be medicated before death are crucial decisions that should be made with hospice counseling and consideration for patient's culture and religious backgrounds, while not infringing on those who may choose another path. Death with dignity should be everyone's choice, and consideration of end of life care should be discussed with patients long before the decision must be made. Doctors should be educated about this aspect with more emphasis on patient's choice. " Agree It is an embarrassment in this country that we do not provide healthcare to all our citizens. We spend more than any other industrialized nation and rank below other nations in our overall health. We could do this easily if we wanted to by using a system like Medicare for everyone. We need to improve our wellness programs and prevent the catastrophic costs for conditions that may well be preventable. Agree "I think a National Health Care Policy for all Americans, much like Medicare, could be financed through contributions by patients and tax monies to provide quality care for all Americans should they chose it." "I agree with this, but am not sure how this should be administered. Independent, but under whose watch. Public should weigh heavily in this discussion, and we should avoid the pitfalls of the prescription drug plan." 31900 08/28/06 PA Agree Agree Agree Agree Agree Agree 31901 08/28/06 NH Agree "Here in New Hampshire we have the ""Healthy Kids Program"". It's a great program that ensures youngsters get the basic health care they need regardless of family income. Those sorts of programs provided at the Federal level would go a long way towards turning things around in the country. " Agree "I think that if Federal funds are being used, they should be used wisely. Oversight needs to be exercised and I like the idea of a dedicated office or ""Unit"" to coordinate that activity as long as it doesn't become too big. " Agree This sounds like your suggesting that we need to improve in our overall mangement of these key health care programs and to that I say yes; I agree. Agree Agree Other countries do it; why can't we? Agree "Singapore has a high tax rate on earned income. The citizen's pay this willingly because they know that once they reach retirement age or should they become disabled, they can count on thier government to ensure that they will not be homeless or without basic health care. We need at least this same level of social security. " "* All Americans deserve the right to feel comforted in the knowledge that our government, local as well as Federal, is truly interested and actively supportive or our Commiunity Heath Care needs. So many good men and women have given thier precious lives so that we can remain free. Poverty and premature death due to a lack of proper health care are issues affecting the third world and should never be seen in a free nation. Shame on us; and what an insult to those brave and patriotic men and women if this continues to happen here in the United States of America...." 31904 08/28/06 VA Agree My concern is how and/ or who is going to pay for this program. Agree define underserved verses rural areas. Disagree Our government (state and federal) does not have a handle on Medicare and Medicaid. Medicare is going to run out of money unless the taxpayer contributes a higher percentage of income. Medicaid has put States under too much pressure to collect monies owed. Disagree What are we advocating here.... physician assisted suicide Agree "Nice idea, However ""managed health care"" for all will not solve this issue. There again, who and how is this program going to be paid for. What happened to individual responsibility. Legistrating health care by government has never been a complete success. " Agree This sounds like the middle class is once again going to pay for services not rendered... Great idea.... evidence based science however is short sighted and expert consensus can be very subjective. Example 30 years ago Autism was not understood. In the 1950's people with cerebral palsy were institutionalized. 31905 08/28/06 CO Agree I believe a single-payer universal program using tax revenue is by far the most sensable solution to our current health care crisis. This will take great political courage because it will reqire taking on the powerful HMOs and the health insurance industry. Disagree We don't need more layers. No response The Medicaid program looks like a good model to base a universal health care system on. The single-payer piece is much less costly than going through hundreds of seperate insurance programs. No response Agree Agree 31906 08/28/06 TX Agree Agree Agree Agree Agree Agree 31909 08/28/06 MI Agree Agree No response No response No response No response 31912 08/28/06 CA Agree I believe we should be like Canada and have free health care for everyone. Agree I believe their should be a system like in Chicago where you just show your drivers license to be seen. Or even where you show your last pay stub where you work. Agree "Although I believe these programs are somewhat good, but you have to go through too much to be seen by a doctor. And they want to know all of your business. Such as do you have a boat,car,ring,home even if it is worth two thousand dollars. What difference does this make if you don't have insurance?" Agree "But my mother had insurance and she was treated horrible at the end of her life. And by speaking to other people they have experienced the same thing. I think health care in this country is going to the dogs,even if you pay or not. Health care to me is only for the rich and famous. They are the only one's that get treated right. Or the folks that have really good health care, that don't have to worry about a thing. And they can stay in private rooms." Agree "Yeah right! You have to go through too,too, much red tape to get anything here in California. I don't know about other states except Chicago where I was sick years ago and had to go to the county hospital there. I had to wait about four hours,but I was seen and did get medicine for free. Thank God for the County hospital in Chicago!" Agree "Come on,what is fair in this society now?" "Right now I have no medical or dental coverage. I was going to a free clinic in Berkeley, but you had to put your name in a bowl and if your name was picked you would have to fill out a form. It wasn't even first come first served and I had to catch a bus and bart to go there but decided not to take that chance. But will try another day!" I only have one thing to say:Universal Health Care for everyone! 31913 08/28/06 WI Agree "I think people who can not afford health care should be provided with health care of their chose.I feel it should also include teeth, and eyecare. I feel the insurance companies have too much control over the people who needs hospitalization, counseling and medication. " Agree "I feel that there is not enough good health care in the unpopulated area and localities. I feel the health care is behind in time where there is no good paying jobs because of the population. I feel the people in the small populated area is so happy to have a ""physician"" of any kind that the people do not question the actions of the physicians." Agree I feel also that there should be transportation aviable for the patients who need the care and that also should be provided. Agree "I feel there should be funds aviable for families who want to take care of their love ones, for classes and also in pay for the family member. The same pay that the government would pay a health provider to take care of that patient. This would also make the family member feel at ease at home for those last days." Agree see the comment made above. I feel the big organizations that already give health insurance to the employees should also continue having health insurance and the government should pay the co-pay.I feel the small business people have a hard time survying the system already that they should not be required to have health insurance unless the government helps them. Agree see above comment. "I agree that health care should include dental and eye care. If a person does not take care of their teeth then that may effect the whole body organs. Eyes everyone needs to see to read, transport, etc." I have been saying that our country is behind times on health care for our people. I have seen many people being refused care by a provider because of health history. I have seen small companies go out of business because they could not provide good health insurance with out costing an arm or leg. I have seen people being denied health care because of their medical condition. 31914 08/28/06 IL Agree Agree Agree Agree Agree Agree 31916 08/28/06 MN Disagree "* It is not the role of the Federal government to guarantee Health Care for everyone. Look at countries around us who have chosen this socialist form of medicine and it is a disaster - no freedom of choice of treatment, location, doctor or timing. If Americans would take better care of themselves - diet, exercise, etc. and do their homework on how to prevent illness, we would have much less a crises. The huge costs come in with poor going into emergency rooms when they are already very sick. I lived 2 years without health coverage and had 3 young children - at first it is scary, but with education, a commitment I found I could prevent most needs for a doctor." Disagree "Again, it is always a disaster when we try to coordinate through a federal agency. I agree we have some need for better healthcare facilities in rural and poor areas - find a way to provide incentives to local organizations to fund these health facilities. Keep the strings to a minimum and keep the federal agencies out of coordination and reasearch" Disagree "* Evidence- based best practices is a frightening movement for me. We, the taxpayers and customers of our healthcare providers, are loosing our ability to seek alternative medical care and treatment based on our unique circumstances and bodies. Reduction of fraud and waste as coordinated by the federal government is the biggest joke I have heard - the feds are the biggest wasters in business. Ask consumers where waste can be removed. I get unwanted mailings from my insurance company and medical center regularly about healthcare and prevention. Save the ink and stamps. I used to get calls from nurses about my asthma which is in control. I don't need this. and so on." Agree I totally agree in helping with end-of-life care wherever the patient wants it and to help them and remove this stress. Disagree "This is a carefully crafted statement. Of course we want everyone to have an ability to get high-quality care - but is that best taken care of by putting it on the backs of taxpayers, on premiums of the insured. I resent having to pay for someone who overeats, lazes around, smokes and drinks and so on. This is a huge burden you are asking us to take on. Maybe if payments are prorated based on healthy living practices - If you smoke or drink your payments go up and so on. " Disagree "* Again, No way is this a constitutional role of the federal government. They can lead a discussion ,provide incentives to insurers and healthcare facilities, but should not be involved in demanding healthcare for all that we all pay for and the government decides what is okay treatments. I strongly protest this movement by the democratic socialists. With this program, all Americans may be covered but the care for everyone will be greatly reduced, unless again, you have money for doctors ""out of the system."" This is not the answer" See all my previous comments but also I can see this panel being people who have a set agenda and philosophy of healthcare. "Please do not look to the huge, slow moving, wasteful federal government for our answers to healthcare costs. Lets work with businesses, individuals, doctors and communities" 31917 08/28/06 IN Agree Agree Agree Agree Agree Agree 31918 08/28/06 OR Agree people should not have to work and pay taxes all of their life just to loose all they have worked for to high medical costs. Agree Agree Agree Agree Agree 31919 08/28/06 IL Agree "There ought to be a National Health Freedom Act, guaranteeing the right to choose the kind of health care preferred and protections for practitioners of alternative therapies--such as homeopathy. These alternative therapies ought to be covered by insurance companies, the same as allopathic coverage." Agree Agree Agree Agree "* In addition, the pharmaceutical industry must be brought into line. It's unconscionable that any human being should pay hundreds--or thousands--of dollars a month in order to remain alive or live without pain, when these same medicines made by the same companies can be purchased far more cleaply in other countries. I feel we are being held hostage by the pharmaceutical industry, and this untenable situation has to be addressed. Also, well-known alternative therapies ought to be available and covered by insurance. As mentioned above, there has to be a National Health Freedom Act which guarantees a person's right to the kind of health care of his/her choice, protection for practitioners, and insurance coverage." Agree We could learn a lot from countries that have successful universal coverage. I was amazed to learn that Cuba provides excellent medical care for all citizens and innovative ways of providing medical care that maybe we ought to study. 31920 08/28/06 MA Disagree "ALL CITIZENS SHOULD HAVE HEALTH CARE, WHEN THEY BECOME LEGAL CITIZENS! OUR CONSTITUTION WAS NOT SIGNED TO SUPPORT ANY ILLEGAL ACTIONS, PEOPLE OR BELIEFS. WE NEED TO STAND BY THAT! MY OWN HEALTH CARE WAS JUST PUT INTO ANOTHER BRACKET FOR THE SAKE OF $11. I AM DISABLED 100%, PERMANENT & TOTAL FOR ALMOST 19 YEARS NOW, & I HAVE TO GIVE TO SOMEONE ELSE? I DON'T SEE ANYONE HELPING ME, JUST DENYING ME! SORRY, NOT IN MY CURRENT PLACE!" Disagree "NO, I KNOW PEOPLE ALREADY, INCLUDING MYSELF, WHO WILL NOT GO TO A DR., BECAUSE OF THE COST, HOWEVER, HAS BEEN UNEMPLOYED & IS 60, BUT HER SPOUSES INCOME IS OVER THE LIMIT! BOTTOM LINE, HOWEVER, IT WILL BE DONE, ANYHOW, SO WHY ASK?" Disagree "ALTHOUGH I AM DISABLED 100% MAYBE YOU CAN ANSWER THIS! FOR $11 I AM PUT INTO ANOTHER BRACKET, AM FACED WITH THE POSSIBILITY OF PAYING A DEDUCTIBLE?, I WILL NOW PAY (I HAVE NEVER HAD TO) MY MEDICARE PREMIUM OUT OF MY ONE MONTHLY CHECK, AND ON TOP OF THAT I MUST PAY AN ADDT'L PREMIUM OF $15 A MONTH FOR MEDICAID! BUT DOES ANYONE ASK ABOUT MY RENT, OR MY MEDICATIONS? NOT ONE!" Disagree "IT ALL DEPENDS ON INDIVIDUAL NEEDS & ASSESMENTS. I'VE LOST 12 TEETH IN 15 MONTHS, I NEED GLASSES & MY HEARING TESTED! IS THAT AVAILABLE FOR ME? NO. AND I AM IN THE STATE THAT WAS JUST GIVEN THE GRANT FOR HEALTH CARE REFORM!" Disagree "I'LL BELIEVE IT WHEN I SEE IT! I WOULD LIKE TO KNOW HOW, WHERE & TO WHOM THE RECENT GRANT OF $385 MILION IS TO BE DISTRIBUTED, BECAUSE YOU CAN'T TELL IT BY ME!" Disagree "WHEN I AM TOLD TO GO TO AN EMERGENCY ROOM FOR AN INFECTION DUE TO MY TEETH FALLING OUT, AND THERE IS NO TRANSPORTATION SHORT OF AN AMBULANCE TO GET THERE, WHICH, BY THE WAY, IS ALSO NOT COVERED, THEN IF YOU WERE TO GO TO THE ER THEY WOULD TELL YOU TO SEE A DENTIST ANYWAY, WHICH YOU CANNOT AFFORD. SO I GO TO MY MEDICAL DR., IN TOWN, WHO PRESCRIBES AN ANTIBIOTIC ETC. I THEN GET A BILL THAT ROUTINE CHARGES ARE NOT COVERED! DID ANYONE HEAR ROUTINE? AND READ ABOVE! THANK YOU!" "I PROVIDED EVIDENCE FROM THE SURGEON GENERAL REGARDING MY TEETH, ALONG WITH THAT OF DENTISTS & DOCTORS! I WAS STILL TURNED DOWN! " "WHEN I CALL MY STATE'S INSURANCE LINE, I AM EITHER PUT ON HOLD, TOLD THEY ARE TOO BUSY, AND TO LEAVE A NUMBER, BUT THEY NEVER CALL YOU BACK, OR THEY HAVE NO IDEA WHAT I AM CALLING ABOUT, EVEN THOUGH I HAVE LITERALLY SPELLED IT OUT. INSTEAD I GET ANOTHER BOOKLET IN THE MAIL!" 31921 08/28/06 IN Agree "* Too much of the expense of today's health care is inflated by ineffective and / or dangerous medications and treatments. The poorly regulated pharmaceutical industry aggressively markets prescription medications that are responsible for over 100,000 deaths a year, taken the way they are prescribed. Hazardous, ineffective, but lucrative examinations such as mammograms are freely ordered while a better and safer test such as breast thermography is unknown. There is essentially no emphasis on preventive approaches to health that doesn’t involve expensive medications. Physicians are spending too much time with their Palm Pilots, and ignoring the humanity of their patients. The value of Health care lies in its quality, not quantity. " Disagree "The Federal Government has been unable to secure our borders, deliver aid to disaster stricken areas of the country, manage Homeland Security, be honest about its machinations, or further the cause of National and International peace. I shudder to think what they might do with an already ailing health care system that is dominated by greedy corporations and political corruption. A large proportion of the Food and Drug Administration is on Pharmaceutical company payrolls. " Disagree "* 1. ""Evidence Based Practices"" are usually financed by drug companies. Too often, the researchers find what the drug company wants them to find. There is well documented evidence of conflicts of interest among those who presume to provide ""evidence"" that all practitioners will be expected to follow. Rather than raising the floor on Medical practice, this idea will lower the ceiling. 2. Implementing Health Information technologies in teaching hospitals where medical residents are trained is completely contrary to fact. Cuts in Federal Funds for teaching hospitals and decreases in reimbursements from Medicaid and Medicare are the main reason that teaching hospitals have had so much trouble. Since the Federal Government was unable to finance teaching hospitals at the older level, where will their increases in funds come from? 3. ""Reduction of fraud and waste""? The ungodly red tape involved in making claims on Medicare and Medicaid have lead most physicians to conclude the taking these insurances is " Agree "All the above are positive practices, but there is no suggestion as to how they can be implements. Hospice has done an excellent job, and yet it has gotten relatively little Federal Support in the past. That would be a good place to start." Agree "We should begin by regulating Pharmaceutical companies the way they are regulated in Europe and Canada. Eliminating poverty is really the first step toward an affordable health care system, otherwise some other segment of society will be forced to support the needs of the poor. " Disagree "This sounds like an empty politically motivated promise that has little chance of actualizing, but which sounds good in principle." 31925 08/29/06 IL Agree "Very high sounds like a weasel word. The definition of high out of pocket costs varies widely with income, costs of necesities like housing, etc. that vary across the country. We need adequate coverage for all Americans. At present many bankrupcies are caused by unmanageable health care bills." Agree Agree "Here we need to contain escalating and unnecessary costs by negotiating drug prices, eliminating advertising of perscription medication, for profit hospitals and doctor owned treatment centers which skim off the more lucrative patients and treatments and dump rest on non profits and underfunded public hospitals, regulation of insurance companies that cherry pick the clients that are least likely to be sick and therefore are the most profitable, etc. etc." Agree Agree Amen. This is the fundamental policy that needs to be implimented Agree We need to reorder our financial priorities away from massive military expenditures and adventures to providing for the basic human needs of our citizens. We need to truly reform our tax structure so that individuals and corporations with greater wealth bear a larger share of the burden. 31926 08/29/06 NM Disagree "* This recommendation is implying that every American should have access to a high deductible, Catastrophic Coverage plan. I strongly support the idea that no American should be impoverished by high health care costs. However, I am concerned about: 1) 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. 2) 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. 3) I 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 "I believe that it is important to include preventive health measures and means of handling patients with chronic illnesses in this recommendation I agree that federal support is necessary to develop integrated community health networks and ensure efficiency of the process. I would like to recommend incentives to encourage physicians-in-training to choose primary care residencies, for example loan forgiveness programs. " Agree "Improving quality of care and efficiency must be a top priority of health care reform; however, I do not want to limit federal involvement only to federally subsidized programs. Private programs should also be evaluated for quality of care. I would like this recommendation to include improvement of healthcare technology with respect to Emergency Medical Services. I believe that focusing attention on technological advances is the next step in increasing efficiency and quality of health care." Agree "I support means that would allow for quality, affordable long-term and end of life care to individuals in need. I am disappointed that the recommendation does not recommend increasing federal funding for Medicare to deal with the aging baby boomers generation" Agree Access to quality affordable healthcare is a human right. I applaud the CHCWG for this recommendation. I am 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 "* It is my belief that Single Payer health care is the best financing mechanism. It will provide access for all Americans but will also have the key ingredient of cost control. The current system is wasteful and needs to be reformed. We cannot continue to sustain the current system and control costs, there are too many holes in the dam. Moreover, a single payer system would maintain and expand provider and patient autonomy. It would not interfere with delivery but only streamline it. Doctors would remain private practioners, as would hospital. Single payer is the answer to the principles of fairness, efficiency, and shared responsibility." I call for this recommendation to go a step further and provide means of evaluating and enforcing the coverage package. "I 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. I applaud your commitment to fixing our ailing healthcare system." 31928 08/29/06 OR Agree Expand medicare to all with complete coverage. Disagree Sounds like big bureaucracy. Agree Eliminate private insurers. Agree Agree Include basic dental health. Agree "Eliminate the middleman, private insurers and there will be plenty of money to finance universal health care." Keep private insurers out of negotiations. Keep the private sectors fingers out and it just might work. 31929 08/29/06 CA Agree "* The health care system in this country is almost useless to a large population of middle class Americans and totally useless to those in the lower economic group. Many of us have some form of unsurance, but that is not the same as having actual health care if we can't choose our own doctors (and then get in to see those doctors in a timely manner!), afford the co-pays and deductable, or, in the case of a crisis and expensive care, spend hours on the phone navigating voice mail systems so we can argue with underlings to try to get our life saving care covered because their beaurocratic rules only cover x percent of that procedure and doesn't cover the anesthesioligist for that procedure or we happened to get rushed to the wrong hospital for that other precedure. It's a nightmare. I still have unpaid healthcare bills from 10 years ago because the insurance company declined to pay for this or that or only wanted to pay a certain amount for a certain procedure, even though the hospital billed more. I cert" Agree "We definitly need to strengthen the health care process on a local level. This is where people need care, right in our own communities, and it is where cost-saving preventive care is likely to be the most efficient." Agree "I think it would be relatively simple to expand one of these programs, such as Medicare, to cover more and more people until we are all covered. Each of these programs have their own problems, but they do a remarkable job of providing quality health care for a large number of people on relatively small budgets." Agree End of life care can ruin a family and spoil some of the last years for our elders. My grandma lost a fortune caring for her mother and husband in the last years of their lives and is now almost obsessed with not placing the same burden on us when she goes. Agree "All human beings deserve quality health care. The balance in your bank account does not effect your rights as a human being for this basic level of care, and it doesn't change our responsbilities to care for our fellow human beings. Shame on us for letting so many people suffer for so long! How can this even be open to debate?" Agree "Why make this any more complicated then it is? The government should collect taxes on all income and use the revenue to fund a comphrehensive network of community clinics that provide care for everyone, regardless of class, gender, or economic status." "This is the only fair way to do it. However, since scientists know what they're talking about, and since consumers know what they need and are actually the ones footing the bill, (though perhaps through an indirect route), these groups should be far more prevelent on the board than ""payers."" " "* The government should be paying doctors and nurses running community health clinics, just like schools and libraries (only please, let's fund the health clinics appropriately!) Just like schools and libraries, everyone can have access. Everybody gets a basic level of care. Everybody gets preventive care. Everybody can choose their own doctor within their neighborhood clinic or go outside to a different neighborhood if they like that clinic better. Popular clinics get to hire more staff to accomodate increased consumers. Clinics are run by health care providers, scientists, not uninformed political jockeys. Wouldn't it be great?" 31931 08/29/06 MN Agree "We have to get to this.Our medical care system is spiraling downward and the frustration of Americans, especially those in need, is escalating into rebellion, anyway." Agree "We are in crisis and if there is no change in our current system, the current system (and, the people) are on the verge of imploding." Agree Change is necessary. The current system is not working. Rebellion is on the horizon. Agree "Change is imminent. So, is rebellion." Agree We are in crisis. It is clear that change is necessary. Agree "Some type of ""taxation"" is obviously necessary, but it has to be implemented/taxed according to affordability of ""taxees"". Maybe, even put a portion of current taxes (that are wasted on items that most Americans object to) and put toward what is really necessary, our health." "* And, these benefits should serve everyone's needs and that includes holistic health care/alternative health care,e.g. acupuncture, herbal medicine, and these procedures should only be performed by those who are extensively trained in these areas, and not by MDs or Chiros who take a weekend seminar and certify themselves on the same level as practitioners who spend years studying these alternative medicines, and who take Boards specifically designed to test the knowlege level of those trained in these alternative areas. We should not be forced to use unnecessary drugs and succomb to unnecessary & dangerous surgeries, when there are affective alternatives. These changes absolutely must include choices in medicine, otherwise we are trapped in the same medical prison & bureaucracy that is causing most of this medical crisis, and that is the self-serving politics and control of drug companies & AMA who only want to line their own pockets, care only about profits, and do not really care about the health of peopl" 31932 08/29/06 WI Agree Agree Agree This will be difficult to implement as many physician groups are uninterested in working with underserved/low income populations. Agree I have privacy concerns with electronic medical record systems. Agree Supporting home care at the end of life is essential. Agree "It is very important to the majority of Americans that the medical model of care is not the only one supported. Midwives, naturopaths, chiropractors and other ""alternative"" practitioners should be covered as well and should not only be available to the wealthy." Agree "It is very important to the majority of Americans that the medical model of care is not the only one supported. Midwives, naturopaths, chiropractors and other ""alternative"" practitioners should be covered as well and should not only be available to the wealthy." 31933 08/29/06 TX Agree I think this will be good the county and the people . Agree Agree Agree Agree Agree 31934 08/29/06 TX Agree I think this will be good the county and the people . Agree Agree Agree Agree Agree 31937 08/29/06 MI Agree Coverage for all citizens and citizens only. Agree Coordinate public or private health providers to give basic medical care when or where needed. Not routine hospital care for indigent people who do not take care of themselves or abuse the systems. Agree Get medical community and drug companies to limit their profits so that basic care can be provided at reasonable costs. Agree Include alternative care procedures if applicable Agree Require copayments to reduce overuse or abuse to the system Agree Allow for health care funding or savings accounts to assist or provide more advanced care. Provide for citizens only Government programs often become a bureaucracy to themselves and so private companies should provide the services at competetive rates with the government guaranteeing payment. 31939 08/29/06 WA Agree Divert some of the funds being spent on wars to finance health care for all Americans. Agree no comments Agree Establishing reaearch programs on how to promote quality. Agree no comments Agree no comments Agree We should take care of our people here on earth before we go to the moon. 31941 08/29/06 IN Agree Health care insurance has become out of reach for so many Americans. We need help. Agree Agree Agree Agree Agree 31942 08/29/06 OR Agree Why should we further financially punish those who are unfortunate enough to be stricken by chance with complex conditions or who experience a life altering accident that was no fault of their own? Agree Agree Agree Agree "Strongly agree. That said, I recognize that not all services can be provided without limit. At the very least every American should have affordable and regular access to basic checkups and knowledgeable preventive care. " Agree See ArchimedesMovement.org Strongly Agree Please. Our current system is unsustainable and absurd. 31943 08/29/06 NY Agree There still needs tobe a copay for each individual. Agree Agree Agree Agree Agree 31944 08/29/06 DE Agree "Do not install a system of social medicine, It does not work in a manner that serves the needs of the public in a timely manner." Disagree We pay too much now for health care. We do not need a federally funded program to support health. This leans too much toward a federally funded social welfare system of social medicine. Agree Agree Who is going to pay for this effort? Not something to add to the burden placed on the tax payer. Disagree NO More Welfare Systems...you liberals don't get it.... No response No to increases in any type of taxes. 31945 08/29/06 PA Agree Agree Agree Agree Agree Agree "Stop giving Congress free health benefit,so they can how the average has to suffer" 31946 08/29/06 TN Disagree "* While universal health care coverage is an admirable goal, the experience of other nations’ experiment with this concept should give us some important lessons. The providers must be paid a reasonable fee for their service, otherwise there will be endless waiting lists for life-saving services as currently exists in Canada. There must be at least some accountability on the part of patients who make poor lifestyle choices, as these are largely the ones who are running up the nation’s total health care bill. Certainly we should help people quit smoking, lose weight, etc., but human nature dictates that there must be a penalty for not doing so, either in higher premiums for coverage (which will lead to some who will refuse to pay, and hence be “uninsured”), or in increased payments for medications (which will lead to some not buying them, and becoming “non-adherent”). To help people make better lifestyle choices, I have no problem with requiring a specific license to purchase tobacco or alcoh" Agree Agree Patients must ahve some responsibility for themselves in the process. Disagree "The system cannot be “all things to all people”. Resources are limited, so to make the system equitable, it must be on a ”most good for the most people” basis, even if this means letting the sickest people die ( and putting them in some form of Hospice along the way). Most of Europe already has the standard that those on the public health system who are over a certain age do not receive the same level of service that younger people do. " Agree "Those requiring financial assistance should not be allowed to purchase tobacco, alcohol, or other luxuries." Agree "Basic services will have to be funded at the federal & state government level, adding this burden to employers will further hasten the exit of manufacturers to less a less hostile environment. Any services above this should be paid by the employer or individual." Patients must share in the responsibility for acheiving & maintaining their health. "* If everyone is to be covered for basic services, then the system cannot be “all things to all people”. Resources are limited, so to make the system equitable, it must be on a”most good for the most people” basis, even if this means letting the sickest people die ( and putting them in some form of Hospice along the way). Most of Europe already has the standard that those on the public health system who are over a certain age do not receive the same level of service that younger people do. Adding health care to a growing list of “entitlements” to which our country is already addicted will only increase expectations, and resultant litigation. A universal health care system cannot work until ALL litigation is placed on a “loser pays” basis such as exists in Canada or Great Britain " 31947 08/29/06 MD Agree Agree We should take a look at work works in other countries such as Canada and take the best parts of these programs with our own ideas. Agree "However, let us not make another bureacratic top heavy overregulated monster. The program should be streamlined and nimble." Agree Agree Agree 31948 08/29/06 IL Agree "Premium subsidies are recommended for low income people, but will the subsidy considerations include out of pocket expenses for day care, mortgages, chronic medication therapy, etc.?" Agree I believe that establishment of a public-private group may provide the best chance for health care reform. Agree Electronic medical record systems will have to be implemented before increased communication among health care providers can occur. Agree Agree Agree I believe a single payer system should be instituted such as the Medicare example. People should not have the option to purchase private insurance because that will increase inequality among the poor and wealthy. Nothing is mentioned about allocating finances to ensure a qualified work force in health care is maintained. 31949 08/29/06 NH Agree I need help iam keaving abroad non aprent earlier age of my life adopteed right now iam facing fanacial not at all and all my facts info has being missing by my MUM late . What can i do to hold on my health care and social orders. Help me iam planing to be there soon for my study. Thanks Femblix Agree You help is needed any ways Agree your help is needed always i agree Agree Your help is needed always your is wish i agree Agree Always Agree Always Always Always 31950 08/29/06 IL Agree Agree Agree Agree Agree Agree 31951 08/29/06 NY Agree long overdue. Insurance co's have ruled long enough. Disagree not needed. Agree Agree Agree Agree 31952 08/29/06 MD Agree Agree "Co-ordinate these efforts with those directed at creating transparency, perfomance measurement systems, and related efforts to improve quality and responsibly contain cost---see IOM reports and NQF activities. " Agree "In regards to HIT, build on the recomendation of ONC and the work of AHIC. " Agree Agree Agree 31953 08/29/06 MD Agree THERE NEEDS TO BE SOME ASSISTANCEWITH THE WORKING POOR. I AM IN NEED OF COVERAGE THAT WILL AFTER THE PREMIUMS ARE PAID THAT IT WILL PAY FOR THE SERVICE. NOT PAYING AND PAYING AGAIN WHICH AMOUNT TO NOT REALLY HAVING COVERAGE. Agree Agree Agree Agree Agree 31954 08/29/06 IL Disagree not our job Disagree not our job Agree govermental programs keep health care costs high Disagree let the private sector do it Disagree it will ruin health care in the usa Disagree let the private sector do it health care is not a goverment job and all govermental programs should be done away with that is the only thing that will bring down cost 31955 08/29/06 NY No response "* In principle, I would support this recommendation, but your decision to place it at the head of the list gives me pause. I cannot support the evident consequences of that choice. Given the abundance of health expertise in the Working Group, it is hard to reconcile the decision to begin the list with this particular recommendation. The paradox is underlined by the focus on catastrophic coverage to the exclusion of any consideration of the importance of primary care. Is there not a heavy cost to be paid in future illness and in avoidable acute care if people cannot afford routine primary care and therefore fail to seek it when they should? When polled by the WG as to whether payment for “everyday medical expenses” or protection against high medical costs is the “MOST important reason to have health insurance,” a clear majority of respondents chose the latter. But if presentation of a loaded question leads respondents to overlook the importance of affordable primary care, does that justify the" Agree "* I agree with this recommendation in its broad outlines. The need for more comprehensive systems with ease of navigation is critical. But applying the “safety net” idea is problematic, and failure to mention the importance of assuring beneficiaries’ continuity of care and choice of provider are serious oversights. The safety net concept in medical care delivery carries undesirable baggage. Surely institutions like community hospitals and health centers, and FQHCs and public hospitals in particular, make vital contributions to community health, and they have a critical contribution to make in the foreseeable future. However, “safety net” has long carried an implication of a separate and unequal delivery system. Genuine commitment to addressing the special needs of vulnerable populations should make the miserly term “safety net” obsolete. Creation of a group is to be responsible for advising the government on the performance of the medical care system in meeting the needs of vulnerable p" No response "* I support the proposals for achieving higher quality of care. With regard to the proposals for improving efficiency, the focus on reducing fraud and waste in administration and clinical practice is of central importance, but the administrative waste inherent in our reliance on private insurance with multiple carriers is not mentioned. In terms of constraining the cost of care, one important area not addressed at all is the fairness of pricing of medical goods, services, and equipment. Another is redundancy of capital investment by medical institutions competing for market share in metropolitan areas. Further, in pursuit of efficiency, the WG suggests that consumers could be given information on prices of medical services and that such information could guide consumers when they are considering seeking medical care. Because this is presented along with a reference to consumer usable information on cost sharing, there are at least two possible interpretations of the WG’s intent. One interpretation is th" Agree Agree "* The placement of this recommendation in the WG’s presentation reflects an inappropriately low priority. In the printed presentation of the WG’s Interim Recommendations proper, the structure of the illustration that appears along with the opening passages (page 8 of the PDF presentation) suggests that, if the nation starts implementing the four preceding recommendations in 2007, somehow by 2012 that will lead us to a public policy that all Americans should have affordable health care. There is no strategic logic to support this sequence. Is it not the absence of a national commitment to such a policy that explains the nation’s failure to set forth on the entire course? I believe the American people are ready for such a commitment, and it deserves the higher priority that the WG gave it in the first iteration of the Interim Recommendations. Indeed the only policy commitment that I can see as deserving even higher priority is a commitment to realize the conditions for all Americans to be health" Disagree "* It follows from this that when a patient incurs a medically necessary service cost that falls outside of the core package, the patient will need to pay out of pocket. Although there must inevitably be a limit on the nation’s spending for medical care, the method recommended here by the WG is not the best way to allocate finite resources. It would arbitrarily exclude services a priori that might be medically necessary for some people’s survival. The recommendation is particularly troubling given that the WG has failed to make recommendations in several key areas of system inefficiency and waste (notably, administrative waste inherent in our reliance on private insurance with multiple carriers; unreasonably high pricing of many medical goods, services, and equipment; redundant capital investment by medical institutions competing for market share). In its Interim Recommendations document, the WG fails to point out an important finding: in its community meetings and online polling, the overwhelming " "* A preferable strategy for allocating finite medical resources would be practicable if the provider payment system were reformed to eliminate incentives for over serving and under serving. With such a reform and with global budgets for defined regions or communities, allocation within those budgets could be entrusted to clinicians. The WG’s discussion of Values & Principles argues that individuals should be responsible, to the extent possible, to be good stewards of their health and health care resources. Requiring copayments or other cost sharing is a poor way to promote responsible use of medical services. Such financial obstacles are at least as likely to cause people with limited incomes to skip important services as to skip unnecessary ones. Promotion of responsible use is best done by doctors. This will require (1) assuring that everyone has a medical home, (2) reforming the provider payment system to minimize provider incentives either to over serve or to under serve, and (3) through public heal" 31956 08/29/06 GA Disagree "Low income individuals and families already have coverage,ie medicade. I would welcome a private medical insurance program which only covered catistropic expences, say, above $10,000.00. The cost of this insurance should be tax deductable for all tax payers." Disagree This looks like another way to spend the tax dollars and get very little in return. Disagree The federal government will use this mandate to impose requirements which just increase the cost. If you want to lower the cost of health care change the third party pays system (Insurance or Medicare/medicate pays). Disagree When the government gets involved in this they only complicate the problem. People have the right to make life and death decisions without government involvement. People have the right to die when they want. Disagree "This can only be done by the private sector. Health care expenses should be tax deductable for everyone reguardless of income. The consumer should be more involved in the financial decisions so he can make better, more cost effective decisions. Preventative medicine for all ages should be incouraged, and manidatory in all publicly financed health care systems. Medicade/medicare etc." Agree "* All persons receiveng medical service should have to pay part of the bill for those service out of pocket. This includes low income persons. When something is free it is abused. If the government pays for the majority of the cost by increasing taxes the cost will continue to increase at an even faster rate. Raising taxes will not solve the problem. Set caps on pain and suffering libility, limit damage suits to actual expense, revoke the medical license of doctors and hospitals with poor records (The AMA does a very poor in this area and should be taken out of the process) require real second opinions, require doctors to provide consumers with alternatetive procedures including alternative medicine, keep the consumer informed of all cost for care as they are occuring, prevent hosipitals from overcharging and penalize them when they do." 31957 08/29/06 TX Agree Agree Agree Agree Agree Agree 31958 08/29/06 MI Agree I strongly support a universal coverage program. Agree Agree Agree Agree No response 31960 08/29/06 CT Agree Agree Agree There should be a preventive medicine/alternative medicine rider attached to these coverages to allow for a wellness based system that avoids or deters the use of expensive medication when there are other proven alternatives (i.e. chiropractic care for migraine headaches). Agree "Home health care should be emphasized for situations like this. Not only is it less costly, but it also allows an individual to die with dignity." Agree Agree Force employers to insure their employees. Their higher profits should not be at the cost of the greater good - nor should society be paying to insure their employees when they are pulling huge profits. Perhaps a slight tax incentive for this (even though there already are tax incentives). "But these definitions should encompass the opinions of professionals from many different areas, including naturopathic care." 31961 08/29/06 NH Agree Agree Agree Agree "The people who are working with the elderly in their homes need a living wage. These caregivers, like the visiting nurses(which are often not just nurses) are unpaid and have no benefits." Agree Agree 31962 08/29/06 MO Agree "Health care costs are out of hand as is health insurance. Costs, whether one has insurance or not, should be regulated. Quit charging higher fees to those with insurance...all this does is raise our premiums and makes it very, very difficult to carry affordable health insurance. Every one or two years I have had to go to a higher deductable and reduced benefits in order to have any insurance at all. What am I going to do in another couple of years when I cannot afford it at all. HELP! Please!" Agree Agree Agree Agree Agree Whatever it takes as long as it's fair and equitable. Dental care is important. "Do something about the medical care costs and equitable health care for all, but it needs to be accomplished quickly. Please, no more politics when it comes to the health care of citizens." 31963 08/29/06 MI No response Agree if we don't do something we could have a real crisis on our hands. Agree I think it is sad that so many people abuse the current system but sometimes it is the only way these poeple can get payed for helping someone. Agree we nedd to help people make informed dessions. Agree this is something we all need small businesss can afford to offer health care to its employees much longer. I have never been in the porition of making the desion of taking my children to the doctors or putting food on the table but I know of alot of working people who are and it is really sad. Agree most people can't afford medicine and the mental health isn't covered in alot of plans. so we need help. 31964 08/29/06 MD Agree I believe we should have coverage for everyone especially the elderly. Noone in America over the age of 60 should have to go without good health care and medication. Agree "* Checks and Balances are a necessity. But, we should be mindful not to spend all of the funds allocated for the health care for the under priviledged and uninsured to line the pockets of those in the position of monitoring. There should also be a mechanism that checks COMMON SENSE practices. Individuals who are not HEALTH CARE PROFESSIONALS should not dictate the health care for those who need it. Listining $$ as a reason that the care recommended by your doctor is not necessary. If medical professionals are found to abuse the system for $$ - Prosecute them - not the patient. Here in the U.S. MONEY and greed has to stop dictating the road that we take. Compasion and Human decency must prevail when it comes to the health and welfare of our citizens. " Agree "* I think this is important. I have on so many occassions encountered terrible patient centered care for veterans to be absolutely horrific. I myself have asked receptionists, attendants etc., that I have witnessed being rude, why are you in this profession? No one deserves to be disrespected because they have to come to medical facilities where they are receiving free or help with medical costs. I believe attitudes have to be changed in respect to providing health care to those who are receiving federally funded health care." Agree We must check the credentials before people are allowed to care for these types of patients. People need to be prosecuted to the fullest extent of the law when the rights of these patients are abused. People deserve that respect. Agree By all means. Those who can - provide more. Agree "This is the most important issue of all, how do we do this? It is much easier said than done. But, just as we pay taxes, we must pay for this. Let's look at how other countries do it. Let's incorporate the best of all of those and make our system the best of the best." "Staying focused on the goal at hand is the key. Having the group dynamic that includes patients, providers, and taxpayers is great! I think ordinary everyday people must be part of the group. Not just the well off." Not at this time. 31967 08/29/06 NY Agree Disagree too much goverment invalvment Agree Agree Agree Agree "all americans should be part of the financing of there health care, but americans who are unable to pay any money due to illness should be covered without any loss to them or there familys." 31968 08/29/06 TX Agree America needs to ensure that people do not become impoverished as a result of inadequate resources to pay for health care. Agree "The infrastructure exists for many services, coordination and payment are key to improving access to these services." Agree "There is much redundancy in health care services. Too many facilities compete for services which are duplicative and expensive. Coordination of these services should receive primary consideration, in order to reduce the competition for the services. Competition leads to improved quality, therefore we need to find a way to reduce competition, and at the same time, improve quality." Agree Too many resources are spent on keeping people alive when they should be allowed to die with dignity. Our society believes that all technology should be used even if the outcome is eventual death. We need to reallocate resources and focus on education and acceptance of end of life. Agree Absolutley! We need to ensure that ALL people have access to reasonable health care. Preventative care should be first and foremost. Agree We need to focus on a core benefit package for everybody that provides the basic services outlined within this recommnedation. "I applaude this group for the efforts and recommendations they have ade. Now let us, as Americans, listen and do what is right!" 31970 08/29/06 TN Agree Health insurance should not only be for the priviledged. Public health care (government sponsered)would keep the increasng cost of medical care down for everyone. Agree Agree Agree Agree Agree 31971 08/29/06 TX Agree Agree Agree "* I believe this should also include access to alternative disciplines to medicine in which preventitive and restorative health measures are available: nutritional counseling, nutrative support vs allopathic medicines, midwifery care for all families with referral for medical care if needed, chiropractic and massage therapies build up peoples bodies and decrease the need for expensive medical interventions. Most physicians are never even exposed to alternative/preventitive treatment modalities and are skeptical and afraid of them; neither do they take time to research them as they are not educated to view them as viable possibilities. In turn, the general population also remains ignorant.Better education of health care professionals and respect of other disciplines could benefit the American people greatly. I hope the truly Best-evidenced based practices will be studied, because right now they are being ignored by the medical communtiy." Agree Agree Agree "I think there should be some sort of income/profit percentages paid into the national healthcare system, so that higher income/ higher profit companies contribute proportionately to the welfare of all. Maybe even extra giving incentives are possible. Health savings accounts should be available to all people, so that younger families are encouraged to save and invest toward their own care later in life. Many companies only offer fsa and the extra they keep, not right." "* If basic physical, mental and dental health care is universal it may well decrease the amount of acute and intensive care needed. Again, I hope that evidence based care will not be striclty limited to ""medical group"" research. Medicine has made wonderul advances, unfortunately I find that many of the evidence sits by the wayside and physicans continue to treat people the way they were taught in school. Many groups do not even follow their own professional recommendations. (ACOG)People have turned to such a wide variety of alternatives because the medical system is incomplete in and of itself. It is the most familiar and therefore the most used. " "* I applaud our government for this endeavor and the time and effort going into this project. I am disappointed that there was not more publication of these events except to certain organizations. I found out about it through my ""alternative medicine/ grassroots"" associations. I did not see or hear any public notices. I am a nurse also, and no one at my work was aware that this incentive has been going on. I have family in different parts of the country, also involved in health care and health care administration and they also were ignorant. How can so much of the general population involved in healthcare be ignorant of this important matter?" 31972 08/29/06 VA Agree Agree Agree Tricare needs to stop sending claims back when they have all the info on the EOBs attached to the claim form. They are coming back without any info from TRicare. Looks like they are trying to buy time so not to pay. Now tricare won't pay our claims if we submit them and not the doctor. Why do you give us access to print claim forms if you won't accept them from the patient? My doctor does not bill secondary insurances. Agree Agree there should be some work for care like welfare plans also Disagree "everyone should pay the same amount. If it goes up, everyone's payment goes up. No scales. All pay the same. " "Any time you add ""experts"" like they did to the FDA, it only means that big business wants to make sure it gets its' own way. Citizens must have a huge role in this or forget it working for the people." 31973 08/29/06 OH Agree Some people do not seek health care bacause of the high cost. Some have been denied health care because they have no insurance and cannot pay for the care. Agree There is a need for a National Health Care Program for everyone. The insurance companies have too much control and denial of treatment for some results when some companies refuse to fund a procedure or treatment. Disagree Thee are too many variations in payments for health care. Make it simple and provide a National Health Care program. Agree Assistance in the home through Hospice and Palliative Care reduce cost in hospitals while comfort of family is maintained. Proper prepration of personnel in these programs is most important. Agree There needs to be a National Health Program available to all regardless of income or lack of income. Agree Keep it simple. Move and make it simple Make a program available that will restrain insurance companies from charging doctors high insurance and prevent people from suing physicians and developing scams. 31975 08/29/06 TX Disagree Health care should be available o all Americans- the industry and costs have gotten way out of hand. Providers are milking the system. There should be a way to limit the exorbitant costs. Disagree Most of the recommendations are in place in one way or another. The problem is theri taking responsibility. Agree Agree Agree Agree Financing can some from the savings due to fraud and checking costs. 31976 08/29/06 AZ Agree As a healthcare professional I have seen the highly negative impact of catastrophic ilnees on patients and their loved ones. This is long overdue. Agree "Having lived and worked in rural South Dakota and Nebraska as a health care professional, I have seen the the need for such a healthcare safety net. In addition 2 members oif my family are uninsured and one of those had a thyroidectomy for cancer and a $100,000 hospitalization for a head on MVA by a chemically impaired driver. TRhe pharmacy benefit without a ""non-competitive bidding clause"" must be included. " Agree "* While I support this in theory and feel that it can accomplished, I also recognize that there are ""feifdoms"" in federal healthcare: DOD, VHA, IHS, NIH and the FDA. A major GAO report in 2005 criticized the enabling legislation for the new T-NEX contracts because the TRICARE Regional Office Commanders authority and accountability did not supercede that of the like service commander the military treatment facility response to his/her higher authority (i.e., Luke AFB 56th Med Group Commander to his USAF superior vs the Navy Admiral at TRO-W." Agree "My wife was a certified hospice nurse and we as RN's for the last 41 years have seen the devastating impact on patients and families, and have both lost a parent requirng hospice." Agree "While I agree with this in principle, I reserve the right for a healthy degree of skepticism because of the concerns for the technologoical challenges of guranteeing HIPAA,ADAMHA and Privacy Act professions. Arizone is the identity theft capitol of the country. I've had two episodes of potential ID theft since 2001 as a TRICARE beneficiary. And yesterday I received a state Department of Revenue inquiry, over 1,200 miles from where I live and have never lived or been stationed in." Agree "* ""Doughnut hole"" and ""non-competition clauses"" for pharmacy benefits are totally inappropriate. Banning importation of drugs from Canada and Europe that have manufacturing requirements that are as stringent as ours, is ripping off the poor to pay the pharmacy robber barons. Recent studies have shown that the only ones to benefit from the phamacy ads are the pharmaceutical manufacturers, for genertating demands for drugs that may not be appropriate for the patient/or when a simpler drug may be just as effective. Pharmacy patent manipulations to extent patents by reformulations to retain market share are adding to the cost of mnedicine. In addition you have the hearing aid dispensers who have the same product that advancing technologies generates doubling and tripling in prices while in consumer technology, the same laptop computer capability that cost $5,000 in 1995 now costs as little as $400 with greater computing capacity. Public reporting should extend to all bio-medical equipment suppliers, pharamc" "* It is interesting that the core benefits avialble to Medicaid patients is more benefits rich than that supplied to Medicare recipients, and requires less accountability for self-care behaviors/partcipation. I have seen DOD and IHS beneficiaries show up for delivery with no prenatal care, despite the fact it was free. I have seen Medicare recipients marking hard choices between food & shelter, and medications to keep them alive and healthy. I have heard the observation that Medicare is more willing to pay for acute hospitalization as a complication of coronary artery disease than to pay for the medications that would have avoided it." This sounds like a number of ideas that have been floated around for at least 10 years and compiled into a laudadble plan. Too bad the billions spent in Iraq and Afghanistan couldn't have funded it sooner. 31979 08/29/06 PA Agree "I agree that every American should have the opportunity to receive medical services with the medical costs being capped. For example: a doctor's office visit should be a fixed cost based on time rendered and not subject to annually increases because this is a time based service. As far as inflation, it should not be percentage based but a fixed dollar/cent amount." No response * I never agree nor disagree with this statement because it is so confusing. I think there should be a community clinic available to every American for basic medical services within 60 miles of each other that would include mandating current private or public medical facilities to participate with more extensive care available within 90 to 120 miles of a clinic. This would simulate a spider web network of facilities across the USA that is available to everyone regardless of ability to pay. Physician's & Residents should be required to volunteer at least 8 hours a month to one of these facilities. (Or time could be calculated based on the number of current practicing physicians. I do not know this number to come up with a figure.) Agree * This sounds good but will it really do any thing for health care except it is really nice wording for people to feel like their getting something. I feel that all the programs listed should promote best practices but what are the guidelines or what is the standard of care???? This is what should be outlined by the government by physicians and technicians for testing. For example: One hospital does a test but if referred to a specialist at a larger facility they do not believe the results from the smaller facility so then that physician demands the test be redone at the larger facility because the he states the practices for doing the testing is different. What a waste of money! That is why I think standards should be implemented across the nation to eliminate this duplication and payment of services. Agree I agree with giving whatever help that would be needed to families dealing with end-of-life situations. Agree * I agree with this statement and believe it could be attainable if duplication of services are eliminated and private insurances are mandated to following governmental insurance guidelines. Commercial insurances/HMO's make up their billing rules which makes payment of services difficult to obtain. I believe that if the insurance carrier is licenced to provide health coverage the standard UB92 rules need to be followedfor IP & OP services and should all be electronically accepted. No paper should be utilized for billing or for payment of funds. Same thing goes for Auto & Worker's compensation. Standardization of rules are needed without this one wanting this and that one wanting that. To much time is wasted here. Agree "Financing Health Care - good question. I don't know how much more the working class of people can be taxed any more. Maybe there should be a health care fund tax on fun things that well people do. For example: Sporting events, Concerts, movies - I guess anything that is entertainment that people with extra money would spend it on be taxed for health care. That's my idea for a universal answer to this question." " I agree with this but would also include hearing & vision in the Health definition. ""Health is defined to include physical, mental, dental, hearing and vision health. Definitely services for wellness and preventative care should be covered." "* I do believe coverage for all American's is attainable. Lobbyist's need to be out of this picture because this is a life and death situation and their need's should not be voiced. Physician, Pharmacutical, and Hospital reimbursements and ordering practices should be tracked and evaluated by diagnoses to identify trends for fraud and waste. Every Health insurance carrier should be mandated to adhere to UB92 billing standards without deviation for Inpatient and Outpatient care even Medicaid in every state. One standard form, one set of billing rules and electronic submission a must to be licenced as a health insurance carrier. Standards of care or protocols developed for tests as well as cost accounting for basic testing should be developed. That way when Medicare audits maybe health care costs can be contained and made reasonable for everyone and not cost shifted to the underinsured. Another idea is to have an independent government auditing firm to look at the costs of the services compared to the a" 31980 08/29/06 MN Disagree "* Name a government program that works, is cost effective, and people don't mind paying the additional adminitration/boondoggle costs. Can't think of any? Me, either. PLEASE do not further subject the very personal decisions between patient and doctors to government control, oversight, and ""cost sharing"". A National Health System will be a national disaster. All you have to do is look north of us to see the lack of quality care, long waits, and unneccessary tax burden such a plan. Many Canadians come to America for their health services for a reason. " Disagree See above! Disagree See above Disagree See above! Disagree See above! Get the government out of the health care business and see what less legislation and control and government approved insurance schemes will do to improve health care in this country! Disagree "See above! Keep your hands out of my pocket, and stop controlling doctors and insurance cost structures, and I'll be able to finance my own needs, thank you very much." "Great, and who will pay for this?" 31981 08/29/06 UT Agree "Our lack of a national, affordable medical care system for all Americans is a disgrace." Disagree "Sounds like you are spending a lot of money avoiding the issue that we need a national health care program for all, not more money spent on letting us know how the systems are still not working." Disagree "Still avoiding the issue, the federal government has already sold out its power with the Medicare drug Part D when they prohibited any negotiation or cost controls for drugs sold to medicare." Agree "Stop spending a fortune to extend life, help us die with dignity." Agree Agree "Stop cutting taxes to the top 1% and reinstate them, paying for National Health care." Stop being wishy washy and get us all National Medical and Dental care as well as mental health services. 31983 08/29/06 NC Agree Agree Agree I cannot emphasize enough that enforcement needs to be put in place so providers adhere to DHHS guidelines to provide language services to population with limited english proficiency! Agree Agree "A country's policy about the provision of basic medical care to its citizens and residents reflects the overall morals, ethics, and values of our society. It is disturbing that the US is one of the only developed countries that does not affordable care or social healthcare to all." No response "With the disturbing racial/ethnic health and healthcare disparities in the US, it is essential to begin providing language and culturally appropriate services to at-risk groups. Working in the healthcare system for the past 9 years, I have witnessed blatant racism, discrimination, inadequate care, and medical errors due to providers not using language services. Federal government needs to provide financial assistance to providers so they do not have the financial burden of providing language services. " 31984 08/29/06 NC Agree "* This idea of the ""free market"" providing the best possible choices and coverage is insane! Private insurance companies are in the business of making money; first and only. The company's goal is to take your premium and then to find every way it can to NOT cover you or reimburse your expenses. This process requires a huge workforce: not only in the back office of every insurance company but also in the backroom of every doctor's office. It has been estimated that close to half of every dollar spent for health care goes to this process. If every dollar being spent today for coverage by every individual and every business were directed to a single payer system (that would have an overhead cost of what, 3% like medicare?), we would have an outstanding health care system that would cover everyone in this country. It is time to get insurance companies out of the business of healthcare! " Agree Agree Agree Agree "Healthcare should be avaliable to all; just like water, food and shelter. " Agree "Healthcare should not be a profiteering venture for insurance companies and drug companies. We need a single payer system supported with the same dollars that now go to pay for CEO salaries, backroom admins and stockholders." 31985 08/29/06 AZ Agree "I think it is critical that we emphasize personal accountability for age appropriate screenings, immunizations and all health maintenance behaviors as well as utilizing disease/condition management programs to support consumers. Providers need to be formally educated in more appropriate counseling skills that support consumers in self-management behaviors to support this effort, eg motivational interviewing or positive reframing. " Agree "* I believe it must be a partnership between the government and public/private networks. Our federal government cannot do this without the committed involvement of public and private networks. We must have a clearly defined strategy such as defined in the NIH study results ""Crossing the Quality Chasm"". Each party must have clearly definded accountabilities and health care providers must assume leadership. We need to analyze current law that inhibits access to care (individual state licensure that limits telehealth support to consumers)and come to agreement on liability issues and tort reform. All healthcare providers should be more accountable in managing poor practitioners but frivolous law suits must be eliminated so providers can practice evidenced-based care and still preserve the consumer's right to sue when they receive poor care that causes damage/death. " Agree ABSOLUTELY. All healthcare providers must realize that we all must use our skill sets to the benefit of patients/consumers instead of competing with one another. The need to work in partnership and use technology to decrease the fragmentation in health care is critical. The patient and family/significant others should drive the process as they demonstrate positive health behaviors. Agree "* These formal programs are very important. More emphasis needs to be given to families that are caring for individuals at home. As a Masters prepared nurse working full time and responsible for the care of my 93 year old Mom who has had a stroke, I cannot imagine how families without my knowledge of geriatrics, the health care system, and coping skills manage. We need to do more to assist family caregivers with affordable home health aides, assistive devices, and home modifications. The patients usually benefit from a home environment and it still can be more cost effective than long term care facilites. There may be a point where a long term care or hospice facility is helpful to a family but if they choose to have their loved one at home, the services should be there to help support their effort. " Agree "B do agree but I also agree that patients and consumers must assume accountability for self management skills when they are able. Behaviors like smoking, sedentary life style, poor dietary habits, etc. should have some consequence after concerted efforts are made to support improved behaviors. As I mentioned earlier, I think healthcare providers should be competent in counseling skills that support self-management skills since a ""you should"" approach has rarely produced positive change. " Agree "* There is incredible waste in healthcare (and the most levels of government). We must use technology to decrease redundant documentation. Evidenced-based care should assist in decreasing the need for providers to order exams, lab, procedures and even surgery to protect themselves from unfounded law suits. And while I believe the drug company research is very important, the burden of its costs should not be passed on to the degree it is to consumers and the government. And if patients choose to continue poor health behaviors, such as smoking or non compliance with medications, after efforts to support them in changes have been made, they should have to pay more for their care. " "We also need to identify core self-management skills that a consumer must be held accountable for - maintaining immunizations, getting age-appropriate screenings, making positive life-style changes and following chronic disease/condition guideline with the support of healthcare providers. " "This cannot be an you/them approach - it must be all of us, from the consumer/patient/family, healthcare provider, payor(private, public and government)- taking step by step actions to achieve one strategic plan for health care that meets the need of being accessible, of high quality and cost-effective. " 31986 08/29/06 VA Agree "No one should die, or loose thier home and/or all thier life savings because of medical care costs. Those that are able should pay inot a ""system"" to protect all. A society should fund medical care and research ""to the best of its ability."" Priortize a ""standard"" for spending on health care much like other areas of government spending." Agree Agree Agree Agree Agree 31987 08/29/06 WA Agree Agree No response Given the current administration's prolific ability to lie at every opportunity this one has great potential to do great harm. Agree Agree Agree In the current model the Health Insurance providers actually have control over individual health care decisions. It is imperative that decision - making process be returned to the individual and their doctor. the current system focuses on prescription drugs and surgery almost exclusively to solve any medical problem. This makes health care confusing and dependant on an expert to tell you what to do. Any move away from this perspective will be of benefit. I don't see anything about eye care 31988 08/29/06 MI Disagree The Federal Government was never set up to ensure all individuals have health care or financial security. The Federal Government has oversteped its authority in this area for far too long and need to back off. Make people responsible for thier own circumstances and take responsibility for their own actions. If the government does anything it should be limited to ensuring that healthcare providers and insurance cokmpanies are not taking advantage of their position. Agree I agree that the federal government should assist communities in setting up local helath care facilities and encsure that these faciilities are operated with compatent individuals. This should not be a mandate however. Each community should have the option of establishing a safty net or not based on the needs and desires of their constituants. Agree Its alwasy a good idea to ensure that money is used to the most benificial outcome and limit waste where eveer possible. Agree "My only comment here is that ""the care they want"" should be reasonalbe and necessary for that individual and their family. This dokes not include suech things as livesupport systems for extended periods when any hope of recovery or self sastaniabl life is not believed to be attainable." Disagree * It is the individuals responsibility to make approperate choices concerning their wellbeing. This nationb has plenty of jobs that provide care for its employees. The federal government is not responsible for all individuals health care. A national health care program to this extent would be simular to that in canada or europe. In both these countries it takes far to ling for an individual to get any type of help unless they pay for it entirely on their own. This would be ok if they wern't forced to also pay for national care for everyone else who chooses not to take advantage of all the available oportunities offered in this great nation of ours. Disagree "* The federal government has no business financing the healthcare for all citizens. This so called ""universal coverage"" is nothing less than socialism at work. Each individual should pay their own way based on their life choices. Smoking, alcohol, and ""free sex"" are among many things that are proven to rise the cost of health care. The government should not ban such things as we are free to choose our lifestyles. However if we choose to paarticipate in such risky behavior we also choose to face the consequences. These consequances may include higher health care premiemuns or the inability to recieve coverage at all." The Government should not provbide universal coverage. To that end a core package is not necessary. We are NOT a socialist country. We are suppose to be a FREE nation. 31989 08/29/06 SC Agree "With everybody having coverage, the total cost will decrease. The hospitals and providers will not have to charge excess fees to cover the unisured and underinsured." Agree Excellent -the FQHC have been a great success and are cost effective- should be expanded further Agree Agree Agree Agree 31990 08/29/06 WA No response Disagree Ioppose modifying the federal community health centers model--the integrity and importance of the consumer based board of directors is the single most important factor keeping these programs true to the mission of service to all people in the communities in which we serve. Agree "Federally funded programs are on the forefront of quality and health information technology advances in primary care. Please continue to support our efforts in this arena, not only with start up support but also with on-going support for implementation. Community health centers are working hard to bring quality care and use of health information technology will assist. " No response Agree No response 31992 08/29/06 OR Agree "The key word is Americans, but some thing tells me this is just a gimmick to make sure who ever gets the contrac gets paid" Agree "but, what is wrong with the system we have now,i.e.,medicar or medical?" No response "so now you whant to take the only medical coverage i have thanks to my time spent in the service and give it to every one and or anyone. Well there goes my one ,last , and only bennif. i have oppps sorry i had left thanks agian Bush. I bet you will never ever have to worrie about med coverage." No response I quess the gov can see just how much private co. are making and now they whant in on it too. Personely i think the gov is in to just too much of our lives now the whant to get in on our death No response we have a system now it is called Medical or Medicade. I do not understand why we need to add another avenue for the feds to get in to our pockets No response "Enrollee CONTRIBUTIONS.INCOME TAXES, S I N TAXES. Do you hear your selves. Tell me just how can a tax be a ADDED VALUE, to who, not me " this whole thing stinks.All you whant to do is justify taking more out of our pockits and call it a favor to us. 31993 08/29/06 NC Agree Agree Agree Agree Agree Agree 31995 08/29/06 WA Agree The program should be private sector not government. Disagree Disagree Disagree Disagree We have the best health care in the world and every time a government regulation is imposed it gets more expensive and more administratively intense. Get the government out of health care. Agree Emphasis should be on private sector members of the health insurance industry and medical industry. 31996 08/29/06 WA Disagree "All Legalized Americans is a requirement that should be included. If someone is not in this country legally they should not enjoy the benefits. Protection against high ou-of-pocket medical costs is ambigious and needs a cap on income. Americans in general should be afforded the same treatment that our Government employees receive. It makes no sense that those paying the taxes to employ their representatives, should be penalized because of the high cost to maintain that Government that they pay for. " Disagree "* The above rhetoric exemplifies exactly what is wrong with this countries government. Simply put, we have too many organizations within the government now that are capable of maintaining the above. Establishing a public/private group is redundant. Focus on populations and localities where improved access to quality care is most needed means only that we should focus on the entire United States and the cost to Middle and Lower class. Keep it simple, why do we always to need a lawyer to understand something so simple?" Disagree "Though those are all admirable efforts to put forth, the question is, why aren't these agencies doing this now?" Agree While I do agree with all of the above the same question pops into my mind. With all of the funds that we the taxpayer have provided why in the world is this not being done. I am sure that if we went back through the piles of so called directives we would find all of the same rhetoric already on the books. Agree "Once again, it should read All legalized Americans. " Disagree "Health Care for All Legalized Americans is in fact one of the monumentel and important issues facing particularly the aging and handicapped in this country. The funding for this should preempt most other considerations, particularly the tax cut for the rich. As America is being bled dry for a war that is illegal the very people who are getting richer get the break. Make our government care for the people who own it." "Once again, it's redundant. For the mountains of paperwork and the Administrative costs to create the so called group, and the time that it will take examining it by officials who barely read it, enforceing the ground rules already in place and creating the few new items you are suggesting, will take less time and money." "* Though my comments may appear to be trite to you, the answers are simple but the process has become so continuously difficult. Simply hold the feet of those already responsible to the fire. Make all of the already existing organizations do their jobs. Some of the more important items in this recommendation should be funding from the Congress that enjoys a particularly generous health care program from the very people that they are relunctant to provide even the basics too. It's too simple to make difficult." 31997 08/29/06 OR Agree "* Americans have certain ""inalienable rights"" and ""among these are the right to life, liberty, and the pursuit of happiness."" The right to LIFE is T-H-E issue with health care. I whole heartedly believe in the free enterprise system as has been developed here in the U.S. However, no system is perfect (even if it was developed here in the U.S.). The flaw with our medical system is that it creates a caste system as tight and permeating as the model from India. The HAVES have access to it and the HAVE-NOTS do not. Yes, there are indigent programs -- but for the vast majority of Americans who are a couple of paychecks away from fiscal disaster -- and who cannot afford or do have have available to them an adequate medical coverage plan -- medical coverage is non-existant. These tax-paying, contributing citizens 'earn too much' to be afforded even the most basic medical coverage provided to the indigent. Many of the 'indigent' are deliberately so -- just so that they can QUALIFY for the medical coverage th" Disagree "* This type of political, governmental double-speak says and will accomplish ABSOLUTELY NOTHING. It wastes precious oxygen to breathe and exerts valuable effort on meaningless political babble? -- Better yet: The federal government should establish a health care system much like the United States Postal Service with the responsibility to provide health care for all citizens. Healthcare is then provided in BOTH the public and private sectors. Set a profit margain STANDARD for ALL MEDICAL CARE INVESTORS -- INCLUDING THE DRUG COMPANIES AND OTHER ANCILLARY PROVIDERS -- and require a fair billing system for all persons, irrespective of medical plan coverage. Every worker will pay into the system -- like Social Security. Yes. This is socialized medicine. The only thing 'wrong' with the concept is the fact that there are billions and trillions of dollars to be made -- regardless of the suffering and pain it causes to those who cannot afford the services. Either -- we are a nation that cares for our citize" Disagree "* I agree with the basic concept is sound. All that the first sentence says is that the government will attempt to develop strategies. hOW CAN ANY REASONALBE PERSON AGREE WITH THIS SOLUTION TO OUR PROBLEM. Since the government and the private sector have already studied this issue, ad nauseum, this recommendation is another PERFECT EXAMPLE of politically expedient double-speak babble. It says and means absolutely NOTHING. I agree with the concept of integrated management. THE PROBLEM, SUCCINCTLY, IS 'TURF-DOM' within the federal government. Every agency is like its own kingdom. The Kingdom of the VA ----- the Kingdom of the Public Health Service --- The Kingdom of Medicare --- etc. Like the homeland security department -- there needs to be an overall agency to superintend (and manage all the funds for) medical care in the United States. It needs to be as pervasive as the United States Postal Service with branches and offices in EVERY community, with workers who go into the community to serve the" Agree "* The suggestion that I have made will accomplish exactly this. In the debate surrounding service and care for the terminally ill -- there MUST be an affirmative declaration that a person, facing a terminal illness, has the INALIENABLE RIGHT to LIFE and HAPPINESS by chosing the manner of death they will experience. THE RIGHT TO DIE IS AS BASIC AS THE RIGHT TO BREATHE. DEATH IS A PART OF THE LIFE EXPERIENCE AND IS TO BE NEITHER FEARED NOR CRIMINALIZED. Being able to chose the manner and circumstances of ones death is a personal decision and should be absolutely FREE of governmental interference. Federal legislation is required to establish a persons RIGHT to make end of life choices, including the right to chose how, when and where a terminally ill person may chose to die. " Agree DELETE THE WORD 'AFFORDABLE'. Then I would agree with this statement. Agree "Establish a profit margain STRANDARD for all investors in the health care industry, including drug and ancillary services. SUBSTANTIALY TAX all profits ABOVE this STANDARD. Incentive REMAIN to make excess profits, but a portion of the excess will be returned to fund the provision of medical care to the public. Unfettererd profits promote biased services in favor of those most likely to reap the biggest benefit. " "* in addition to a 'national committee' there needs to be local and regional 'committees' that can assess and respond to local and regional concerns and realities. NO single committee is able to accomplish this objective universally with the sensitivity and fairness that accounts for regional/community realities that vary from area to area throughout the United States. -- Succinctly, what works in Portland, Maine may make little or no sense in Portland, Oregon. There must be flexibility built into this paradigm that resognizes this and makes provision for it. " "* The greatest fear I have of this process is that it is a politically expedient methodology for politicos to brag about what they are doing for the ""working mom."" I have read a lot of political double-speak and bureaucrat-ese in this presentation that makes me shudder in disgust. The ESSENTIAL problem in America's healthcare system is PROFIT: M-O-N-E-Y. The healthcare system in the United States is subject to, driven by and answers singularly to those who control MONEY. Until this strangle-hold is broken, NO SUBSTANTIVE CHANGE is possible. Several things need to be accomplished concurrent with or BEFORE substantive changes can be made in the Healthcare Industry. 1) A patient's Bill of Rights needs to be promulgated and codified into federal law. 2) An individual's Right To Die needs to be codified into federal law as an inalienable RIGHT. 3) A profit margain STANDARD must be set for ALL contributors and investors within the healthcare system and its ancillary support system within the United " 31998 08/29/06 VA No response Disagree "FQHCs should be expanded, but the program shouldn't be gutted through any shortsighted modifications. It is working and should be continued as is....!!!" No response No response No response No response 32001 08/29/06 NY Agree * The central problem of affordability in health care must have the goals of: 1. Remove financial barriers to health care - shared responsibility for financing care cannot mean high patient cost-sharing. 2. Making premiums affordable by requiring high deductibles or high co-pays at point-of-service would create shallow insurance that Americans could not afford to use. 3. The recommendation for a national program is also hampered by the statement that it should be public or private. It might combine both public and private elements. 4. Medicare has won widespread support by combining private delivery of care with public coverage. 5. The above points will then address the invaluable elimination of medical bankruptcy – clearly a problem unique to our nation. Disagree "* There absolutely should be no modification of the Federally Qualified Health Center concept. 1. We believe in expanding integrated community networks - providing high quality coordinated care to vulnerable populations through integrated community networks is certainly an essential goal. 2. As the health care safety net is strengthened, preserve community control of the boards of federally qualified community health centers. 3.Paralleling the necessity of continuity of comprehensive care in mental health and substance abuse services, beginning with preventive services and early interventions, coordination has to be between ambulatory care and in-hospital care, between primary care and specialty care. 4. The problems faced by providers in the current safety net stem from both under funding and obstacles to obtaining hospital and specialist care. 5. A true integration would mean the gradual disappearance of a separate sector called “the safety net.” " Agree "These are all important and valid goals which are parts of promoting better quality and more efficient use of resources, with this caveat: 1. As long as health care remains fragmented and there is no continuity of care working for people, these goals above cannot achieve what is needed and possible. 2. Promotion work in these areas must be allow for patient choice, facilitate the continuity of care, and facilitate the coordination of health care. " Agree "The principles and concepts from these recommendations on palliative care, hospice care and other end-of-life services, must be fully applied to all people who suffer with the whole spectrum of chronic diseases. " Agree "* The Interim Recommendations must be revised: 1. To remain consistent and true to the Principles and the Value of “shared social responsibility” – the core value that “we’re all in this together” - that these are all issues of what is needed to promote the common good. 2. To not start regressing and relying on the concept of “financial assistance” to individuals in this recommendation - this concept invariably has promoted budget cutting of “safety net” programs. The Working Group statement that “benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security” is soundly based on the belief that benefits that are broad in scope are indeed vital. Public online input clearly wanted broad, inclusive, comprehensive benefits, and rejected exclusion of types of care as a main tool to limit cost. This recommendation also does not reflect the majority of public input, basically because it r" Agree "* My Recommendation on Financing Health Care That Works Financing strategies must be linked to principles of fairness and efficiency: 1. Efficiency in financing means reducing the paperwork shuffle, the administrative waste, the plethora of confusing and concealed prices (of course, including all the for-profit costs in health insurance, managed care,pharmaceutical and biotechnology companies. 2. Fairness means financing care in ways based on one’s ability to pay, not one’s health status - 47% of survey responses support income-linked payment standards for determining who should pay more for coverage. 3. This emphasizes the importance of the Working Group’s mention of the graduated income tax as a potential revenue source. 4. Survey participants also reject making people pay more based on health behaviors or health status - 70% disagree with requiring people who use more health services to pay higher premiums. 5. We, the people, want a universal, comprehensive, high-quality system that does no" "* I insist that we must have greater discussions with the Working Group about what constitutes an adequate mental health and substance abuse care benefit – as always, “the devil is in the details.” The decades-long propaganda by the drug and insurance industries, the marketing of drastic rationing of mental health and substance abuse care services, and of the “great values of ‘managed care’ and ‘quick fixes’ by drugs” has profoundly distorted the thinking of the public and of elected officials about these very essential details, and has led to the further stigmatization of mental health and substance abuse conditions in America. The delivery of truly ""medically unnecessary"" (as defined by the health care professions), of truly non-core benefits is not what makes American health care so unaffordable. The cost problem in American health care results from three main sources: 1. Excessively high prices for care in the U.S. 2. Administrative costs of highly fragmented private insurance. " "* I have been paying close attention to the work of the Citizens’ Health Care Working Group, to your working process and to the input you have received. I have recognized from the outset the potential value of your effort, the import for solid and genuine reforms which would benefit all in our nation, as well as the potential misuses of your valuable work by powerful interests that are vested highly in only self-serving, profit-making changes. I agree with the Principles for health care that the Working Group has concluded. I wholeheartedly agree with your statement comment about how important it is to “reconcile contrasting views about the role of the marketplace and government, of competition and planning, of individual and shared responsibility.” I am pleased that your Values and Principles Section emphasizes the role of shared social responsibility both in paying for care and in consideration of health care costs. Most importantly, you state that you “do not believe that the most important barr" 32003 08/29/06 MI Agree Agree Agree Agree Agree Agree Its especially important that community health center boards continue to be governed primarily by those who use the services of the health center because it is they who can best identify the community's needs. 32004 08/29/06 VA No response Disagree "* I agree that we need federal leadership in promoting and supporting integrated health care networks to provide care for underserved and vulnerable people, but I strongly disagree that the Federally Qualified Health Center provisions of law should be modified in any way. These health centers are not only crucial points of quality health care for their communities, but also the ONLY part of our American health care system in which the very people who receive care there are in charge on determining how that care is organized and delivered. There are many other safety net providers, who care for low-income and uninsured individuals and make that care available regardless of an individual's insurance coverage or ability to pay - and those other providers may well deserve both givernment funding and special recognition in Medicar and Medicaid law; in such case, the Congress should be encouraged to provide such funding and to extend such consideration to those providers in a way that is independent of the FQHC " Agree Better organization and inter-communication of local health care systems is essential to improved availability of health care. Agree Agree Agree 32005 08/29/06 FL Agree Agree Agree Agree Agree Agree Financing should be a national priority much like defense and homeland security. Who are you trying to protect if those that in America cannot get health care. 32008 08/29/06 CA Disagree Government is too corrupt and wasteful already. I don't believe in taxing Americans who work in order to pay for health care for those who don't. Why don't we have tax-free medical savings accounts? Disagree "Again, the federal government is incompetent and cannot be trusted to run our health care system. They are already too intrusive." Disagree "Market forces will ensure competition and price reductions if we had tax-free medical savings accounts. Working Americans should be able to dictate their health care, not government." Disagree "Again, tax-free medical savings accounts would build up year-by-year in order to take care of the above concerns. " Disagree I personally do not want to contribute to anyone else's health coverage and I don't think any other working American should. Disagree Shared responsibility!? What about personal responsibility? When did we become a cradle-to-grave socialist society? We are a REPUBLIC!! Universal Health care is an abomination. Can you say CANADA? Tax-free medical savings plans...... I do not want government intrusion into our health are system. I want tax-free medical savings plans. 32009 08/29/06 MN Agree This is a laudable goal. Now how do you do it? Disagree The federal goverment has no place in managing health care. Keep this in the private sector. Keep competition. Focus on the creation and discemination of health care information so health care consumers can make informed purchasing decisions. Disagree "* I agree and disagree. Elminating waste and fraud is important. However, my health records are my property and should not be automated and put into a national data base. It is okay to use it for research but only anonymously. How soon before a national data base on the health history of Americans is used to discriminate against sick Americans? How soon before health care providers use the data base to push away ""difficult patients"" in the name of showing that they deliver quality care. Treat only the easy patients with high potential for favorable outcomes and a health care provider looks good, when in reality they are really poor. " Agree I strongly agree with this recommendation. Watch out however for rationing of health care to low birth weight babies and the elderly. Agree How could one disagree with this recommendation as a goal? How can we ever agree on how to achieve the goal? Agree * Focus on understanding and publishing the true cost of health care to the health care consumer. Shifting the visibilty of the cost of health care from individual health care transactions to goverment subsidies funded by higher revenue streams does not address the core issues and simply masks the true costs of the health care system. Keep the costs and benefits within the health care arena and do not shift the costs of paying for health care into general revenue models which are not transparent to the health care consumer. "I agree with the goal, just keep the Federal Goverment out of the equation. This must be achieved in the private sector with Government guidance and input, not management." "* Please protect the privacy of my medical history. I own this, not the goverment. It should be for the use of myself and my health care providers only. Please keep all decision making between the health care provider and consumer. Publish information (especially pricing and options) to the health care consumer so they can make better decisions. I do not want the government in the treatment room. I want my health care provider making decisions for treatment based on my medical situation, not what outside parties believe are best for me. Focus on torte reform and medical malpractice payments. Get bad health care providers out of the system, but stop making lawyers rich by suing every bad outcome regardless of any fault. " 32010 08/29/06 NY Agree "My friend had his appendix out. He had to have the surgery or he'd die. He stayed one night in the hospital. Now he owes $46,000 and will be in debt probably forever as he has no health insurance. I do not understand how hospitals get away with charging whatever they feel like and put people into financial ruin simply because they have no insurance." Agree Agree It seems the true costs of medical care are very much a well guarded secret...why do ER visits range from a few hundred to a few thousand per visit for the same diagnosis? Agree Agree "* I don't understand why we are the only industrialized nation without socialized medicine. A country that prides itself on democracy and freedom for all, but seems to care very little about it's individual citizens. Furthermore, it is very easy for those who choose not to work, to be able to take advantage of public resources such as Medicaid, but for a young working artist such as myself, these resources are not available and I pay all my medical bills out of pocket. Somedays I think I should just quit working altogether so I can have health insurance. It's ridiculous and scary." Agree "Currently, the only health insurance plan I might be able to afford is Healthy NY, which is affordable, but doesn't cover any psychiatric care, which is where most of my medical costs come from. To include physical, mental, and dental care (and eye care!) are of vital importance to all people." "I really hope the situation in this country changes, and fast, for the sake of us all." 32012 08/29/06 WA Agree "but i also believe this is too important to put into the hands of insurance companies with bottom line profit motives, legitimate motives in their own right BUT inconsistent with actually getting services to those who need them." Disagree "* putting all power in the hands of a single point will inevitably play into the hands of those with the money to BUT political clout and reduce the interplay of competing interests to the detriment of all. Further, allowing those who do not meet the FQHC community based requirement to profit from enhanced reimbursement without building in the community responsiveness REQUIRED of an FQHC. The days of someone else knowing what is best for everyone is very Rubublican but the FACT is, one size does NOT fit all and it is time this administration realized that. It is essential to KEEP control of FQHCs in the hands of the communitiees, not churches, health departments, hospitals, etc who think they KNOW what others need. They only know what they BELIEVE others need and only from their own limited perspective." Agree "I agree but ONLY provided that ""controlling costs"" actually means that - NOT just controling insurance payouts while increasing insurance payins. Why are we continuing to believe that the current problem can be solved by the folks who got us into this, insurance companies, to whom cost control means ""profit protection.""" Agree hands down i agree. Agree how about graduated payments based on income that INCLUDES passive income? Agree i don't like any of the tax proposals but would propose a national sales tax EVERYTHING other than food. the core set coverage should be financed and administered by a single payor who has no party to which it is accountable for turning a profit. 32014 08/29/06 CO Agree Agree Agree Agree Agree Agree 32015 08/29/06 TX Agree "Good idea in theory but, be care not to give a ""free ride"" to those who are expecting a free handout." Agree Excellent! Agree Very much needed!!!! Agree Agree "Good idea in theory. An issue that will need to be addressed is that of illegal immegrants.... They are not American's yet and as such, DO NOT qualify for free medical coverage.... IF they want coverage, become legal, pay for taxes like everyone else has to and qualify for benifits of being an American." Agree no comment 32016 08/29/06 IN Agree Disagree "* i believe that community based clinics are important in urban neiborhoods. However, I worked in a community centered clinic with a dental, lab capacity, pharmacy and medical providers. What was obvious is that the management did nto have proper oversite in reimbursement requirements for Medicaid nor the compassion to take care of low income people. Staff were distant, low paid personnel. Grants were obtained for some programs but were not promoted well enough to get the patients in the door. Management staff were not advocates for the CHIPS program in order to enroll underinsured children and families. And lastly, the apathy in the community for timely healthcare by the families themselves." Agree Agree Agree Agree I believe that the Public Health Nurses and staff may be the way to engage vulnurable populations into the health care system. Transportation issues are always a problem in getting to clinics or appointments. The Health visitor program in England maybe a model for low income populations. 32017 08/29/06 SC Disagree "* Learn from history. The European countries that have tried to provide health care coverage to all have several problems, a few are: 1) Long waits for healthcare, 2) No incentive for providers to spend huge amounts of money and time on medical education because they cannot get a return on their personal investment, 3) People will demand services that they don't need and the lawyers will be the only beneficiaries as they bring cases to court, 4) anything that the gov't manages skyrockets in cost and plummets in quality, 5) gov't has NO BUSINESS in health care provision!!!! 6) people who spend their money over indulging in sex, drugs, food, and gambling should not be able to pull health care resources away from people who take good care of themselves and their resources, 7) private charitable organizations should be allowed to collect donations and provide services and should be given incentives to do so, but you have no right to STEAL my money and give it to someone who has never worked a day in their lif" Disagree "Our federal government is already TOO BIG!!! STOP!!! We don't need more federal gov't units. Let the private community networks and charital organizations work on this. They will do it much better and where needed, whereas if the federal gov't gets involved, it will only profit those areas that have politicians who are trying to buy votes. This is nonsense!" Disagree "Getting the federal gov't involved will only multiply the amount of fraud and waste!!!! Creating more gov't jobs, bureauracies and red-tape will only bring our nation down. Have you looked at the ""consumer-usable info"" put out by the gov't?! It's crap! They do a horrible job. Let the USA follow the tenets of our forefathers who wrote the Declaration of Independence. Cut gov't--don't grow it larger!" Disagree "* By making end-of-life services free to all no matter how stupidly they spent their money (or as in so many cases--the money they received while they pursued a life of leisure and everyone else worked to support them), is just plain wrong! Again, every one of these recommendations is suggesting that gov't grows--whose going to pay for all those new gov't programs? The people who are working and getting less benefit from the money that they EARNED. The people who didn't do anything to help the country or themselves will get all the benefits. It's just wrong!!!" Disagree "* The problem with the current ""financial assistance"" systems is that they are abused. They don't help the people who deserve assistance and they encourage ennui in the people who don't deserve assistance. To put additional tax burdens on those who have worked for their money is to enslave! It's nothing less! People who find out that they must work in order to earn rights will keep this nation great. If you put more and more tax burdens on the people who work, it makes it more attractive for those who are in the lower incomes to just quit and live off the ""financial assistance"" that politicians have stolen from the worthy to give to the unwilling." Disagree "The federal gov't has never been known for fairness, efficiency or shared responsibility. To say that they will be able to do that in health care is absurd! Again--it's NOT YOUR MONEY!!!! Keep your hands out of our pockets. " "Once again, the federal gov't has never been able to appoint members through a process defnied in law that includes citizens representing a broad spectrum of the population. It ALWAYS becomes a political gain game whereby those who are family, friends and finacial backers of politicians will make decisions based upon their greed. It happens with gov't contracts, it happens with gov't jobs, and it will happen with health care. Let the private sector handle health care!!!!!" "Whoever crafted these questions obviously slanted the questions to get favorable responses. It seems that if you actually want honest feedback, you should write the questions with both the tax payers and the beneficiaries of the proposals represented. " 32022 08/29/06 PA Agree Disagree Agree Agree Agree Agree I think you should limit the number of patients per provider so that I can go to an appointment and spend more than two minutes talking with my provider about my situation. I think that in order for health care premiums to rise they should have to show a rise in services that will be provided. 32023 08/29/06 CA Agree "I support a national health care system. However, I believe that children born of alien parents should be naturalized citizens that allow them the coverage that American citizens should be entitled to receive. This change would discourage illegal aliens from crossing American borders taking advantage of an out-of-date law that was instituted to protect African-Americans, in order to allow an entire family to become naturalized, poor and an impossible drain on this national health care system." Agree "Excluding illegal immigrants and any children of illegal immigrants. These individuals should pay for health care because they are not entitle to benefits that American citizens enjoy. This would help discourage illegal immigrants from bankrupting hospitals. Current policies encourage illegal activity, which the enormity would overwhelm and devistate any national health care system." Agree "Special emphasis should be placed on patient confidentiality in regards to electronic medical records, as evidenced by the recent thieft of computer records from the Veterans Administration." Agree "These choices are individual and private and should not be dictated by any other individual, group, organization, or government. Individual choices should be respected and supported by the federal government." Agree Excepting illegal aliens and their children. National health care should only be available to American citizens. Aliens should be required to pay for their health care to avoid a drain on the system that would cause it to collapse. Agree A healthy American population is a creative and productive contributor to the National health care system. The return on the investment comes in the form of health contributors the sytem supports. I believe that an expert team of scientist should evaluate the beneifits of alternative medicine in order to utilize ones that are effective and eliminate ones that offer no medical purpose. "My comments regarding illegal immigrants are my honest feelings about one of the major components that encourage illegal migration, sometimes at the ultimate cost of human lives. The law that allows children born on U.S. soil to become naturalized citizens should be repealed. It served its purpose and is no longer a benefit to the children born from African slaves, as it was intented to do." 32024 08/29/06 MN Disagree "I agree that high-deductible ""catastrophic"" insurance is key (as it currently is used with health saving accounts), however mandating and/or providing insurance to all is unnecessary and just one more giant step towards ""single-payer"". NO." Disagree "Just more bureaucratic, expensive regulation. NO." Disagree "Sounds nice, meaningless in reality." Agree Disagree "This is euphemism for ""single-payer"" government monopoly." Disagree New revenues means more taxes. "Core benefits means more next year, still more the following year, and everything you can think of the years after that, eventually becoming rationing for all." "This is the wrong direction. Health care must be returned to individuals, not further bureaucratized by the federal (and state) governments." 32025 08/29/06 WI Agree I believe we need a Universal Health Care plan in the US. Our present system is beyond repair/fixing---too much power and money is involved. No response "I am not sure if from this we are talking about a Universal Health Care System, which I believe in." No response Agree We do need to educate people about end-of-life care and care at advanced ages for those people with serious health care issues. No response No response 32030 08/29/06 NY Agree Disagree Agree Agree Agree All AMERICANS! NOT ILLEGALS WHO SEEM TO HAVE BETTER COVERAGE THAN MY FAMILY DOES!!!!! SOMETHING IS DEFINATELY WRONG HERE!!! Agree 32031 08/29/06 LA Disagree "If people should not be impoverished by health care, they should not recieve the high-cost items in health-care. People are living longer and longer lives because we are ""saving"" them from when they would normally expire. The costs of providing this care to a person rises with the age and debility of the patient. There is not money to assist everyone...it is horrible to think, but the militray has it right: save those that can be saved, that have the best chance. The rest is in Gods hands. " Agree "We do need health-care providers to provide care to the underserved. Healthcare is expensive training, and there are few healthcare providers that can afford to work for nothing or very little. Having a national network of healthcare providers paid by fully or assisted by government that give basic needs would be nice. " Agree Agree Minimum is the word. We need to do what we can for end-of-life patients to have as little pain as possible without prolonging life. Agree "The core services should be very, very basic. They should not include any expensive procedures, etc. " Agree "* Do not believe in a Eurpoean or Canadian government health-care system. Maintain as private as possible. However, place limitations on insurance companies with how much of a write-off the can bargain for. This will in turn, decrease the charge of health care...allowing increased affordability by self-pay patients. Contracts between healthcare systems and insurance companies are so extreme, sometimes up to 70% write-off, that it does not allow for self-pay options because people have to pay the full price. " Be careful who you choose. 32032 08/29/06 PA Disagree YOU CANNOT PROVIDE FOR EVERY LOW INCOME PERSON IN AMERICA AND NEITHER SHOULD THE WORKING CLASS BE EXPECTED TO. THERE SHOULD BE BENEFITS TO WORKING AND TO OBTAINING THE GOOD JOBS WITH BENEFITS. TO CONTINUE TO HAND EVERYTHING TO EVERY ONE WILL ONLY ENCOURAGE A CODEPENDENCY ON THE GOVERNMENT FOR THEIR CARE. Disagree "STOP DEVELOPING NEW ADVISING GROUPS TO TELL YOU WHAT TO DO. SIMPLY ASK THE MEDICAL PROVIDERS HOW YOU SHOULD HELP, THEY ARE HIGHLY INTELLEGENT PEOPLE THAT WORK WITH PATIENTS EVERY DAY AND CAN BE YOUR ADVISORS POSSIBLY AT NO COST TO YOU." Disagree "* THE MORE YOU LOOK AT THE HEALTH PROVIDERS AS THE CULPRITES IN INCREASING MEDICAL EXPENSES THE MORE TIME YOU WASTE. WE ACTUALLY WANT TO BE EFFICIENT AND EFFECTIVE AND HATE THE WASTEFUL PRACTICING THAT IS DONE DUE TO MORE STRICT DEMANDS THAT ARE PLACED ON US BY GOVERNMENT STANDARDS. WE ARE ALREADY IMPLEMENTING OUR EMRS. START LOOKING AT YOUR OWN WASTFUL SPENDING. PLACE CAPS ON LAW SUITS AND ALSO ON HOW MUCH INSURANCE COMPANIES CAN RAPE A DOCTOR FOR HIS MALPRACTICE INSURANCE. IF YOU DON'T THESE HIGHLY INTELLENGENT PEOPLE WILL ALL BECOME LAWYERS RATHER THEN DOCTORS. OH WELL MAYBE THAT WILL BE A FUTURE FIX IN AMERICA, NO DOCTORS AT ALL. LOOK AT THE STATS!" Agree PEOPLE IN AMERICA ARE SO AFRAID TO DIE. EDUCATION IS THE KEY TO OPENING THEIR UNDERSTANDING. Agree I DON'T KNOW HOW YOU GET SOMETHING FOR NOTHING. ESPECAILLY SOMETHING OF HIGH VALUE AT A MEDICORE PRICE. Agree EVERY PATIENT NO MATTER YOUR SITUATION SHOULD PAY SOMETHING. HEALTH CARE SHOULD NOT BE FREE TO ANY ONE. IT CAN BE AT A REDUCED COST BUT NEVER FREE. THANK YOU FOR ALLOWING ME TO COMMENT ON THESE ISSUES. THE FIRST TIME I TRIED TO SEND THIS I DO NOT THINK IT WENT THROUGH. 32033 08/29/06 IL Agree Agree "* The American Dietetic Association (ADA) commends the Citizen’s Health Care Working Group on its Interim Recommendations. With nearly 65,000 members, the majority of whom are registered dietitians (RD), ADA is the largest association of food and nutrition healthcare professionals in the world. ADA agrees with the Working Group that nutrition plays a vital role in community health networks. Nutrition counseling provided by RDs should be a core component of health care for all Americans; it follows an evidence-based approach covered by both Medicare and private insurers. We look forward to the President's report to Congress on these recommendations and the future congressional committee hearings. Please let us know if ADA can be of further assistance to you as you complete your assignment. Signed, " Agree Agree Agree Agree 32035 08/29/06 WI Agree "* I have had a long time concern about this issue. My husband and I are unemployed are at an age where employers are not too interested in hiring you, because they fear, if they offer health care benefits, you will use too much of it. We both have preexisting conditions and, until my husband went on Medicare earlier this year, we went COBRA when he lost his job which had benefits. When COBRA expired, we had to go with the state high risk plan and have paid well oveer $50,000 since autumn of 2002 for medical insurance and uncovered medical bills. Last year we both needed major surgery and we qualified for ""charity care."" The Golden Years for a number of us are very tarnished! We have exhausted most of our savings, cashed in our tax deferred annuiuties to pay these costs. I have had letters published on the health care crisis in the 5/1/03 New York Times, the June,2005, edition of Oprah's magazine (page 26) and was interviewed for the Fall, 2006, issue of ""YES!"" magazine, which features a cover series o" Agree Agree "* I had an allergic reaction to a medication last December and went to an urgent care center for treatment. The staff didn't ask the right questions or consider drug interactions of treatment they provided; they assumed that one protocol fits every patient who presents with my particular allergy. The treatment I received put my life in peril and I could have died. I presented to their ED several days later and was diagnosed with ""adverse reaction"" to meds that were administered and prescribed. I talked to the quality control people at the hospital and also filed a complainbt with the governmental entities, but they all tell me I received appropriate care. I disagree -- I consider that I was the recipient of a ""medical error."" The system, as it is set up, worked against me. I asked an atty if I had a case and the bar was too high for me to prevail. " Agree Make sure that health care chaplains are fully involved with the care of such patients if the patient and loved ones wish them to be. Agree see comments to my first statement of agreement above. Agree see above comments. "hhealth also includes mental, spriitual and emotional health and freedom from addictions." "call me - I have a lot of comments, wish I could haave attended a mtg." 32037 08/29/06 TX Disagree My concerns is that this would lead to socialized medicine which would once again hinder the lower wage earner who would be at the mercy of a very average health care provider. Agree "This is definately venturing in the right direction. As long as the individual can pick and choose their healthcare provider. Some sort of choice is the key here. People should not be at the mercy of a below average provider. Of course, there maybe some cost to the member. " Disagree Good in theory but my fears of socialized medicine still hold true here. Agree This would definately help ease the burden to all those affected. Agree Once again in theory this is great because it would help the poor and not hinder individuals with monetary means to pursue better health care providers. Disagree I like this. Government beauracracy may prevent this from becoming a reality. Still leads me to believe that we would lean to socialized medicine in this recommendation. Several well thought out ideas. Beware of socialized medicine...as I have mentioned before. 32038 08/29/06 ME Agree "There is no need for people with lower incomes to have to spend food or clothing money on health care. There is money in this nation, Let's distribute it so everyone is cared for with housing, and medical provisions." Agree We have resources to do this and people who can organize this. Let's ger started and keep the fat cats out of the administration of these new provisional systems. Agree "Listen to the nurses, orderlies, and those who work directly with patients and their families" Agree I just simply agree. Agree This is a worry with a number of people I know. I is a concern of mine as I get older. Agree "As for technology, there is enough information in the reseach departments of pharmaceutical companies to cure almost everything. The competition for prizes is shameful. How about some cooperation for the cure and never mind the big money prizes and acolades." How about a watchdog for the insurance companies. Ours is skyrocketing. The paer alone that is used is rediculous. "Something really does need to be shaken up, so people are cared for. The process now is heavy laden with ""process.""" 32039 08/29/06 KS Agree No response "Let's try avoid a two-tier system,one for rich and one for poor." Agree "One of our problems is TOO MUCH information and TOO MUCH choice. Many of us do not have the capability to be savvy consumers, so part of what I want the government to do is work to assure certain quality standards and to simplify our system." Agree We ration our health care now by making it hard to access services and expensive in some cases. Let's make our rationing more rational...have boards/commissions made up of regular citizens (& some health care professionals) to determine our priorities for spending health care dollars and revisit the guidelines periodically. We cannot afford to have all expensive care possible for every dying person. Agree Everyone deserves a basic level of health care. Agree "Our system should avoid a two tier level of health care, one for rich and one for poor. A single-payer system seems best to me. It deserves strong consideration." "Make our system simpler, please! It doesn't help to have the best technology in the world if people can't get access to it or give up getting care because they are exhausted from fighting complexities." 32040 08/29/06 CO Agree Disagree "I certainly agree with the concept of integrated community health networks. I am concerned about ""modifying the Federally Qualified Health Center concept"" if that means eliminating the requirements for providing comprehensive primary care and a consumer board." Agree Agree Agree Agree 32041 08/29/06 TN Agree No response No response Agree Agree Agree * I agree pretty much with the above statement. The system should be along the lines of the VA system. Non-profit! Companies would contribute per employee and employees would also contribute according to their income and family size and if above poverty level. I tend to see for management purposes everything set up at sate level but comparable to other states with support from federal government as well. The program should also assist in coverage of perscriptions or force the pharmacuticals to bring their prices down to a reasonable level. As a nation we must turn from the greed. Pharmaceticals would need less if they didn't advertise products when they must be perscribed by a doctor anyway. Total waste of dollars theat could reduce costs. 32042 08/29/06 GA Agree no american should be impoverished by health care cost. we should cover all americans. i mean AMERICANS. Agree "focus on populations and localities where improved access to quality care is most needed, i agree and to establishing a public- private group to performance and conduct this ongoing concern." Agree i agree if i know the federal goverment would do what say. but we know that would never happen Agree "clear communication between providers,patients, and their families, is needed.CLEAR COMMUNICATION! public and private program should support training for health professionals " Agree totally agree with no comments at this time Agree this sound like a working plan. i would like to know more about the above recommendation "please inform me on these recommendation, they read like what we need today in our heath care system.if i understand it correctly. I WOULD LIKE TO KNOW MORE. " 32047 08/29/06 CO Agree I support a single payor system to achieve this Agree Agree Build in incentives for individual and group illness prevention and health promotion activies such as discounts for related services Agree This is crucial to quality of life and quality of society Agree A single payor system would make this economically feasible Agree "I support single payor, public/private partnerships" This is a necessary first step and I strongly agree with the composition of the group and the core components of the core package Thank you for the opportunity. Attention to the health care access crisis in this nation by our leadership is long overdue. 32050 08/29/06 NY Agree Agree Agree Agree Agree Agree 32053 08/29/06 UT Disagree * This is entirely NOT possible. All Americans cannot be promised coverage nor protection from excessive costs. Americans are creating the situation we are in regarding health care. They expect to save every individual from every disease and injury and natural process. Money is no object. They believe it is okay to do transplants on 70 and 80 year olds. Babies who are less than 2 lbs can be saved but at an initial cost of millions and their lifetime of government assisted disabilities and rehabilitation--each. Every American should have access to emergent and well care services. But no country can afford to pay for the consequences of choices or prevention of death for every countryman indefinitely. There is and has to be a boundary. That is what needs to be defined. Disagree "* I think we already KNOW who is responsible. Establishing yet another layer of advisors and evaluators is a waste of healthcare funds from the start. This sounds like just more of the same bureacracy--just with different hands. We need to think outside the box with healthcare and direct this nation in taking accountability for their choices. After 30 years in the health care business, I have observed the majority of federally assisted patients and their families to be the most needy, demanding, non-compliant users of healthcare. Having said this, I do not think federal assistance is bad, it just requires nothing in return for the assistance. There is no accountability. There is no effort or proactive expectation. THIS has to change. THIS is what is broken. DO provide facilities where health care is most needed and transportation assistance or satellite clinics. DON'T promise the moon. DON'T fix all of their problems. Medicare will now pay for stomach stapling--because the costs of obesity are b" Agree "* I believe we could be more efficient and could work together more in healthcare. I also believe quality health care should be geared toward teaching and expecting society to take quality care of their health. Federally assisted individuals need to know what the dollar amount is of their health care. We are not allowed to send them a bill. I believe many would be shocked and more determined to keep their coverage if they were accountable in some way to maintain it. Recipients of assistance could put in volunteer hours at the community centers, health fairs, etc. as reimbursement to health care received that month." Agree This still needs to be defined and structured within boundaries. Options yes. Disagree "* High quality health care costs money. High end drugs are VERY expensive. Advanced technology equipment and trained personnel is VERY expensive. The goal should be for all Americans to have access to core health care services. But it is a reality that all Americans cannot be guaranteed high end services. When Hillary Clinton revamped healthcare so that no American can be turned down for insurance, it sent the industry reeling. There is not enough money anywhere to pay for every test and treatment for every disease and injury for every American. And if you work in healthcare for 30 years like me, you see that even the rich suffer and die, not just the poor. The fallout of Hillary's reformation of healthcare has been the rapid rise in cost of healthcare insurance so that fewer and fewer employers can afford to offer it as a benefit. As a low income family member myself, privately purchased insurance over six years increased 30-38 percent each year because of excessive usage of its enrollees. The onl" Agree "As I stated above, Americans need to own their health care. Reckless behaviors and the excesses that Americans indulge in are creating the health care scenario we have. There must be individual accountability and consequences or failure will be guaranteed." no 32054 08/29/06 MI Agree "All people need an affordable system for medical expenses, needed medicines to exist and the office visits let alone an emergency." Agree Agree Agree Agree Agree 32055 08/29/06 CO Agree "These ends can best be met by a National Single Payer Health Plan, that will provide quality health care to all of us equally." Disagree This represents only one more bandaide that will proibably get us nowhere. The only answer is a National Single Payer Health Plan. Disagree "All of these good programs should be folded into one National Health Care System, using all of the tools listed to provide q uality care. The only way we will get efficiency is to get ride of the Insurance system and its excessive administrative/advertising costs." Agree "This can best be done by Local Health Care Boards, under the coordination of a National Health Care Board in a National Sinble Payer Health Plan." Disagree "All of us should be covered by the same health care system that provides all aspects of health coverage. There should be an emphasis on preventive care. A ""set ofcore health care services"", means that some will have less coverage than others. It should be the same for all. " Agree "A National Single Payer Health Care System is the only way we will really get quality coveralge for everyone. The transition will be challenging, but ultimately worthwhile. Physicians and patients alike are fed up with the current system. We need to make a clean break and get a system that really works and in the process spend no more that we are currently spending on health care. " I agree with the general concept. It is basically what a National Single Payer Health Care Plan would provide. No one should be able to get insusrance for anything that is covered by the Single Payer Plan. Only such services as cosmetic surgery and other non-essential items could be covered by an Insurance Plan. "The sooner we take the bull by the horns and start the process of setting up a National Single Payer Health Plan, the less money we will be wasting on expensive, inefficient Health Insurance plans that waste money on multiple levels of bureaucracy, CEO salaries, and advertizing. Only then will we be really spending all of the money on health care." 32056 08/29/06 NH Agree Agree Agree Agree Agree Agree 32057 08/29/06 GA Agree I feel that every American should have health care coverage regardless of their financial background. Agree Agree Agree Agree Agree "I do not understand why America, a country that is so well off but fails the America people that need healthcare. This should have been a universal coverage some time ago." Not at this time. 32058 08/29/06 PA Agree Agree Agree Agree Agree Agree 32059 08/29/06 NC Agree Agree Agree Agree Agree Agree "I favor a single payer universal health care system administered by the federal government. It is the only equitable and efficient means to guarantee our right to life as Americans. Private, for-profit health insurance is too expensive and inefficient. " I favor a single payer universal health care system. Billions are wasted on administrative costs under a private for-profit insurance system and too many people are deprived of health care. American companies are less competitive because we do not have publically financed health care like the other industrial nations. Now is the time to establish a single payer universal health care system. 32060 08/29/06 FL Disagree You are suggesting another entitlement program when we already have too many that are too generous. Disagree Elected officials spend other people’s money while government bureaucrats waste money. This horrible combination leads to bloated programs that always cost more than promised and never terminate with no improvement in the underlying problem. Look no further than failing public schools protected by teacher's unions for an example. Agree "I agree with a portion of your proposal. That is making available all healthcare outcomes and pricing for consumer study. Published outcomes and related pricing allow consumers to make informed decisions. Further, why does care cost substantially more for cash pay clients versus costs paid by insurance companies or Medicare for patients covered under those plans? This is ridiculous." Agree "Does that really mean you want to kill people who are terminally ill? Your commentary sounds like ending life, not making the most of the end of life. If you really mean providing comfort, then I agree with you." Disagree "This too sounds like another entitlement program in the making. We need fewer programs, not more programs. Who do you think is going to pay for all this?" Disagree "We do not need more programs. And I am not willing to pay more for other peoples care. Instead, we need to reduce costs of existing programs to enable covering more patients. This starts with tort reform. Doctors run every imaginable test on Medicare patients to enhance revenue and mitigate their liability risk. The less likely they are to be sued, the less likely to run unnecessary tests. (Take your elderly parents to appointments and you will see what I mean.)" You are suggesting another expensive entitlement program run by people who have a desire to spend other people's money. Look at the pork coming out of congress and you think this makes sense? "First, no entitlements for smokers. We have known for years that smoking causes cancer. If you smoke, pay for your own healthcare. Second, until you spend every dollar of your own money to expand programs, don't ask me to pay more taxes." 32062 08/29/06 OH Agree Agree Agree Agree Agree Agree Sin taxes should not be used for additional financing for health care (or anything else for that matter) 32063 08/29/06 AZ Disagree No response Agree "We are paying very high salaries to staffs at HMOs, PPOs, etc. These monies are not going to provide health care! We have a middle-man system that is wasting the money citizens have to pay for health care! The government needs to provide health care as it as done for Medicare, Medicaid, and Veterans Health Care systems. No middle-men making decisions on health care that they are not qualified to make!!" Agree See my comments on the above recommendation. Agree "This is a must in our country! I have visited poorer countries that do a better job of providing health care to all of their citizens than we do in the USA! This is unforgivable! Everyone deserves to have needed health care that is affordable, culturally appropriate and of the highest quality possible!!" Agree "See my comments above. A system of government financing that includes contributions from those who can afford it is a must. The pharmaceutical industry must be a player, with the government negotiating costs with it!! They must not be treated with any kind of special hands-off activities! We deserve better!" "In addition to acute care, I would include chronic disease care as well. This is where most of the costs are concentrated!! Also, the services of death and dying such as hospice care should be included." "I was involved in public health when the Nixon administration first proposed developing HMOs. I thought, at the time, that this was a good move. I do not agree with that concept any longer. When the owner of an HMO is listed as one of the five wealthiest man in a particular state, we are not spending our health care monies wisely!!" 32064 08/29/06 CO Agree Agree Agree Agree Agree Agree I agree with this recommendation. 32065 08/29/06 CA Agree The government should take the steps to assist all Americans with health care but I don't feel that the government should be providing illegal immigrates with health care. Agree Agree The government needs to crack down on private health care systems that cheat for profit and cheat the patient. Agree Agree All leagal AMERICANS Agree Make it so all Americans pay but make it so it based on what you make. Set it up so a wide variety of individuals participate out of all classes and races and all stages of life and poverty level. 32066 08/29/06 NY Agree "For all Americans, not illegal aliens" Agree "I agree with this recommendation and I would support a grant program for medical students that would pay most of thier education costs in return they would work in government sponsored clinics in low incomes areas. This would take the burden off hospital ER's and be more cost effective. A secondary benefit would be precare and education, thus reducing the need for more expensive medical intervention later." Agree "Cap costs, a new drug is not inherently better than a long established drug. A perfect example is during the Anthrax scare the U.S. gov't bought 4 million doses of Cipro from Bayer (a German co.) for about one twentieth the price Doxycyclone (a generic drug) would have been as effective and more readily available." Disagree "If we treat every condition that the elderly present we will be forced to ration health care. The elderly with many comorbid conditions should be stabilized, comforted and have thier pain releaved. To expend limited resources on an individual that will not recover nor regain thier quality of life denies others that can recover prompt effective medical care." Agree Agree "Americans must be made more accountable for thier lifestyle choices which negatively impact thier health. Obesety is at record levels, Type 2 diabetes is reaching epidemic levels. The population must be educated to make wise decisions that may effect thier health. Smoking, drinking, poor diet, unsafe sex are all choices with negative outcomes." 32067 08/29/06 MO Agree "even with insurance many people are required to pay astronomical sums. If you have an 80/20 plan on a $100,000 dollar bill $20,000 out of pocket is just too much." Agree "I am from a rural community and the nearest hospital is around 20 miles away. By having access to healthcare closer to those who need it, and quality healthcare is very important." Agree I think that creating electronic records will greatly improve the quality of care as well as the safety. It will be so much easier to know what medications a person is taking as well as their allergies and past medical history at time of admission instead of having to wait until the next business day to get the records from their doctor's office or pharmacy. Agree I believe that people at the end of life do need more services that are not in the hospital or nursing home setting. The patients should want and need to be closer to their family rather being segregated from them in a facility. I like how additional training will be given to providers to speak proactivly to patients and families about end-of life/terminal conditions. Sometimes I have seen that Dr's seem to avoid this subject. Agree It will be great for everyone to have access to services that they need and can also afford. Agree I think that what we pay now in insurance premiums should go to the program. For those in povery a subsidized fee based upon income. Taxing items that are poor for health such as fast food and cigarettes and that money going to the program are other ideas. It is good to have these services that will be available for everyone. It will be hard to determine what services will be applicable for everyone at every age. Could there be seperate plans that will apply more to certain age groups? 32068 08/29/06 MI Agree I completely agree that it is criminal that people be financially devastated by the costs of a health care emergency. All programs should be affordable Agree "The closer to the community being served, the better. Especially important for people to establish and develop trusting, caring relationships for the system to work well for all." Agree "Quality of care and efficiency include the development of caring, trusting relationships which will improve health and decrease costs." Agree Choice and freedom in end of life is critical in a functioning democratic republic. Agree Core services should include education and incentives for healthy living. Agree "Financing should include single payer possibility and restructuring federal and state expenses, especially federal." "The expert consensus must go beyond the conventional medical practices which rely on habit, not evidence based treatment. Must also include evidence from Europe and Asia, and integrated medical practices." "We should move quickly and make this a more obvious public discussionl. I found out about the group in an issue of a magazine published in Europe: the information should be ""advertised"" on the Internet and all television medias as well as newspapers and news magazines." 32070 08/29/06 CA Agree major reform needed- single payer system- take the profit motive out of health care - eliminate insurers - change the system to focus on health care issues- funds are there but are now misdirected to compensate insurers to the detriment of many Americans health Agree "simplify system to single payer- devoid of private insurers and mixture of revenue streams- which lead to confusion, frustration and missed care opportunities" Agree single payer needed modeled on CA SB840 Agree change financing of care to single payer- need to radically reform the system to focus on people and not profit Agree need a single payer system- modeled on CA SB 840. Agree single payer model- see all of the work re benefits and funding (and major system savings) detailed in CA SB840 model after CA SB 840 * Incremental change will not do anything!! The entire system needs to be restructured to put people's health before corporate (and political) profits and benefits. Need to provide coverage and support for all Americans - Don't strip away at Medicare but build on this public health program- Look at VA model- Political priorities and processes need to change so that the government is there to serve (and whenever needed take good care of) its public not its financial supporters (and its own survival). The issue of access to affordable quality health care permeates all of all of our lives. It is detrimental to keep going forward by putting corporations and greed 1st. Health care is one of the most important social justice issues- health care is a right and not a privilege. 32073 08/29/06 MN No response No response No response No response No response No response "I spent a lot of time typing my responds only to have them nullified by some so called error into the zip code field, which I had sufficiently filled out Please don't impose any more of this type of 'filling out forms' and let what I have submitted be retrieved and entered as my response. Thank you." 32077 08/29/06 MI Agree "More people have die in the U.S. each year because of a lack of health insurance than have died on 9-11 or because of the hurricane Katrina. Our government has allowed these people to die. This is immoral. I support a single payer, universal health care plan. There is no longer any excuse when people have accurate information as to what this means." Agree Insurance with no accessability is of no value. Agree Improvements in efficiency will help control costs. Agree I agree except that euthanasia is out of the question. Agree We are a community; we must care for each other. Agree "We need a single-payer, universal health care; that must be the goal. " It is cheaper in the long run to provide a sufficient range of health care. The media do not seem to be explaining the health care crisis we have in the U.S. Efforts must be made to get them on board. 32078 08/29/06 CT Agree "Essentially, I agree with this. Mainly because it will ease the burden of skyrocketing costs for hospitals overcharging those with insurance, to balance the loss of the indigent who have title 19, medicare, medicaid, or no insurance whatsoever. I believe that it creates tension with those who provide medical service, namely nurses and physicians, even though they are honor bound to serve regardless of the patients' economic status." Agree Agree I agree except for the fact that states and municipalities must have more imput----the federal government cannot be absolute in this control. Agree Agree Agree 32079 08/29/06 AZ Agree Financial protection also needs to include recovery for individuals and families already impoverished by high health care costs. Protection against high costs must also protect high quality care. Agree Agree "Steps must be taken to ensure fair, nonpartisan promotion of systems. All systems, programs, and practices must be judged on a level playing field." Agree Sorely lacking in the current system. Agree Most important recommendation. Agree "A baseline of care from public financing will be necessary to achieve true universal, fair access to healthcare." Recommandations must carry some weight and legal standing with legislators or else they are meaningless. How many commissions have issued recommendations that have been ignored by lawmakers? 32081 08/30/06 WA Agree I am not convinced that a on going drug addict should be entitled to a 2nd or more kidney transplant or such things. The ethics of health care for our country are things that need to be worked out in a community forum with long and broad discussions over time. Not closed panels like Hillary did Agree Agree start with fraud and waste in the US Congress Agree "I hope I am reading between the lines that people have the option to opt out of more health care. I also question the ethics of spending so much money on end of life ""saving techniques"" for incurable conditions -- money that would be more bang for the buck if spent on say prenatal care and pediatric preventative services. There is a terminal point to life -- it should be respected and it should be made comfortable but that is it. Let people die with dignity as well as live with dignity." Agree Agree "* Health care is already a huge protion of the gnp. But much is used on the multi layers of administration through insurance companies and their holding companies (literally holding the money). Huge savings could be made in eliminating this step alone. Standardizing reimbursement so that for instance the state of WA which has a high cost of living is not one of the lowest reimbursement states because of our (and the rest of the West Coast)past efficiencies in delivering health care! Malpractice issues have to be addressed. It is not a lotary ticket for someone with a bad outcome --- caused by someone or not. Millions, if not billions, could be saved in health care costs for significantly less defensive medicine. Then a neurosurgeon or obstetrician could do their job, be paid appropriately and have salaries that were in line with a general surgeon plus the extra time spent in training." "Again, broad conversations across the country over a significant amount of time need to happen. This process is educational as well as informative to all. Europeans expect to die sometime and do not expect the majority of health care dollars to be spent on ""saving"" them from an incurable disease or even a ""cureable"" disease past a certain age. Americans seem to think they should live forever no matter what the quality of life is and make money if they cannot." Good Luck. Change is difficult but necessary and the change itself needs to be managed well. I hope trained healthcare executives such as physicans with a masters in medical management who spend lots of time thinking of these issues are included in the process. 32085 08/30/06 OR Agree Agree Agree Agree Agree Agree " It is simply a shameful tragedy that national healthcare for all americans does not exist when billions of our tax dollars are used to destroy the homes, health, and lives of innocent people in Iraq....we pay these taxes and then have no voice in how the money is spent!! What has happened to this once great country??" 32087 08/30/06 AZ Agree Agree Agree "Bullet point # 2: How will data security be assured? In an age of intrustions by hackers and government spying, this is an important consideration." Agree "With us Baby Boomers being the largest segment of the population and with the first of us turning 60 this year, quality, diginified end-of-life care is extremely important. We will be 26.75 % of the population by 2030. Something's gotta give!" Agree "I unequivocally agree!! Over 46 million Americans, according to the latest report, do not have health coverage. This is unacceptable in a country of such wealth. Furthermore, no family/household should be just one illness away from financial ruin -- even when they have health insurance coverage. We ignore at our peril the state of our health insurance and delivery system. American families should have health coverage at least equal to that of elected officials." Agree "I believe that all options should be pursued for creating a financing and implementation plan to transition to a univeral health care system. I am willing to pay my fair share -- taxes, premiums, etc. -- so that all Americans can have access to quality health care." It is very important that those defining the core benefits package be a truly independent non-partisan private-public group. The core benefits should provide quality services for every stage of a person's life. "Our current system has MBAs at insurance companies defining what healthcare we should receive, rather than our doctors. This cannot and should not continue." 32089 08/30/06 KS Agree Assistance with repairing credit problems incurred by past medical costs. Protection from employment lay-offs when long term health problems are the only reason for not working. Agree Agree "It has been proven that employers with Wellness Programs have lower health costs. Mandatory Wellness and Wellness education from employers, possibly tax credits for the company when they have above 50% participation." Agree Agree Agree "Any prescriptions for drugs needed to ensure quality of life, long-term medication for diseases such as diabetes, high blood pressure, depression, thyroid disease, etc, should be covered as they will prevent more serious illness. Taking this type of medication should never be a finanial burden." Absolutely agree!!! Thank you for allowing our input and good luck!! 32090 08/30/06 na Disagree If people had to pay for their own health care at the time of service. The cost of health care would decrease drasticly. We need the regulate or do away with the 3rd party insurance companies. I recently had dental surgery. Because my dentist thought I didn't have insurance he charged my $20.. When I received my statement from BC & BS he had charged over $200.. I am for doctors and hospitals making a profit but not at the expense of the citizens of America. Disagree "I live and work in England for the DOD. I have observed in America and England because of their welfare systems and socialized health care people are not motivated to accept responsibility for their own welfare. This type of government program promotes the ""YOU OWE ME ATTITUDE."" People on welfare should be offered employment training for two years and after that, ""NO MORE WELFARE."" " Disagree "The ""federal government"" has had the opportunity to control waste, fraud, and abuse, and have failed. Buyer beware and if a company, individual is cheating their customer then the punishment should be such that it will deter others from cheating their customers. Our judical system is becoming a ""joke"" just like our system of government." Disagree The information is available. Here again let people accept responsibility for their own lives. Disagree "I live and work in England and lucky for me I have health care services at a DOD base. The socalized health care system in England is a big joke. The services proveded out out dated. Below standard if you can even get services. Here again when the government tries to ""fix it all"" it turns into a rip off for the citizens. Let the people of America take responsibility for their own welfare and health care. ""You will get what you except"" from people. " Disagree ABSOLUTELY NOT!!! Look at England NHS. Look at our own system with all the government involvement. Its a joke. This is just another program to increase government bureaucracy. 32091 08/30/06 LA Agree "As a single woman I live in fear evey day that I will get sick and require medical care. I work full time but the cost of my insurance is about to break me. I cannot help but wonder why, as the richest country in the world, we don't have heath care that is affordable and obtainable. Shame on our government and shame on the special interest groups." Agree Agree Agree Agree Agree 32092 08/30/06 NM Agree Agree Agree Agree Agree Agree "* I hope that once these Interim Recommendations are approved and implementation has begun, that the federal and state governments do not allow themselves to be convinced that this is all that needs to be done. This is only the beginning. While I would love for the US to establish universal health care ASAP, I don't believe the current Administration and Congress can truly see the facts for what they are and ensure our people's health, a necessary prerequisite to the right to pursue happiness. Maybe the success of the policies contained in these recommendations will convince future leaders of the need for further reforms." 32093 08/30/06 CA Agree "* Health care coverage should be universal and continuous. Heath care should be affordable for individuals and families. Deductibles are what put families in financial jeopardy. Consider that they are already paying a large monthly sum for a family of 5, then to place a large deductible for a medical emergency could cost them their home, the family homeless and leave them in financial ruin. The system of health insurance should be sustainable for society. Health care provided should be effective, efficient, safe, timely, patient-centered, and equitable. " Agree "Health care provided should be effective, efficient, safe, timely, patient-centered, and equitable. Heath care should be affordable for individuals and families. By having local health centers return into the communities the needs of the people could be greatly met with well care. Those that are not covered currently are being turned away and any diseases they may acquire will affect even the healthiest, but it could also hurt our youngest citizens. " Agree "I believe this recommendation is long overdue. This recommendation is extremely needed. Health care provided should be effective, efficient, safe, timely, patient-centered, and equitable. Is price gauging going to be looked at as well? Will they set a standard for cost of supplies? It is a shame that hospitals will charge $5.00 to 10.00 for one individually wrapped maxi pad. " Agree I agree with all points on end-of-life services. Agree "* Health care coverage should be universal and continuous. Heath care should be affordable for individuals and families. Deductibles are what put families in financial jeopardy. Consider that they are already paying a large monthly sum for a family of 5, then to place a large deductible for a medical emergency could cost them their home, the family homeless and leave them in financial ruin. The system of health insurance should be sustainable for society. Health care provided should be effective, efficient, safe, timely, patient-centered, and equitable. " Agree "* Healthcare in the good old days was to save lives and to feel good about it. Now it is an industry that doesn't care whether one lives or dies unless they get their money. Making a profit off the health and welfare of another is not something health insurance companies should boast about. If we are to fund healthcare, then the industry should be non profit. The wealthy should be giving back to the ""community"" since the community made them wealthy by buying their products and services. It could possibly be used as a tax break incentive for the extremely wealthy to help fund healthcare? " "Eye health should be included in the definition of health. Consider that Macular Degeneration is occurring in our elderly. The loss of eyesight thus becomes a disability. Astigmatism runs in the family and everyone needs glasses, some prescription lenses can be thick and costly. Headaches become a daily problem without glasses. In this country we promote literacy; you can't read if you can't see what you are trying to read. I am happy to see that mental health is in the definition." "* One of our greatest obstacles is obesity. As a child I was very active in physical education at school as well as after school sports. It was mandatory to do jumping jacks, sit ups and to run laps and we were timed! Where has the physical education gone? My children today receive physical education once a week at best. Sports is no longer an activity in school. As we age, we lose HGH(Human Growth Hormone), our metabolism slows and we start to eat unhealthy because we are running around with the kids to sports and dance activities a few times a week to make up for the lack of physical activities on a daily basis. If you want to see health problems reversed, try putting back physical education with an emphasis in nutrition to promote healthy bodies and healthy living. Working parents are coming home to greater amounts of homework, quick dinners and are not doing the physical activities they used to do. I hope to see us getting the bodies back on track (no pun intended)." 32094 08/30/06 HI Disagree "* Take Lawyers out of the eqation and Drs. wouldn't have to do CT's, Endless lab work and xrays on people just to cover their asses . That drives up health care for the insurer and the consumer. Standardize forms so that all people at all times can understand the paper work! Support home care that allows familys to be paid for caring for their loved ones in a home environment. Do away with big hospitals that spread disease and end up supporting patients that need to die but again aren't allowed to because of fear of lawsuits and family issues." Disagree "* Ladies and Gentlemen, what we need here is one more committee to pay for and make miles of recommendations to fill thick binders and books and add another layer to our lives. By the time the committee is formed the baby boomers will be dying in the streets. We need ACTION not endless deliberation. Ask Drs. and Nurses what we need. Ask famlies with members suffering long term illness what we need. Ask the elderly that can't figure out their insurance or the bill and can't even read them cause the writing is so small. Insurance needs to be regulated and not get rich on the backs of those dependent on it. " Agree "* Integrated systems via computer cuts waste, duplication and much of health care could be administered thru computer kiosks set up with a blood pressure cuff, stethascope and a simple finger tip blood analysis. I see the computer playing a huge role in diagnosis and treatment even , down to printing out prescriptions based on the above info combined with a stethascope and ekg linked into the kiosk with interactive programing. Like, answer the questions, hook up the steth/ekg/ fingerstick according to directions and get a differential diagnosis printed out with further advice on how or if to follow-up with an MD. I have lots of ideas on how interactive the computer could be in removing the human error factor and with all the facts combined behind its questions be able to figure out the disease quicker than a human. Plus do it more cheaply and with less error. " Agree People with no hope of recovery should not be kept alive long term on ventilators with the hospital assuming the cost after insurance runs out. If the hospital can not allow the pt. to pass due to family or other constraints they should get daily reimbursement from the opposing party in the form of a minimum of $100/day cash. Agree "* Again, I say, reduce lawyers say in medicine. Increase the use of computers for diagnosis and treatment. Kiosk medicine where even the poorest can put in $10 and get a differential diagnosis and a script. Combine that with medications at the same price the 3rd world pays and we are onto something. Oh, lets throw in an increase in family responsiblity for the care of the person. ( also like the third world.) Instead of warehousing, embracing. Cover family caring for family. It will always be cheaper than a hospital or nursiing home even if specialized equipment and a visiting nurse was thrown in." Agree "* Again, I say, remove the lawyer factor, involve the family in care. More home care, less ""other"" care. Address long term care issues and who is financially liable for same. We would all like our loved ones to live forever but in the face of skyrocketing costs do I have to pay for your Parent to be kept alive on a vent for months? Address End of Life as a finacial fulcrum which can tip any facility into financial jeopardy. Computers programed with medical knowledge in an interactive fashion which can take care of many simple medical needs. Introduce simple universal forms for insurance coverage and recovery. Isn't insurance federally regulated. Do we still have any say over the largest lobby in Government. If so, then make a mandate with payment dependant on a universal form. That will save office hours, office errors, elder headaches , calls to children etc. The bottom line is Money is here. We just need to use it wiser not create new committees or taxes. We need to look hard at our pr" "* I agree that basic health care needs to be defined but at the same time what about behavior affected health care? Should the smoker who continues to smoke be eligable for a ventilator? Should the diabetic who is non-compliant be eligable for dialysis? Should the homosexual who continues to practice unsafe sex be eligable for aids tx ? Should the IV drug abuser with Hep C be given Interferon? Where/when do we say ""Your choices and behavior have directly and adversely impacted your health and we can't heal/help you unless you can pay for the treatment yourself. Why do I have to pay for a child's antibiotic when their parent has multiple packs of cigarettes in their purse? People are aware of proper diet, exercise, vices, stress and yet each day make choices that will take them more quickly to mortality. Just what are the ""core rights"" of the taxpayer and the ""moral obligation"" of the medical profession?" "I have lots to say on the subject and have been in the health care system for 33 years from Clinic medicine to ER to ICU to Hemodyalisis to Cardiac Cath Lab. I am also a consumer of health care where most recently my daughter at the age of 20 is refused coverage because she has been on an anti depressant medication. They are afraid their cost potential may go up and after all, they are in it for the money. I am always willing to say more..... Thanks for the forum." 32095 08/30/06 NC Agree Agree Agree Agree Agree Agree 32097 08/30/06 OH Agree Agree Agree Agree Agree Agree 32098 08/30/06 AK Disagree health care is not for the government to be involved in. Disagree health care is not for the government to be involved in. Disagree "health care is not for the government to be involved in. The VA is for the Veterans hurt in the line of duty, and is not part of the public health care system." Disagree health care is not for the government to be involved in. Disagree health care is not for the government to be involved in. Disagree "It is not for me to pay for other peoples health care. The more the government get involved in the more it cost. I have worked hard to get what I have, and you tell me I have to help pay for those did not help themselfs. It looks and sounds like the less you do, the moore the government will take my money to give ot the ones did not go for themselfs. There will allways be those can not do for themselfs, these people should be taken care of by there family. " health care is not for the government to be involved in. 32099 08/30/06 TX Agree Agree Agree Agree Agree Agree "I'm in favor to nationalized universal health coverage for all Americans that would be financed & managed fairly, efficiently, & comprehensively. " 32100 08/30/06 IN Agree We need to have the gov. set up a national health care program the cost for prescriptions are unreal and the drug companies should be made to correct the prices Agree Agree Agree Agree Agree THE PEOPLE SHOULD NOT HAVE TO FUND THIS OUT OF THERE POCKET THERE ARE MORE THAN ENOUGH TAXES PAID BY THE LOWER INCOME PEOPLE NOW THE MAJOR DRUG COMPANIES WOULD HAVE TO BE PICKED TO BE ON THIS COMMITEE VERY CAREFULLY 32101 08/30/06 OH Agree "As I read about the number of poor in our country I feel that coverage is not only a need but a right of all Americans, especially our most vulnerable - the children, the poor." Agree I especially recommend doing anything possible to provide a safety net. Agree Reduction of fraud and waste is absolutely necessary. Agree Every person deserves to die with dignity and this recommendation will enable this to happen. Agree Agree It is imperative that we take the time and energy to work through this financing issue to provide the care we need for all Americans. "These recommendations are clear and concise, well based on the needs anddemonstrate practical avenue for their implimentation." 32102 08/30/06 GA Agree Start teaching Health. It doesn't have to be a pill No response No response Agree Everyone should make informed choices about their health and their death. Agree "They should have healthcare, but lets start teaching wellness instead of the prolems after McDonald's" Agree If we chose to consider why we are sick and focus on wellness your expenses would decrease 32103 08/30/06 CO Agree Agree Agree Agree Agree Agree 32104 08/30/06 OH Agree Agree Agree Agree Agree Agree 32106 08/30/06 na Agree We are a rich country and we need to invest more money on its citizens. Our country has spent too much money on issues that do not merit tax money expenditures. We should be on the vanguard of health care for its citizens at a relative inexpensive rate. Agree Agree Agree Agree Agree 32107 08/30/06 WA Disagree "There is no way to have everything at no cost. Better than a national program would be reforms to make health care affordable, instead of insurable." Disagree I do not want a federal megabeaurocracy messing with this. It should remain local. Disagree This is a beaurocratic solution to a local problem. Don't do it. Disagree What we have works now. Disagree "That they have access to affordable health care should be the policy, but that they have it, means Uncle Sam is caring for you and further does away with personal responsibility for health." Disagree "Again this will be inefficient, costly, and bankrupt government. Keep it private and work to reduce the burden of litigation, unreasonable expectations, and the myth that perfection is attainable at any cost." "Reducing access to alcohol and tobacco, and the culture of alcohol, stopping advertising of the same, a tax on sugar and fat in foods, raising cost of fuel to promote walking, and opening our boarders to imported cost effective drugs from outside would do more at less cost than a big governmental pay for it all approach." 32108 08/30/06 TX No response No response Agree Both Medicaid and Medicare should be available to all recipients over 55 years of age in all of the United States. This would allow all disabled as well as healthy seniors access to necessary medicines to live as healthy as possible with age related infirmities. Agree "Additionally, all medications should be allowed to all over 55 years of age with no co-pay. The amount of social security benefits is not equal to the cost of living and many seniors and disabled persons cannot afford some treatments not covered by Medicare and in many an instance Medicaid could be used not only for additional hospitalization and treatments but for medicines as well." No response Agree I strongly endorse this recommendation!! "* It is well known and recognized that HHS should focus more on the needs of the elderly and disabled as well as for minor children. We have more needs now than ever before and have worked many years contributing to the development and growth of this country and the programs that are being offered. However, many of us still live below the poverty line and cannot afford the treatments and medicines needed to lead productive lives. We could continue to be productive for many more years with the proper medicines and social programs for us to take advantage of. We need to be able to afford medicines and the ability to participate in social programs in place already and to help initate newer programs that will attribute our continued good help and longevity." 32109 08/30/06 MI Agree Agree Agree Agree Agree Agree 32113 08/30/06 PA No response No response No response No response Disagree "This is the only recommendation on which I have a comment. I think the whole idea of ""affordable"" is problematic. All Americans should have health care. Figuring out who is going to pay how much, etc., will be like re-living 1993. I doubt that we have a political system that can be any more successful 13 years later. Who has seen evidence of this? I think we should take the best aspects of single-payer health plans, as in Canada and European countries, and have our own national health service." No response 32117 08/30/06 MI Disagree "When individuals are within national borders without proper documents, it is difficult to properly finance healthcare or any other necessity. A few (perhaps many) are taking advantage of the system by crossing the border or visiting the country and remaining within its borders because of the birth of a child who is claimed as a citizen. Occasionally this child is burdened with birth defects and requires a multiplicity of resources draining healthcare dollars. The issues are complex." Disagree * Providing basic healthcare to all is a worthy goal. Healthcare needs to be stratefied with costly interventions reserved for those who are able and willing to purchase them. I recommend self-reliance and adherence to the law of cause and effect. Those who make wise choices and avoid at-risk behaviors should not be required by tax and other fees to subsidize the care of those who engage in them. Often those who avoid taking risks are penalized by extra demands on time and finances. This practice is blatantly unfair. Agree Agree Agree Agree I am amazed at the injustices encountered by ordinary citizens. One example is police requiring my 84-year-old mother on limited fixed-income to purchase from them the equipment in their possession which was stolen from her home. Justice lies trampelled in our streets! 32121 08/30/06 CA Agree Health care should be a basic right. The lack of an adequate system is costing us far more than other countrys and we are receiving less. Agree Agree Agree Agree Agree 32122 08/30/06 NE Agree Agree Agree Agree Agree Agree Health care tax based on income but must be us citizen 32123 08/30/06 OR Agree Agree Agree Agree Agree Agree 32125 08/30/06 DC Agree "I believe a single-payer, Canadian-style system is the only way to achieve this objective, so I would delete ""(private or public)"" Basically, I think Medicare should be expanded to include everybody. Most people like Medicare, and the Government has proved it is capable of running a massive program." Disagree "This recommendation suffers from being too complcated, reminding me of the Clinton ideas that didn't get off the ground, and the current Part D Medicare ptogram. I suggest that the objective be addresssed within Medicare as it might be expanded" Agree This objective could be accomplished forcefully in a single-payer system Agree "As stated above, I believe reference to ""public and private"" payers and programs should be deleted so that it is clear rhar a single-payer system would be set up within Medicare to do the job. As it is, this recommendation is imprecise and complicated." Agree "People and politicians seem to want a single-payer system, but then they call it ""socialized medicine"" and won't vote for it. A major educational program should be integrated into these recommendations." Agree "First, explain that a single-payer syestem means billions in savings in administrative costs compared to today's practices. The difference is the user pays taxes instead of insurance company premiums. To ease the transition for insurancw companies, the change might be made in increments, for example, Medicare coverage expanded to 55 now, 50 in five years, etc. " "Considering the savings that could be realized with a single-payer system - $286 Billion in 2002 in the Public Citizen Health Letter August 2006 -- I do not understand why the idea politically is so widely unacceptable. It needs an inspired political lobby. I support the Physicians for a National Health Program, organzation, but its resources are limited. Please include this objective in action recommendations." 32127 08/30/06 NJ Agree Agree Agree Agree Agree "Individual choice of providers should remain a key element within the essence of free enterprise, i.e. consumer choices should be arranged to discourage poor perfomers, without a financial challenge to ones cared for. (ability to pay should NOT be discrimanator to favor best givers)." Agree "An element for stratifying basic to most advanced care-giving, should guarrantee basic coverages to all, even if ability to elect more advanced care is optional." "The whole body should be considered, to include the likes of optical and dental care is basic. Preventative care should be emphasized, for the optimum benefit to the individual and economy of the programs!" 32128 08/30/06 na Agree specially for senior citizen. Agree Agree Agree Agree Agree "1.one ideal could be a 1% federal sale tax on everything and for everybody, that way every person pay their share in this plan. 2.Base on income. 3.If you work in a company or agency that pays a group health plan, they should recieve a credit and the portion that the employee pay for their plan should also be give a credit. " 32134 08/30/06 WA Agree Agree Agree Agree Agree Agree Everyone pays a flat percentage based on their earnings is one method that should be examined 32138 08/30/06 NJ Agree "* Not only is it morally right to provide universal health coverage, it will also do much to help American businesses and workers compete in a global economy. One of the major reasons multinational corporations are choosing to outsource jobs from the United States, or else choosing not to create new ones here, is because of America's astronomical health care costs. The employer-based health care system is a relic of the mid-twentieth century, and it is vital that the federal government step in and provide a viable replacement." No response No response Agree Agree "People who can afford health coverage on their own should be forced to pay for it. Medicaid and SCHIP should be expanded to cover all low-income adults and all low- and middle-income children, respectively. Those who are not covered by public programs but cannot afford coverage themselves should be given assistance from the government to buy insurance from a private provider." Agree "* Financing universal health coverage should be part of a greater effort to simplify the federal tax code and eliminate wasteful spending programs. The tax code should be restructured in a way that puts a greater part of the burden on the wealthy and less on the poor and the middle class. Ideally, this would include replacing the payroll tax with a progressive consumption tax, as suggested by the New America Foundation. Additional revenue could be garnered by raising the cigarette tax, raising the gasoline tax, introducing a cap-and-trade system for greenhouse gases, and creating a tax on unhealthy foods. Furthermore, the government should follow the recommendation of the Progressive Policy Institute and create a commission to identify and eliminate wasteful corporate subsidies, especially farm subsidies." 32139 08/30/06 WA Agree Agree Agree Agree Agree Agree 32141 08/30/06 WA Agree "Health is a public concern, and deserves a public program. " No response No response Agree Agree Health care is a right. We should have a single-payer plan similar to that of Canada or the UK. No response "All citizens should contribute according to their means, not according to the status of their health." "Keep the insurance and pharmaceutical companies away from any legislation regarding public health. Develop legislation according to the public weal, not private profit." 32142 08/30/06 WA Agree "Healthcare premiums should NOT be as close to average mortgage payments as they are, with families paying more than $1000 (some are lucky enough to have their companies foot part of the bill on that). Preventive care should also be recommended and encouraged. Spending 200 dollars for an aid to correct a slight problem as opposed to waiting until the problem causes the patient to require surgery for several thousand, it's obvious that PM is the more reasonable path. " Agree Agree Agree Agree "There is no reason that healthcare should be so expensive. With premiums almost as much as a mortgage payment, they should be providing more instead of fighting patients for claims that should be covered." Agree 32146 08/30/06 NV Agree needed this YEARS ago!! Agree About time we started looking after our own 'needy' besides the foreing countries! Agree Maybe we won't have over crowding in our emergency rooms any more! Agree It could be one of us needing this aide! Agree "Yes, but without the doctors lowering their standards of any type of practise they are in. No matter what!" No response "I think no matter what ones income in the middle and upper class, we should have the same insurance coverage , benefits and rates. The lower income people and families should get the very same care but, at a cost according to their personal income." Maybe doctors shouldn't charge such outrageous fees for their services. Maybe a field can have a range and capped so no matter what state you live in coverage is fair and affordable to everyone. 32150 08/30/06 WA Agree Agree Agree Agree Agree Agree 32155 08/30/06 WA Agree Agree Agree Agree Agree Agree I favor a percentage of income tax to be dedicated to health care financing; this seems fair to all and need not require an increase in income tax dollars. Health care financing and insurance should not be a for-profit business. "The nursing profession should play a large role in this effort, due to our expertise and long experience in all areas of health care, and our emphasis on services promoting wellness and prevention. This is crucial to controlling health care costs." "A major improvement in primary care and acute care would be a vastly expanded workforce of non-physician providers, nurse practitioners and physician assistants. This would decrease health profession educational expenses and improve access to health care in both urban and rural areas, and in all care settings." 32156 08/30/06 WA Disagree We need to stop seperating what we produce and contribute from benefits received. Agree Agree Agree Disagree Agree "* We need to go to a system that has very high deductibles. Perhaps as much as $5,000 to $10,000 per year or per occurence of a disease. The premium savings should go to a medical savings account. The government or employers should jump start the account with perhaps $2,000. Policies should cap out at $1,000,000 in benefit. These measures will make us all ""cost-conscious"" instead of indiscrimately consuming a ""public good"" or ""common"" without regard to cost or efficacy. More importantly, this capitation of revenue to the system will force medical providers and researchers to inovate not just in the areas of cures and therapy, but to inovate in how to deliver the care a price point that American's can afford and will choose from competing alternatives for their finite MSA's and captitated policies. Lazik surgery is not covered by insurance and the cost of it has dropped from from $2,400 an eyeball to as low as $400. Finally, the government needs to indpendently research efficacy of different tre" 32160 08/30/06 WA Agree Agree Agree Agree Agree Agree "I agree in principle with the recommendations, but there is no need to ""re-invent the wheel"". Other countries have working systems and we should use the best of those systems for a national health care program." 32162 08/30/06 WA Agree Agree Disagree "A single health program should be created from all of the named, and other entities. This would cut down on administrative expenses. " Agree Agree Agree 32166 08/30/06 WA Agree It's about time! Agree Get rid of insurance companies. They cost more than the actual health care cost. Agree Agree Agree Eliminate insurance companies which try to prevent this --and waste our money that could be helping people. Agree "Raise taxes if necessary. We can learn from ""civilized"" countries that already care about ALL their citizens." "We can afford this if we quit trying to control the rest of the world. WE can't continue throwing money at Iraq, much of which is funneled thru' contractors and never fulfills its goals. " 32174 08/30/06 WA Agree Our country is running as fast as it can to shed what are called 'entitlement' programs. We seem to be willing to do anything to remain #1 in the world. At this point that means removing the saftey nets at all levels and calling it 'an ownership society' which really means you are responsible for every outrageous fortune that is thrown your way. We are a civilized country and should act that way. No response No response Agree Agree Agree Fairness that means that the richest get the best and the poorest get the worst care is not a fairness I would sign up for. We need to put some compansion in our country and those who enjoy the best of what America offers should be a part of reaching down to those not as fortunate. We need to have a healthcare system that encourages people to live well so check ups and other proactive medical services should be part of core benefits. On the other side no one should go bankrupt because of health reasons so catasrophic issues need to be included as well. Perhaps the 'frills' should be for those who care to purchase medical insurance to cover those things. 32179 08/30/06 MI Agree This is essential. Agree The entire health care system needs to be more fully integrated. I cannot see a certain doctor because he or she is not in the particular group with my primary doctor--this is crazy! Agree Please do this but do not limit doctors' judgements to over-ride the system. Agree Agree Agree "If there is a cost, it should be paid for with a flat tax increase for all Americans." I agree completely with this recommendation. Please DO these things as quickly as possible. 32180 08/30/06 WA Agree "We are not a great nation, until we protect all Americans from high health care costs. The deductibles mentioned in the interim recommendations $4,000 to $30,000 are much too high. " Disagree "* We need everyday citizens, physicians, Naturopathic doctors, etc from every health discipline involved. We cannot trust the government we have in place to follow through. Our experience with the Bush administration is embarrasing and we already know how they have responded to important issues in the past. They talk big and only take care of themselves financially, they do not care about the everyday guy who pays all the taxes. Just look at Katrina, No child left behind, no body armor for our troops, Haliburton being allowed to charge our troops for substandard food, it goes on and on and on." Disagree We need to dismantle anything touched by the government and replace it with a task force we can trust. Agree Agree Agree "This may take some time, but in 2 years it should be in place, not 6 or 10 years. We are already paying enough taxes to put this in place, we need to take the middle man out of it, ie, insurance and pharmeceutical companies. They should only be allowed to make so much, not gouge the public. " Transparent is the key word. All of us should be able to navigate the system and see for ourselves what is being done. 32182 08/30/06 WA Agree Agree Agree Agree Agree Agree Why not expaned social security? 32187 08/30/06 WA Agree Agree Agree Agree Agree Agree 32191 08/30/06 WA No response No response No response Agree "should be ujiversally available at no cost to the patient other than insurance they MAY have to assist. Should all be part of a national care program (possibly medicare), but independly administered according to the wishes and needs of each patient." Agree "the rich should not be allowed to opt out, which would deplete the care of the total. A low monthly fee ($90-100) should be paid by the majority and all covered equally." No response STOP SUBSEDIZING AND CODDLING THE PHARMACEUTICAL INDUSTRY AND USING sOC. sEC. FUNDS FOR OTHER PURPOSES. tHAT SHOULD NOT BE ALLOWED UNDER ANY CIRCUMSTANCES EXCEPT COMPLETE COLLAPSE OF OUR GOVERNMENT. ALSO ALL STATES AND DOCTORS SHOULD BE REIMBURSED AT THE SAME RATE! tHEN YOU WOULDN'T HAVE SUCH A DISPARITY IN DOCTOR COVERAGE IF THEY COULD GET THE SAME REMUNERATION NO MATTER WHERE THEY PRACTICE. iT IS CRIMINAL THEY WAY IT IS DONE NOW!!! I CERTAINLY AGREE THAT DENTAL AND HEARING PROBLEMS SHOULD ALSO BE COVERED AS ANY OTHER HEALTH PROBLEM. wHAT WORKS FOR ONE PERSON MAY NOT FOR ANOTHER. WE SHOULD BE ABLE TO CHOOSE THE KIND OF CARE WE WANT. "GOVT. NEEDS TO REGULATE VITAMINS AND OTHER SUBSTANCES PARADED AS HEALTHFUL. NOT TO STOP THEIR SALE BUT TO INFORM THE PUBLIC AS TO IT'S SAFETY AND USEFULNESS. THE MANUFACTURER SHOUL HAVE TO PAY FOR THAT TESTING, BUT ALL SHOULD HAVE THE OPTION OF BEING TESTED." 32196 08/30/06 CA Agree Over 46 million people are not covered. This makes health care much more expensive for everyone since the unisured delay their doctor visits and use the emergency rooms much more. Disagree Agree Disagree "I agree with the public part, not the private." Agree Universal insurance is necessary to include all Americans fairly in the health care system. Over 1/2 of personal bankrupcies are due to medical costs. Agree "Financing should be from income taxes. Of course increased efficiency is important. Presently there is too much paperwork involved with processing medical claims. A single payer model would reduce the administrative overhead significantly, allowing more of the money to be applied directly to health care delivery instead." Core benfits for both medical and dental coverage are critical. Public service education by the government regarding proper nutrition and exercise are imperative. Universal is the only fair way to deliver health care. Health care is part of our infrastructure. Noone should feel insecure due to worries about paying for and receiving adequate care. 32199 08/30/06 WA Agree "I very much agree with this recommendation. It's a shame that there is so much wealth in this county, while at the same time health care is not available to so many. " Agree "* I agree, but hope it won't take too much time and red tape to get though the list above. My mother lives in a rural area where it takes months to get a doctor's appointment. She ended up having to go to the emergency care clinic a couple of times to get prescription refills while she was on the waiting list to see her doctor. I'm sure there's not a lot of incentive for health care providers to move to low-income, rural areas. Perhaps incentive programs (not only for doctors, but for nurses and nurse practioners, as well) can be part of the solution." Agree "I agree, but only somewhat, as I'm afraid the program will cost more than any savings that will ever be realized. I hope I'm wrong. " Agree Agree "I strongly agree with this! Not only is health care expensive, but so are the insurance premiums. Many employers have recently begun to cut back on insurance benefits offered to employees, and many now only cover the employee and give the employee the ""option"" of paying several hundred dollars a month to cover their children and/or spouse. That is not a realistic option for most peopole. " Agree "This sounds like Oregon's health care plan. I like their model, and since it has been in use, perhaps we could learn from their experiences." 32206 08/30/06 WA Agree "* Even with insurance, when my son had an accident with a lacerated spleen and was hospitalized for a week, we had a VERY difficult time paying off the deductible and 20% co pay. We had enough income as not to qualify for financial assistance, but barely were able to cover the thousands of dollar cost. It was VERY tough on our family in many ways, and as much as I wanted the best care for my son and wanted him to get better, in the back of my mind I kept thinking.. I wonder how much this is all going to cost us... " Disagree "I think that adding a private sector aspect to this model is not a good idea, since the private companies are generally out for profit. I also think that the Rx drug plan confusion is an example of trying to get public and private networks to solve a problem collectively; it doesn't work. I do, however, agree that there should be more rural health care and community based health care with emphasis on PREVENTION and disease management. " Agree "* I think that having ""consumer-usable"" information about health care services is VERY critical so that patients can be informed consumers. I also think there should be more standardization of private insurers so that customers can easily navigate the convoluted system. It is difficult to be your own health care ""manager"" when, for example, there is a billing problem. A customer needs to call the billing office of the doctor who tells you to call your own insurance, who then tells you the doctor needs to code somthing differently, so then another call is need back to the doctor's office, etc. It is very frustrating and highly inefficient. " Agree Agree "Why is it that health care company stocks have gone through the roof? Why are drug companies consistantly profitable? Some of this money should also be used to help those in need to receive affordable healthcare. It also scares me that large healthcare companies such as Aetna, Cinga, etc buy up smaller companies and are able to set the healthcare agenda. " Agree "I like the idea of ""sin taxes"" paying for the illnesses that they cause. However as mentioned in my previous comment, I think that healthcare and RX drug companies that have been consitantly reaping profits should help shoulder the cost. " "Those with genetic or other chronic diseases such as auto-immune diseases shouldn't be denied coverage if their treatment is not within the bounds of ""core"" services. On the other hand, those with diseases that could be managed through lifestyle changes such as diet, exercise, quitting smoking, losing weight, etc should have support with those approaches as they receive treatment. " I wish your organization patience and understanding as you sort through all these comments. The system sure does need to be reformed and I hope my comments are one small part of making this reform happen. 32207 08/30/06 WA Agree "If we'd stop spending so much on wars that we have needlessly started and cut back on military spending, we could afford universal health care for all Americans." Agree "I guess this ok, although it sounds mostly like a bunch of bureaucratic jibberish to me. Just what is the Fedrally Qualified Health Care concept anyway?" Disagree "This just sounds like your promoting the expansion of several buracracies and failing to establish what we need, which is health coverage for the now over 40 million Americans who currently are uninsured." Agree Why do you have to make it so complicated? Obsfucation is always the federal government's way of communicating an idea. There should be government supported palliative and hospice care for any American desiring it. Agree Agree "Reduce Defense spending by at least 60%. Adopt universal coverage. All working Americans should pay monthly insurance premiums. The asmount of the premium should be based on an individual's size of income. The more you earn, the higher the premium, you as an individual would pay." "You forgot to include drug treatment, but maybe this is included under ""physical"" health. We need coverage for alcohol and drug depedency." I think I've made thoughts clear. Can't say that you have though. 32210 08/30/06 WA Agree Healthcare is a basic human right and it should not matter if you are rich or poor to receive basic health care. Agree Agree Agree "Yes, Hospice is wonderful and should be encouraged and provided instead of expensive painful procedures that only extend life for a short time." Agree "The rest of the world seems to do this pretty well, why can't we??? Are we the richest and most advanced country in the history of civilization or not?" Agree "We need a one payer system to cut out some of the middle man costs, like insurance companies that take the cream off the top of our money into the health care system. " "Basic and preventative health care should be a right. Advanced, experimental and very expensive medical procedures may need to be in a different category. " I am upper middle class and I can't afford my healthcare....What has this country come to. 32211 08/30/06 WA Agree "* i agree however,some people who have health insurance, have limited health care. some believe that inidviduals s/b held accountable for health lifestyle choices. who decides healthy lifestyles. some people have illnesses such as diabetes due in large part to obesity. however no health plan will pay for weight loss treatments including gastric bypass and other surgeries that have clinically proven to help those individuals for whom lifestyle choices don' work. Dieting alone does not solve the problem of obesity for many inidviduals. any program that will include healthcare need to take the whole of healthcare into consideration. simply creating a program that includes incentives for ""health lifestyle choices"" almost seems punitive to those who suffer from illnesses due to lifestyle choices. the best plan to me seems to be universal healthcare such as those programs seen in Canada and Europe. if taxes have to be raised to cover those costs so be it. to live not just longer but healthier is good for " Agree Agree "* we do need to heed the lessons learned from failed HMO plans that actually did more to fail to provide medical care by heavy handed ""gate keepers"". Individuals need fair access to specialists and medical procedures in a timely manner. Evidence based health care is fine however, sometimes there are treatments that maybe outside of traditional health care individuals need review boards that will give timely decisions for those who may benefit from those treatments. Timely meaning decisions within days or weeks not months for those who wait for treatment. " Agree as long as paying programs do not require patients and families have to sacrifice their values and beliefs in order to have services covered. Agree this sounds good on paper however my fear is that middle income families will still have their financial security at greater risk than other parts of the population. we ususally have to choose between higher premiums or higher out of pocket costs. (which is worse?)it would be better to create a program that will lower costs rather than increase them either way. Agree * you already have a system in place it is called Medicare. it stikes me as odd that no one is talking about expanding that program to include all Americans. it could be funded by payroll taxes instead of healthcare premiums. you already have all of the necessary infrastructure in place. all providers already are familiar with the way Medicare works and there would then be only one billing system as well as a review system in place for any medical service that requires preauthorizations and managed health care as stated above the simplest solution is to use the system in place and allow Medicare to provide health care for everyone. if people choose to purchase additional health care they should still be allowed to do that much like life ins is sold. however rather than trying to reinvent the wheel we have a system in place it would just need to be expanded to cover all citizens. 32216 08/30/06 WA Agree Agree No response Agree Agree Agree 32218 08/30/06 WA Agree Agree Agree Agree Agree Agree I certainly think that small reductions in military budget wastefulness (on the order of 1 or 2%) would go a great way towards providing funding for this. We should trim existing government programs like military expenditure on nuclear program upkeep and make a serious long-term investment in the healthcare of our citizens as that will pay huge dividends over _not_ doing so and having to pick up the tab later. 32219 08/30/06 WA Agree Agree Agree Agree Agree "I strongly agree with this. I was recently forced to do without treatment for chronic illness even though I have health insurance. A single treatment would have cost approximately $5000. My insurance would have paid for 80% of the cost, but I cannot afford to pay the $1000 that remains. Any public health care policy should not place anyone in the position of having to forego necessary treatment because of cost." Agree "NO one should be expected to pay more than he/she can afford to have decent health care. There are countries whose health care costs are born by everyone, according to their means. We should aim for a system that does the same." 32220 08/30/06 WA Agree "Exception: The program should be PUBLIC, not private or public-private. The private sector has shown over decades that they are simply too greedy to take car of providing reasonable cost medical care. Period." Agree Ditto - keep the 'private' out of this! Agree Yes - exactly Agree "Again - the private sector has no business here - they have shown that even for end-of-life issues, they are more concerned about their executives' pay and benefits than the public's welfare." Agree YES YES YES But there should be no need for 'financial assistance'. The system should be a federally funded and run program for all. Agree "Health care should be charged based on financial ability to pay, and the ""insurnce"" premiums - be they taxes, co-pays, etc., should be levied based on income. An indigent person should pay nothing; the wealthy should pay a lot. NOTE: I'm wealthy and would be happy to pay much more than middle or low income people to ensure all have equal PUBLIC health care. The same applied to business. They must pay in proportion to their income and revenues." "Exception: The private sector should be only one party having input. But they must NOT, repeat NOT, have a say in writing the actual legislation or setting up the terms. If they do it will be like some of our 'public/private' fisheries management groups, which, because of 'private' members' (read: commercial fishing concerns) railroading and screaming have managed to drive many of the fisheries they were supposed to 'manage' right to the brink of extinction - and still doing so." PUBLIC not private or public/private. Coverage for 100% of citizens and residents. Individuals and businesses charged proportaional to income/profit. 32223 08/30/06 WA Agree "* Any program should include long-term care coverage. The government pays for most nursing home and long term care anyway. The poor are covered and many middle class people transfer assets in order to obtain coverage. Those of us who have saved and have purchased long term care insurance are punished both by having to pay any amounts not covered by our insurance and by paying for private caregivers to supplement the inadequate staffing in nursing homes where many patients are covered my Medicaid's inadequate reimbursement rates. Finally, we have to battle with insurance companies who frequently refuse the care the contract promises. Surviving spouse's are often left with their savings so depleted that they have inadequate income to last for their lives." Agree "Administration costs for private insurance runs over 25%. This vastly exceeds the cost of administering Medicare (6%) and the costs of administering any other western country's health care system (the highest no more than 11%, I believe). A combination of private and publicly supported health care is just going to reduce the amount available for actual health care since so much is absorbed in administration and payments to insurance company exectutives and stockholders. " Agree I agree since I use TRICARE and find it works well. Federally funded programs are the most efficient since they reduce administrative costs. Agree "* My husband died of Alzheimer's after 15 years with the disease. I cared for him at home until the last 4 years and went to the nursing home almost daily. About a year before he died, he had a grande mal seizure. The hospital wanted to do a cat scan which as far as I could see would serve no medical purpose. I had to insist on their not doing this as I thought it a waste of taxpayer funds. About 4 months before he died, he developed pneumonia and the nursing home gave him antibiotics without consulting me. I had to remind them that this was my decision to make, not theirs. I brought him home for the last 3 weeks of his life and with the assistance of hospice care for him there. We used only meds that would make him comfortable. " Agree "People should not be forced into bankruptcy or poverty by medical costs, including long term care." Agree "Continue the estate tax, but provide a large exemption perhaps two to five million per person. Have both corporations and individuals pay a tax that is earmarked for health care." It is ridiculous that not all health care programs cover dental and eye care. Glasses are as essential as any other prothesis. Dental care is essential to over all health care. My father neglected his teeth and this eventually led to a life threatening infection. The prostheses that are provided by private insurance companies are grossly inadequate compared to those provided by the VA . Insurance companies should be required to provide state of the art prostheses and to replace them as they become ill fitting. 32237 08/30/06 WA Agree "we need a single payer for health care, i.e., national health care.... with the option of the richer buying supplemental health care coverage... designer care... if they want it... but all americans should have access to basic and critical care services regardless of ability to pay" Agree but don't want just another commission and another report that takes years to produce and then gathers dust on shelves Agree Agree Agree Agree we need to eliminate the health insurance industry as it currently exists.... we will go bankrupt whaile the insurance companies get richer and richer...imagine how much health care could be provided with the money that currently goes to support the operation of so many... how many????.... health insurance entities all getting their piece of the pie.... "* we keep applying band-aids to what i think is a hemmoraghing (sp?) wound that is our health care system... if you can even call it a system... our population has become so self-involved and selfish that no one is willing to make sacrifices anymore for the greater good... the prevailing attitude seems to be... as long as i get mine, who cares about the rest ... sure it's a complicated problem but if we don't face reality about our limitations and our responsibilities we will never solve the problem of equitable care for all.... years ago i heard the then editor of the new england journal of medicine on a ted koppel program discussing health care in the u.s.... this was years ago...we're still having the same discussion and we're not getting anywhere....anyway, she asked the question... do we, americans, believe that health care is a right or is it a privilege????? we need to answer that question" 32239 08/30/06 MA Agree The single most important step to take is to divorce health care reimbursement (coverage) from dependence on employers. A universal single payer system is the one way in which all citizens may have health care service access and not suffer catastrophic financial burdens from a for-profit fragmented system. Agree "* I would go several steps further: Use the VA as a central model of care provision. Convert Medicare to a geriatric healthcare service arm, and transform Medicaid into an access and reimbursement system that covers ALL other citizens. Eliminate the for profit health care insurance industry. Regulate all prescription medication costs via a national formulary. Use the state funding and reimbursement mechanisms for Medicaid, and expand them based on the larger population pool by redistributing tax dollars to the new model. Divorce reimbursement from the treatment setting. Allow the healthcare provider flexibility to partner with the patient to assure the optimal service setting (often between home, hospital and skilled/extended care settings). Incorporate the Public Health Service and Indian Health Service into the national model. Use the civil service wage and salary scales to pay licensed health care providers (MD, DO, RN, APRN, PT, OT, etc.) to promote professional autonomy not dependent on the healt" Agree "* I would go several steps further: Use the VA as a central model of care provision. Convert Medicare to a geriatric healthcare service arm, and transform Medicaid into an access and reimbursement system that covers ALL other citizens. Eliminate the for profit health care insurance industry. Regulate all prescription medication costs via a national formulary. Use the state funding and reimbursement mechanisms for Medicaid, and expand them based on the larger population pool by redistributing tax dollars to the new model. Divorce reimbursement from the treatment setting. Allow the healthcare provider flexibility to partner with the patient to assure the optimal service setting (often between home, hospital and skilled/extended care settings). Incorporate the Public Health Service and Indian Health Service into the national model. Use the civil service wage and salary scales to pay licensed health care providers (MD, DO, RN, APRN, PT, OT, etc.) to promote professional autonomy not dependent on the healt" Agree Encourage experts in end of life care to develop national policies and create opportunities for expertise to be shared and supported at the state and local levels. Make palliative care available and accessible to all who desire it in the setting of choice. Agree "* The sole way to fully accomplish this is to divorce healthcare access and reimbursement from employment status and to abolish the for profit healthcare insurance industry. A single payer universal healthcare system is the only way in which to achieve this. Otherwise, we are simply promulgating a generation of people who are too ill to work at peak efficiency, too chronically ill to recover, and therefore, much more likeley to suffer a catastrophic financial burden. Eventually, in the not too distant future, this will bankrupt the U.S." Agree "* I would go several steps further: Use the VA as a central model of care provision. Convert Medicare to a geriatric healthcare service arm, and transform Medicaid into an access and reimbursement system that covers ALL other citizens. Eliminate the for profit health care insurance industry. Regulate all prescription medication costs via a national formulary. Use the state funding and reimbursement mechanisms for Medicaid, and expand them based on the larger population pool by redistributing tax dollars to the new model. Divorce reimbursement from the treatment setting. Allow the healthcare provider flexibility to partner with the patient to assure the optimal service setting (often between home, hospital and skilled/extended care settings). Incorporate the Public Health service and Indian Health Service into the national model. Use the civil service wage and salary scales to pay licensed health care providers (MD, DO, RN, APRN, PT, OT, etc.) to promote professional autonomy not dependent on the healt" "Preventive care is directly linked to the availability of qualified registered nurses, primary care physicians, advanced practice registered nurses, mental health clinicians and dentists. The recommendations do not address how these providers will be made available in sufficient number and with sufficient financial and practice support in order to provide this care to all Americans." "* Not once have registered nurses ben mentioned in the recommendations. However, I believe that professional nursing - its availability and promotion, must be addressed concomitantly. Nurses are in the optimal position to provide preventive care in situ - in schools, in the home, in the community, and in public service. The Nurse Reinvestment Act does not fully address the need to convert the entry level education for professional nursing to a minimum of a four year baccalaureate education. It does not address the financial support needed to educate and prepare adequate numbers and types of nurse faculty and to provide them with equitable salaries and working conditions. It does not address the pressing need to make professional nursing practice fully autonomous and not tied to the bottom line profit margins of healthcare employers. The literature clearly shows that baccalaureate educated nurses who are available and accessible to patients, and who directly provide their nursing care, lower the morbid" 32240 08/30/06 CA Agree Expand Medicare to cover all citizens and resident aliens. This recommendation MUST include long term care and drug benefits. Disagree Expand Medicare to all and let case management or disease management fill the voids. Developing integrated delivery networks will not work--there is a significant body of research describing the falacy of this notion. Agree "This is consistent with my earlier recommendation. But recognize that ""evidence-based best practices"" works for simple problems with relatively simple (not complex) interventions. The greater the complexity in problems or procedures this less likely ""evidence-based"" best practices can be identified." Agree It should be an option not a requirement. Agree It has to be more than public policy--it has to be a right! Agree "Expand Medicare to all. Establish a basic benefit package for all. Allow for ""Medi-gap"" policies to give people additional benefits (or expanded choice). " This is consistent with my earlier comments "Build on what works. Medicare is well regarded by all, expanding it to cover all Americans with a clear package of benefits will simplify access to care, reduce administrative burdens and costs on providers and patients, will increase the competitiveness of American businesses here in America and provides coverage for workers in the expanding service sector who often do not have coverage." 32242 08/30/06 OH Agree "* Your wording is almost too vague. Everyone should have availability to affordable health care not continual rising costs due to those who abuse the system. Some people are having financial problems because they did the responsible thing and have been financially responsible for their medical costs. There are far too many in inner-city America who choose not to go to the Dr. office because it would have to come out of their own pocket. They get their health-care by going to the emergency room for simple constipation, flu, a cold and then complain because it takes hours to be seen. Whatever is provided totally free is what will be used to excess. There has to be availability but with limitations. " Agree "* Let's make it a good thing to be in the health care profession. Look at how many wonderful OB-GYN DRs no longer deliver babies because of the rediculous costs of malpractice insurance. There are issues involved that complicate the healthcare of everyone that can't necessarily be ""fixed"" by the government dictating policy. There should be more Drs and more clinics. I've only been seeing more and more of them closing due to costs involved in trying to give health care to those who can't pay or won't pay or abuse the system making it impossible for Medical Professionals to stay in practice." Agree Some programs are already working. They are not perfect but they work. Agree "DNR means DNR. When there is no hope left and nothing left to do, then being kept comfortably should be available. Quit telling people how they can and cannot die." Agree "What ways will there be available to document family finances in the first place? There are so many who now hide their actual financial situation so that they are ""eligible"" to not pay. This is happening more and more and health care costs are rising and we see more people choosing not to be in the medical profession. No matter how hard you try you can't make people be Drs and nurses." Agree Be certain people are citizens. Health care is important. More and more jobs are taking all they can from their employees but not giving back. Too many people and employers are only thinking of themselves. Everyone else is paying the price for that selfishness. 32244 08/30/06 WA Agree Agree Agree Agree Agree Agree 32248 08/30/06 WA Agree Agree Agree Agree Agree Agree No new taxes for low and middle income families. We already pay our fair share. 32254 08/30/06 WA Agree I support a national public program to cover all medical services and health related expenses for everyone in the US. Agree "These recommendations are important; at the same time, both accountability and local assessments of priorities need to be included. For example, the current methamphetamine epidemic impacts particular communities and populations, and solutions for managing involve community based approaches and coordination of information. Evaluation by federal agencies can be useful for accountability, but shouldn't become a source of punitive and ineffective substance abuse policy (such as the ""war on drugs"")." Agree "I believe that a universal, single payer health care system WILL reduce costs and increase quality." Agree Our failure to implement these policies is a major moral failing of our society. Agree I believe our public health is endangered by current restrictions to health care access. Such policy is irresponsible. Agree "* I believe US federal government spending priorities are the major reason we do not have good health care, emergency management or other social services here. I believe that the wealth of our country is wasted on war expenditures including profiteering, revenue collection which priviledges the wealthy, and corruption which favors incompetance and cronyism. There are plenty of funds in the national budget for an excellent health care system, education, social services, emergency management and responsible environmental practices, with additional funds to donate to needy people abroad. It is high time to change these priorities." One of the major difficulties of our system is its denial of parity for mental health support. Full support for mental health is vital for good public health practive and ultimately reducing costs. "* I believe that in order to accomplish the goals you have outlined above, it is vital to increase the number of health care practitioners at all levels: physicians and medical service providers, nurses, mental health care workers and social workers. I support beginning with increasing the number and capacity of training programs and providing greater funding support for those enrolled in training. The current system is punitive, inadequate, and relies on recruiting providers who have been trained abroad, reducing available personnel in needy areas. It also enriches profiteers whose connections give them access to medical service contracting. Additionally, incentives and support need to be made available to practitioners who would locate in underserved areas." 32255 08/30/06 AL Agree Agree Agree Agree Agree this is the key tenet Agree 32269 08/30/06 WA Agree "We need to separate access to health care and employment, especially as people rarely work for one employer for life, and employers have cut health care benefits. It should be national, and government-funded. Taxing employers as one way to fund health care makes some sense, but the current maze of employer coverage, or lack thereof, makes no sense." Agree My only caveat is that the private part be phased out. Medicine should not be practiced for profit. Agree "A single-payer system should reduce administrative costs, which is currently a large portion of the cost. The rest of the western world pays less and gets more, because they spend time filling out forms. A system that tracks medical errors with the goal of prevention, not prosecution, would greatly improve care, and make hospitals a safer place for patients " Agree Agree "If everyone has health care, then the people who currently have health care and feel safe will actually be safer, because there will not be a large untreated disease pool living amongst us." Agree "The rest of the world, much of it with better health care and lower infant mortality than us, has proven that government funded care is the only rational way to fund medicine. Doctors should be salaried, not paid piece-meal, and we should fund everything through taxes. I can understand a nominal fee for drugs and services to discourage overuse, but the real costs should not be charged to the individual." "Encouraging preventative care should reduce the need for emergency care, and again reduce costs." 32271 08/30/06 WA Agree Agree Agree Agree Agree Agree 32275 08/30/06 WA Agree "Our health care delivery system is a disaster, in part due to layers of employees pushing insurance claims around. We desperately need a change in this country, and we should be humbled by what our system delivers in contrast to other countries around the world." Agree "My only concern is the current administration's position regarding safe sex, abortions, family planning. I am sick unto death of people with 4,5,6, 7 kids and no jobs and no spouse." Agree Agree In my experience it seems doctors are terrified to tell someone they are going to die fairly soon and try extending life to the tune of hundreds of thousands of dollars that should be spent keeping people healthy in the first place. Agree Agree "Again, the current administration seems intent on making sure the rich pay for nothing at the expense of the poor. I have long advocated you pay according to your income on a sliding scale." 32276 08/30/06 WA Agree "In some countries if you want to send a child to school you have to pay. In some countries if you want physical security you pay, if you want a government permit you pay a bribe, if you need a drivers license you just bribe the chief of police. I wouldn't want to live in these places, but in America if you want good health care you had better be either rich or a politician." Disagree "I'm not sure what this means. Do we assume that the federal government somehow knows where the greatest local need exists and can help areas with poor facilities? How do you ""strengthen healthcare infrastructure"" without giving money to localities? Aren't there always strings when money goes to localities? Are we going to have just certain kinds of services (no teen pregnancy prevention or abortion) in federally ""strengthened"" facilities? " Agree "This is all wonderful on paper but the federal systems are only a fraction of the corporate health giant in America. The health care lobbies will continue to feed millions to their CEOs and corporate boards, not to mention the pipelines that run to Washington DC. If you really want to make the system more efficient you should have opened drug price bidding by the medicare system instead of the ridiculous Part D drug system you passed." Agree "And how, exactly, will the federal government ""support services to assist individuals"" in this health area? This looks like another opportunity for the federal government to dictate (via the purse of course) to states and localities it's personal moral view of life, its end, its beginning, its value or lack of value. I shudder at the thought of Congress laying out my funeral." Agree "* It's difficult to argue against this recommendation. Couldn't the federal government have a system that is like the pollution credit trading system. Give everyone a certain number of health credits in life, and those of us who take care of ourselves could donate credits like pints of blood to people who are struck by unexpected illness. Some, of course, would be tempted to sell their credits like derelicts sell blood, but I could see great motivating factors for people who could actually give health care credits to relatives or leave them to their children when they died." Disagree "If we can finance the largest military in the world, purchase thousands of nuclear warheads, which are absolutely useless in geo politics, develop space research and spend billions on a self-destructive war in Iraq I just don't see why we can't get our poor folks some health care. Cut the military budget and it's paid for. Simple as that." "The core benefit package should be defined ONLY by patients, not by the financial interests of providers, drug companies, medical industry or insurance representatives. It wouldn't be hard to define and shouldn't have a hand in defining the basic package. Ask a few parents, a few coal miners, a few school teachers, a few construction workers. Don't ask insurance executives or hospital administrators." "* Why do I think that the efforts of Congress to fix the health care system is little more than an election year feel-good campaign? When Congress has the drug companies writing the Medicare Part D bill, the banks writing the bankruptcy bill, and military contractors lining up at the lobby trough for government money I just can't see any health care programs coming out of Washington that consider the needs of the people and not the profit needs of corporate lobbyists. I think that eventually the states are going to be the designers of new health care programs and the federal government should either expand the V.A. to cover all of the population, or step aside and let the states take care of the problem." 32280 08/30/06 CO Agree Citizens should all have equal access to quality health care. they should pay for services according to their ability to do so. Children should have equal access to helth cqare regardless of their abiity to pay. Agree The system of care shoud include access to health services in schools. School health care should b e part of the system and continnuum of care School-Based health centers make sense because they improve access and its where the kids are. We know that good health contributes to academic success. B Agree "Evidence supports that school-based health centers reduce emergency room utilization. They also have reduced costs associated with asthma management. they afford excellent, multi-disciplinary health care which integrates health and mental health" Agree Agree Agree 32282 08/30/06 WA Agree Disagree Agree Agree Agree Agree 32284 08/30/06 WA Agree "* I believe Medicare should be expanded to include all taxpaying American residents. (Use a similar system to that in Australia - paid for by taxes.) BASIC emergency and urgent healthcare (to be defined) obtained from public health hospitals and providers should be free . However a second tier of private health insurance should be available and encouraged with incentives. This should cover non-medically essential services - superior hospital room, board, food and services, without access barriers, and optional patient desired health improvement services - massage, cosmetic surgery, counselling etc." Disagree Integrated community health networks are essential of course - nationwide. A federal government agency responsible for the new system should be identified - and while multiple advisory bodies will be necessary - we must guard against fragmented services - a patchwork of good and bad services. Agree But let's be realistic - first emphasis should be on clinical healthcare services for the entire population. Some of the splendid ideals may have to be giver a lower priority. Agree Long term care insurance should be encouraged with better incentives. Agree Agree " Review current costs - why is American health care so much more expensive than in other countries? Let's use the experiences of our western nations and reduce costs using similar payment rates, BUT an INCREASE IN TAXES is probably essential. Why is the American public not given the choice regarding tax increases SPECIFICALLY for their health care?" "PLEASE do something about the shameful health care ""system"" we have. To imply that this country can't afford reasonable health care services for all citizen/residents is dishonest." 32286 08/30/06 WA Agree "Universal, basic healthcare and implementing reasonable cost controls for all Americans should be among paramount concerns on our government's agenda - how can a nation that neglects its own people's health and welfare in favor of corporate profits lead the world in good conscience?" Agree This is absolutely essential - we must take care of our own. Agree "As stated before, we must put reasonable controls on healthcare costs and provide viable, publicly-funded alternatives to private programs. We cannot favor corporate profiteering over the health of our nation's people." Agree "We must take care of our own, in all stages of living and dying." Agree This is fundamental to our nation's health as a political body. Agree 32287 08/30/06 WA Agree "* I basically agree but the devil is in the details and implementation. I am against privitization plans similar to the current prescription drug program or any program that is administered through private insurance agencies with a combination of public and private (individually paid) health care plans. All proposed plans that I have read about would cost American families from $5,000 to $12,000 per year. Most Anmerican families can afford this expense. The so called carrot of a tax deferred health savings account is no more than term insurance for health care and in my view does little to benefit most families, but is a great boon to insurance companies that administer the program. " Agree "* I agree with this with the exception of the private public group. Again the devil is in the details. The current manner in which public private services in many sectors aside form health care are currently managed at the federal level reap great profits for private companies at great public expense. I am against joint ventures between the public and private enterprise, for services that should be administered by the government. The privitization of military serivces is a good example. The companies involved in these joint ventures are making too much money, the contracts are not being overseen with diligence and the service the government receives is not a good value for the public dollar spent. Nor do I feel individual families can negotiate with private insurance companies to get good rates. I feel that until the government takes a tougher stand with private industry on government contracts, the government alone should administer services. Note the low overhead for social security. " Agree "* I agree with this statement. I have had experience with Tricare and feels that it is an excellent program. I do not know how it is managed from the business end. I do not know how much it depends on public private partnerships, but I do know that the facilities are all government facilities managed under the military. From my experience with both private hospitals, HMO's and Tricare, I would say the Tricare then HMO"" give better serivce with less waiting and high quality and high tech care. Tricare is the best use of the military dollare I have seen yet. " Agree "* End of life care is a big issue and an expensive undertaking. If I were terminally ill at this time, I would not spend my private dollar or public dollar to extend my life for a few days or weeks. Management of terminal illness over a longer period is a seperate issue and all people should have access to treatments that prolong life even if the disease is not curable. Of course this is expensive. I know from personal experience being a cancer survivor that insurance companies do not want to provide serivce to individuals with health histories like mine and if they are willing to provide insurance, it is more than I or most people can afford. This is a national disgrace. Why should the profit motive drive health care like it does everything else in our society. Citizens should not be limited to good health care and education by their income or personal status. Again the issue of how the public private partnership is managed is critical. The current drug plan where the government cannot negotiate the cos" Agree And it should not be a big profit give away to insurance companies. Disagree "* First take money from military spending especially the star wars and the overly expensive under preforming contracts to private industry. Maintain a progressive tax structure. Average American families pay less in taxes than other countries, but also receive less in services from their government for what they do pay. I have had expericence with the Canadian health system, and do not understand why the US cannot support such a system. Get rid of some of the real waste in government and we probably could afford such a system. But first special insterests and the big lobbiests need to back out of government. " "* I agree with most of this statement with the exception of the public private group. Define the private sector in this equation. The private sector is intereted in profit not serivce. I truly believe the inclusion of private insureres, and medical/ drug companies input will result in a program that will be more expensive than it should be and not serve all people equally. Sicker people will probably pay more and have less access. The trend in recent years by private industry of any type and our government has supported this, is to shift the risk downwards on to families. There are economists who have shown that some services for the public good are not best administered or managed by the template of the free market. I fear that this program is just another way to privatize what should be a public service for the public good like education. " This poll has not been well publicized and the comment period should be extended. I just heard about it today. 32288 08/30/06 WA Agree Every American should have access to high quality health care regardless of income or employment status. Out of pocket expenses should be assessed on graduated scale based on income. Agree "Community Health Networks are the least expensive way to ensure access to preventative care for all citizens but beyond those networks, access to specialists and emergency care are also critical to maintaining a healthy population." Disagree I agree that there needs to be additional education and integration in the health care sector but resources need to go to care for the uninsured before they go to monitoring the system or creating additional technologies to manage and monitor low income patients. Disagree "Everyone dies eventually, let's focus on keeping people healthy rather than extending the lives of the elderly by a month or two. Since the majority of health care expenses are incurred in the last few months of life, perhaps we should revisit what types of treatments we spend public money on for terminally ill patients." Agree "Medical expenses have continued to be a significant liability for our family, I'm still paying for bills incurred while I was uninsured and my sister is currently looking at spending money she saved for college to treat a blood clot in her arm." Agree "I don't see a reason for keeping medicaid, medicare and state programs seperate, let's take money for these public programs and combine it with a tax on business to provide universal access to healthcare. Why are we seeing record profits in the healthcare sector while more Americans lack coverage. Insurace companies are profiting while the quality of care is declining. We need to make sure that companies have incentives to provide care rather than deny care." 32290 08/30/06 WA Agree Agree Agree Agree Agree Agree 32294 08/30/06 WA Agree Let's focus on access to Health Care. Too many of us have the mindset that private insurance is the only way. We need to provide for ourselves and we can do so with a National Health Service. Agree "Remind doctors, dentists and all providers that Health Care is a Ministry, not a business." Agree Too much of our health care dollar is spent on expensive downtown skyscraper real estate owned by big insurance companies. We can all live without that. Agree People should be allowed to die in dignity and not be drained of their lives' assets by greedy profit mongers. Agree "Begin by firing the insurance companies. Next day, prices for healthcare, including prescription drugs, would plunge to an affordable level. Then ""We The People"" can regain control of our lives and provide ourselves with an effective and efficient ""National Health Service"". Other Western nations do this and their citizens live about 10 years longer than Americans. " Agree Eliminate health insurance as an employee benefit. Collect these funds as taxes to pay for our own National Health Service. Require health care professionals to disclose any financial interest they might have when refering a patient to a specialist or other medical facility. "* The profit system doesn’t work for health care where profits are derived from denying treatment and refusing to sell insurance to those who need it most. (Ever hear of “pre-existing conditions?”) We can’t cut costs and improve quality by having 1,500 separate medical organizations. Fragmentation impedes reforms which would improve quality such as electronic record keeping of patients’ medical histories and system-wide adoption of treatments scientifically recognized as best for particular illnesses. We need to join every other developed nation in the world in having universal health care and a single payer system (“Medicare for all”). " 32295 08/30/06 MS Disagree "This sounds like another entitlement program. Please let the market sort this out as it is finally beginning to do. As soon as inexpensive healthcare is established as a right, costs will soar at an even greater rate. The federal deficit is already enormous." Agree Agree Agree Disagree "This is the redefinition of healthcare as a ""right"", ultimately with the taxpayers footing the bill." Disagree "At the end of the day, new taxes are the only way to pay for the grand, new, federalized health care entitlement. Taxes are already too high." "Core benefits will vary from region to region, and a ""one size fits all"" set of core benefits will not properly serve most communities." "The private marketplace is finally acting in a meaningful way to reduce costs and provide the consumers (patients) with the plans that best suit them. The worst thing that could happen now would be federal intervention to create a new entitlement and perceived ""right"" for every American. Look at the bankrupting costs of every other entitlement that well meaning politicians have established over the last 40 years. " 32296 08/30/06 WA Agree "it is time we stop pretending that this country has adequate medical coverage, it doesn't and it is deplorable that we let our officials continue to act as if it isn't important." Agree Agree Agree Agree "and i point out that it is health care everyone needs, NOT INSURANCE!!" Agree 32304 08/30/06 KS Agree I believe that national program MUST be public if it is to offer real protections against very high health care costs. Agree "I agree we want to make use of the many wonderful private health care facilities and providers now in existence, and that a public/private integrated system would be great, but I think such a plan MUST originate in the public sector - private will never start it up." Agree "I agree, but hink more emphasis must be placed on PREVENTION since that in itself will reduce costs." Agree "Yes, but be sure the use of Advance Directives is stressed - can prevent much useless and costly end-of-life care when many folks really do not WANT it - but maybe their families do." Agree "Absolute, all Americans have a RIGHT to affordable health care, for ""core"" health care services. May mean some fancy tummy tucks and face lifts cannot get done, but so be it." Agree "I believe strongly that a governmental single-payer system MUST be the best way to achieve this. This will greatly reduce administrative costs and help pay for the system and taking away the great profits of the insurance comanies and pharmaceutical companies will help, too. We will may have to pay a bit more taxes, but that's OK." I like this one just the way it is. "I think I've made clear what I prefer, as I commented on the other questions. Thanks for doing this, and I eagerly await your final report." 32307 08/30/06 WA Agree "The coverage need not be all-encompassing, but some level of basic coverage must be provided to all citizens" Agree "Sounds like a great idea, but I fear it will end up as another underfunded, overworked agency" Agree I especially like the ideas on increased health education and disease prevention and getting more usuable info to the consumer so that they can make choices that make the system more cost-efficient Agree Agree Some basic level of health care coverage must be extended to all citizens Agree 32310 08/30/06 WA Agree Agree Agree Agree Agree Agree All of the fedral healthcare programs are more efishent than the privet insuers. I would rather pey taxes and have the money go to care than pay profits to insurence companys. We should all pay somthing. 32311 08/30/06 WA Agree This should be a basic value for any civilized nation in the modern world. Agree "this effort needs to be truly supportive of the recipients, and not become overly ponderous and bureaucratic" Agree Agree Agree Agree We need a strong national health care system for all. 32319 08/30/06 WA Agree Agree Agree Consult with other governments outside of the U.S. to develop efficient processes. Many other nations have generations of experience in offering healthcare to all their citizens. There are examples out there of efficient and non-efficient processes and pratcices within this context. Agree Agree Agree "Low income people should not have to pay more taxes for this. For profit corporations should pay more taxes to insure these people who are, after all, their ""labor"". Higher income individuals should not have to pay more because that would create different ""classes"" of payees. No one should pay more because he or she ""uses"" more health care." This plan should replace the coverage currently enjoyed by the members of the House of Representatives and the United States Senate or the coverages they currently have should be extended to the entire population. The creators of this plan must be required to adopt it for themselves. 32320 08/30/06 PA Agree "* Your solution centered on catastrophic coverage for high health care costs is skewed by your reliance on the private insurance companies. It maybe better to have catastrophic coverage funded by public dollars, but it becomes arbitrary where to draw the threshold since incomes vary widely. Far better and surprisingly, less bureaucratic is to create a properly financed, single payer national health insurance program which provides cradle to grave coverage. It would then provide all three goals: coverage for all, protection against high costs, and protection for low income individuals. That aside, a single payer entity can be a more prudent shopper and can create a level playing field where all can compete on price and quality for providing health care services." Agree "* Well, we actually do this incorrectly in this country. The way to do this is to take advantage of local health department's ability to collect local data and use it to be both a carrot and stick. For example, we collect a wide variety of vital statistics, communicable disease reports, morbidity statistics, etc. Let's give health departments the tools and resources to conduct disease surveillance and use this information to highlight areas of disparity and possible epidemics. Then provide incentives to doctors and hospitals to report this data rather than spend their time justifying billing arrangements. We are collecting the wrong data. We should be collecting public health data. One of the reasons for a single payer system is to stop spending all our resources on billing data and redirect it toward public health data collection. Then with the public health data, use the information to incentivize community networks or to create a community network. bonuses are provided to a community that effec" Agree "* Of course we want quality care. We, however, pay $30,000 to amputate a leg but nothing to hire a diabetes health educator or $100 for a podiatrist to examine a foot ulcer. How stupid can we be? Let's start paying for health education, group classes, real nurse directed health education live and in person, not over a telephone. We need to really invest in prevention and public health. Right now we spend 1% on public health and 99% on the treatment and administration end of health care. We have got to double the CDC budget and start putting prevention first, esp. in early childhood. That is how to really improve quality. Early intervention in 0-2 year olds has been shown to have dramatic impact on not only school readiness, but not surprisingly, drug abuse,chronic diseases, smoking rates, etc. Dr. David Olds has a great model in the Nurse Family Partnership which offers home visitation for every newborn. We should do this nationwide and in every home. Let's get the kids off to a good start and w" Agree "* This is one area that I agree with your recommendations. We should have better, more compassionate hospice care. But we should have realistic discussions of what the choices are. Ideally, everyone should live a full, quality, active life. When they can no longer get around, or keep their bowels going, or able to eat, and they have made peace with their family, have them around you and you pass away surrounded by those who care about you. This would save huge health care costs. But because we want to save everyone, we put them on a ventilator and rack up huge ICU bills. Let's pay doctors to have heart to heart talks, with clergy or trusted family and friends together. It would be worth it." Agree Agree "* The only way we can have our cake and eat it too - quality affordable health care for everyone is to figure out how to provide national health insurance. Study after study has shown it to be the best bang for our buck and the cheapest way of getting quality affordable health care for all. The notion in your report that we have lots of options like HSAs, price transparency, risk pooling, competitive private insurance is simply wrong. We have tried all of these things and it has not effectively made health care affordable or improved quality. We now have Americans taking trips to Thailand and other countries to get affordable health care. This is a crazy system in this country. We have to bite the bullet and have a serious recommendation from the CHCWG about single payer, national health insurance." "* Having been on many committees that have looked at this issue, this is not easy. In fact, it is easier to say what is not ""core"" than what is ""core"". My suggestion is that you approach what will not be covered - easy is stuff like cosmetic surgery. tougher are areas like infertility or abortion or prescription drugs. I believe if we want to ""sell a new health care reform"" package, we have to offer better benefits than what most are getting today. This is getitng easier as companies cut back their benefits. I think that the panel who decide benefits have to be living with a chronic illness or diability or are familiar with its treatment. No one can best describe what should be in a benefit package better than someone who lives it every day. I would make it a requirement. Finally, there will be the obvious call for evidence based medicine. What about where there is no good study or the studies are equivocal? In that case, i would opt for paying for making it as a core benefit only under the po" What is the health policy of the United States?? give up? so have a lot of people. I think it is time for America to have a mission statement about health care. We spend 2 trillion dollars on health care and we have no idea what is our mission or our values. This should end with your report and Congress should end our current non system of financing care. 32324 08/30/06 NC No response Disagree "The community health center program has successfully served the needs of the poor and disadvantaged for over 41 years. I oppose changing the program to accomidate those that wish to undo the user-based governance requirements that are at the core of health centers. Giving those who use the service, the right to dictate how that service is delivered, is an American value that deserves protection. " No response No response No response No response 32325 08/30/06 WA Agree Agree "Expanding access to primary care will help hold down health care costs overall. Not to mention, it's a better way to provide health services than emergency room care." Agree "* This is by far the trickiest of the recommendations. What makes most sense is a single federal health insurance program for all citizens, not targeted programs for seniors, veterans, and poor people. However, these programs provide the model for a new federal health insurance program. What's missing from the bullets, and is most important, is the use of these programs to establish (i.e., dictate) fair prices for perscription drugs and medical procedures. The advantage of a large federal health program is its ability to HOLD DOWN COSTS!" Agree Agree "Sounds fine, but what do we mean by ""access,"" especially if we move toward a more cost-rational system? Does having to wait months for a critical procedure constitute access? How much queuing for health services are we willing to tolerate? Can we come to agreement on how much we are willing to pay to increase the supply of health services to reduce waiting periods?" Disagree "We need to de-couple health insurance from employment status. We can no longer tolerate people loosing their health insurance when the change or loose their jobs. Employer should pay into the system, as should individual taxpayers." "Nice try! 'At-a-way to pass the buck on the really tough question. Let someone else deal with ""the Jerusalem issue.""" "The one thing that is clearly missing from these recommendations is an emphasis on the need to simplify the ""system."" Too many players--providers, insurers, employers--sending paper and money to each other. We will never have an efficient system unless we create a simpler one." 32326 08/30/06 WA Agree Agree Agree Agree Agree Agree 32327 08/30/06 CO No response Agree No response Agree Agree "Citzens of the United States should have access to the best health care available in the world, regardless of their ability to pay." No response 32329 08/30/06 TX Agree Agree Agree Agree Agree Agree Need to have healthcare professionals (especially nurses) in partnership with patients involved in this process. 32331 08/30/06 IA Agree Universal Health Care is a must for all! An expansion of Medicare seems to me to be the best way to secure that. Agree Seems reasonable; but want to be sure it covers everyone and is primarily government subsidized rather than privatized. Agree All changes proposed must be understandable by everyone and simple to interpret. Agree It is important that persons have the latest information and programs to make their last of life health changes as easy as possible. Agree See comment on first question--UNIVERSAL HEALTH CARE Agree "Unfortunately, some decisions as to the extent of extreme health care may have to be limited due to high costs and quality of life" Quality of life possibilities must be included in decision making. 32332 08/30/06 OR No response "* this entire document is lacking in the overwhelming mandate from the meeting I attended to make care universal and single payer and to regulate profits in the health care industry, without these two solutions, none of this is really feasible, facts of which our group and from an article I read in YES magazine, many other groups were aware of as well. Apparently it was even more difficult in some other groups to get the facilitators to put single payer and profit control on the list. What gives? Do you have a mandate not to really tell them what the people said? I certainly hope the final recommendations are very strong on these points." No response No response No response No response No response 32333 08/30/06 VA No response Disagree "* To whom it may concern: I am writing today to express deep reservations about one of the interim recommendations addressing the FQHC concept. Although some of the recommendations have merit, an attempt to change the long history of success of the FQHC model is misguided. It would be of value to know why and how such a recommendation was developed and included in the Interim Recommendations, and when was this issue addressed in the community meetings. The recommendation to “expand and modify the FQHC concept to accommodate” other providers should be removed. FQHCs are community-owned providers of health care. The Working Group’s recommendation would take the community out of the picture, by removing or watering down the FQHC community board requirement. By having the requirement for 51% board representation composed of persons who actually use the services of the center, the interests of the community and those who actually use the services are ensured. Removing this requirement would open" No response No response No response No response 32334 08/30/06 DC Agree Many American are uninsured and many become unemployed and have inadeuate insurance when they get sick. Agree "Yes, community and health care factilities accessible to all is needed. Having community networks will strengthen the hospitals and remove the burden of overworked city hospital emergency rooms. The current hospitals *should not* be replaced or closed because of the addition of the community facilities. More funds needs to be also added to the hospitals. More staff needs to be added to the hospitals and the community centers needs to be fully staffed. " Agree "* Funding needs to be added to all the federally-funded programs mentioned. Because of the war out veterans need more and improved services. More funds needs to be added for the training of new workers and improvement of work conditions for health care workers. Many current health care workers are stretched too thin because of the very high patient loads and the shortage of health care workers. More training, grants, stipend programs and internships need to be implemented so that people can train in the health care area for employment. The technology needs to be used more in health information so that the public can gain more health care understanding. " Agree "Thes recommendations will assist the patient, the family and the health care workers. Funding needs to be increased for this care to train and provide more workers in this are (nursing home, home makers, assistants, doctors) " Agree "Yes, income or unemployment should not bar anyone from health care." Agree "Yes, it will be difficult but as long as many diverse groups are involved in the planning on the national, state, and local levels along with the business (and small businesses) a workable solution that is dynamic and flexible can be established. I do emphasis it needs to be flexible and able to be changed and enhanced." "These members will need information which should look at the the current health care situations and include information, advice and comments from the current providers of area health services, hospitals, doctors, fire and police departments, etc. and include the homeless/homeless shelters and nonprofit groups helping homeless/lowincome/unemployed and families. A way should be made to make sure that no one group is controlling the group and that it is operated in a democratic way." 32336 08/30/06 WA Agree "* While this is all very nice high-level wishes, it's merely a shell. These reccomendations offer no real substance or proceedure, and, as such, are meaningless. One of the major topics not addressed here is the staggering cost of perscription medications. Compared to the number of people in hospitals for proceedures or recovery, the number of Americans being bled dry by artificially high pharmecutical costs is crippling the health care system by forcing people to choose between a confusing number of plans that will never be 'fair'. " Agree "Completely agree. Simplify, simplify, simplify. The system has grown into a morass of responsibilities and accountibility, and it needs to be untangled and reorganized to improve efficiency, transparancy, and reduce costs. " Agree "* I have had this idea myself. Expansion of existing services could work very well, but INTEGRATION is of the utmost importance. There is something very wrong with the national system right now. Because of my family connections to the military medical institution, I am aware of a system called ""CHCS"", probably meaning ""Computerized Health Care System"". Ask around at Madigan Medical Center in Washington state if you aren't aware of it. It is a good idea, but it is a show of the amazing WASTE present in the system. Millions of taxpayer dollars have been thrown at it, and the people in charge of it keep supporting it even though the doctors, nurses, and most importantly, THE PATIENTS are upset with it. I am sending an e-mail to the given address, to outline the problems with CHCS and how it would be far better implemented. With luck, I might be remembered and contacted to do what I want to do: help people." Agree "* More funding is necessary. However, this reccomendation is far too vague. As is, it would result in gross corruption as seen in the 'rebuilding' effort in Iraq or even the areas hit by Hurricane Katrina. We cannot allow our eagerness in implementing policy to advance as a blank check, no matter how beneficial the end result. End of life care needs a great deal of consideration. We will all grow old, and the unfortunate majority of us will become a financial burden on our families, who will be To this end, we need to provide better incentives for people to enter end-of-life care occupations, establish age-discriminatory low-tax zones for development of adult living communities, and take the burden of insurance off employers while somehow incentivizing pensions/improving the national pension plan." Agree "This is a very broad message. Very 'feel' good. Easy to agree with. Problem is how to provide it to Americans (homeless, impoverished, children of illegal immigrants who are American Citizens) who do not have an existing record. " Agree "* Taxes will need to be raised, wasteful spending will need to be cut. We cannot, as a nation, continue to allow our debts to accrue. Unfortunately, this means that we cannot rely on a Health Care finance bill. We need to drastically recast the national finance system, prevent unchecked earmarks and add-on spending, stop no-bid contracts, and reexamine national tax code to make our system solvent by eliminating loopholes and shelters that reward those who should be paying the most because they have, by virtue of the opportunity that our great country grants, become very successful and wealthy. The above will never come to pass without a drastically different political atmosphere and greater public involvement in government. Money talks, and that's the problem. Both parties are going to crush measures that will cut off their major contributors (Pharmecuticals, military, HMOs, insurance, corn...) from taking our money. A finance bill for health care won't suffice. The only option, therefore, is to " "As long as the group is non-partisan and transparent, I see no problems. However, if the group falls prey to religious reasoning (abortions, stem cells, 'day after' medication), I would very strongly object. But this isn't going far enough. There needs to be a way to insulate this group from the whims of congress without making them untouchable. " 32339 08/30/06 NC Agree Disagree "Federally Qualified Health Centers as currently established have an incredible track record of providing high quality and cost effective care in a culturally sensitive way. As a physician working in such a center, I worry greatly about expanding the definition of clinics who can receive support. Such broadening of definitions would threaten to dilute the power of community health centers. Instead I urge increased support to expand capacity for FQHC who have proven track records." Agree No response Agree No response 32341 08/30/06 WA Agree "I think this should be PUBLIC, not private, and that way the government will be able to use its power to ensure affordability. We need to avoid the pitfalls of Medicare D, in which we gave away the store to the drug companies. " Disagree "I am very nervous about the ""public-private"" idea, given what was done on Medicare D, in which the public pays but the private sector (in this case, the drug companies) set prices as they please. Why can't this be more like the regular Medicare/Social Security programs?" Agree "We will also have to fund it adequately. If this is ""double-talk"" for cutting more out of programs, I disagree." Agree "Pain management should be a very big priority. We should also follow the Oregon model and allow physician-assisted suicide as one option. Often people don't use the option, but are comforted that it is available. The combination of the last two items would make a HUGE difference." Agree "This should be done by the government, not by private interests, except for select non-profits. Even within the private sector, non-profit organizations such as Kaiser in California are so much superior to for-profit models." Agree "* I am willing to pay more to ensure that all get health care. However, I do not want my money to go to greedy private interests to raise their stock prices or pay their outrageous CEO salaries or freebie trips for doctors to sell product. We need to use the government's power to negotiate, so we don't have another Medicare D debacle. Also, there must be effective oversight (apart from partisan political interests and private money interests) of all programs so that the money is spent wisely. Of course, one way to save a great deal is to emphasize preventive care, so that people don't end up in emergency rooms. If all had healthcare, this would be more likely. I would think also that a small co-pay would be good (waived for the poorest) so that people chose to use the system appropriately." I am concerned that lobbyists for the drug companies and other private interests could derail the process as they did with Medicare D. We would have to be VERY careful how we do this. "I think the publicity for this poll was inadequate. If I hadn't heard it on my local NPR station I would have missed it, and it also requires a computer, so many people can't respond....there must be a way to get more complete responses to this. Also, sometimes it was difficult to respond....I agreed with part and disagreed with another part...I hope you WILL read the comments!" 32342 08/30/06 RI Agree Agree Agree Agree Agree Agree Abolish separate Verterans helth care system and blend into a fully paid HMO/PPO if not covered separately. 32345 08/30/06 TN Agree No response Agree Agree Agree No response 32346 08/30/06 WA Agree "I believe for this is absolutely necessary. And for it to be successful, it must become a nationwide federal government operated plan that includes all Americans. It cannot be operated by insurance companies or private organizations, or be a hodgepodge of different plans operated by the states." Agree "I support this concept as primarily an interim step toward a universal healthcare plan operated by the federal government, more like Medicare of TRI-CARE. But this national initiative would focus upon the critically underserved populations and draw them into the healthcare system, which ultimately could be folded into a TRI-CARE type of system." Agree "Included in this must be an effort to make health preservation and health improvement a priority of both the federal provider and of the consumer. The efforts of both parties must acknowledge that staying healthy or achieving good health is at least as vitally important to all concerned as medical intervention at time of need or even at time of crisis. Good health maintenance results in happier more productive people, as well as less expensive medical care provided in crisis situations." Agree "I agree and maintain that ultimately a national government healthcare system should prevail, and that it should include all needed palliative care, hospice care and other end-of-life services." Agree "I agree and maintain that this must ultimately evolve into a federal government operated plan, not one that is dependent upon insurance companies and employer sponsored plans." Agree "* I believe that we need a federally operated universal healthcare program, a cradle to grave program, without respect to employment, income, or health or any other status, most similar to TRI-CARE and TRI-CARE for Life. I realize it may be a gradual evolvement to achieve this goal, but I believe this must be the ultimate type of system in order to more efficiently, effectively and cost-effectively serve our public. It must not be dependent upon profit-driven companies. For those who are rich and famous and feel that they must have something better than everyone else, no matter what that is, there could still be insurance offered to provide the face lifts, tummy tucks, and other ""designer"" healthcare procedures that marketers will undoubtedly be able to come up with." 32349 08/30/06 WA Agree We have the most expensive health care system in the world already. Agree Thoroughly investigate what other countries in the developed world are doing as far as their heatlhcare systems. Agree "We have a singler payer system already in place, the Medicare deduction. It has a low administrative cost. " Agree Agree Countries with universal health care have a healthier population resulting in lower overall health care costs. Agree Our health care system is in the process of breaking down and no one knows what to do. It also borders on immoral when you hear of people having to choose between medicine and food. 32350 08/30/06 PA Agree Having put twenty years in the defense of our country I beleive every AMERICAN(this does not include illegal aliens} deserve affordable health care. Agree Everybody(AMERICAN CITIZENS) deserve good health care. Agree As long as the government gives back all that was promised to military retirees. FREE MEDICAL FOR US AND OUR DEPENDENTS> I was promised this for TWENTY YEARS< where is it? Agree NONE Agree I think the government should look at and straighten out current and past practices. Agree "I don't make enough to live now, so I'm not one to say anything about finances." "Dental care is another thing I was promised I would have after retiring. Never had any furnished by the government for the last 28 years. Have had none privately for the last 10 years. How's that for government promises..HA,,Ha,," "* If everyone including the government would stop taking care of illegal aliens the us would be in better shape. There should be laws in every state making it illegal for any citizen to furnish illegal aliens a place to work, a place to live, and any other service including medical help(this only if they have the money to pay) The only thing they need is a way OUT OF THE USA!!!!!! " 32351 08/30/06 CA Agree Agree Agree Agree Agree Agree 32352 08/30/06 NC Agree Disagree I am opposed to expanding or modifiying the concept of Federally Qualified Health Centers to allow for governance which does not include governance board composed of a majority of users of the services provided. This is core to a community health center being responsive to the needs of the patients. No response No response No response No response 32360 08/30/06 NC Agree Disagree "I am a CEO of a community health center in N. Carolina. I just came out of a Board Committee meeting this evening. Valuable information and insight was shared in the meeting and much represented the board members experience as patients of the center. Consumer Boards truly defines a medical practice for ""the people"" because they have a strong voice in the decisions that are made for the program. Let us not dismantle a structure that is working for our underserved communities. " Agree Agree Agree A good example are Community Health Centers! Disagree 32370 08/30/06 MI Agree Agree Agree Agree Agree Agree "* I think that all of the above recommedations are a good start. We obviously need a national health care system, and we are already all paying for healthcare costs in this nation-- whether it be by the deficit in spending on the uninsured or underinsured, through pay-outs for those on welfare or the hundreds of thousands of dollars taken in tax money to cover those treated routinely at public hospital ERs for simple health issues. I also think that the national healthcare agency should be responsible for price controls on pharmaceuticals, tests and controls over the types of legal recourse patients can take when in conflict with their healthcare team. And while I think that focus on end-of -lifecare is both admirable and long overdue, I think that no public health system will work without providing far more preventative care-- to that end we must invest more in funding for educating nurses, NPs, PAs, PTs, nutritionists and others who provide direct patient care, as well as raising their wages to finally pay" 32371 08/30/06 WA Agree Disagree "I have had experience with health care provided in a neighborhood for the poor. The clinic's care was substandard, and the doctor incompetant." Disagree "When the Federal government sets policy, I worry. If we take away the medical coverage the congress people voted for themselves, I will have more confidence in their ability and desire to provide fairness for all of us themselves included." Agree Agree No response 32374 08/30/06 WA Agree "We should be a world leader in this area, instead we are an embarassment to our citizens and the world community." Agree Agree Agree "It is appalling how the American health care system simply writes pepople off when they are dying. Other countries have done significant research and have effective patient and family programs. The one thing that is done right is Hospice....the organization and program should be strongly supported so that members can focus on providing care, not on fund raising or struggling to make their monies stretch to meet all needs." Agree YES! Agree "Redirect the monies currently being spent on the military in the war on Iraq to providing health care to all American citizens. It is amazing that we have the funds to invade another country, but not to provide appropriate health care for Americans." The development of an affordable health care system in American should be a top priority along with education and other social Services. 32376 08/30/06 OR Agree "high out-of-pocket medical costs being a relative term, protection should be connected to income. This recommendation should also entail an expanded RBRVS type system for medical coverage, to prevent doctors and hospitals arbitrarily raising costs since they know payment is more certain." Agree no comment Agree "Health education is vital to this. We need widespead community health education, and possibly even incentives for people who successfully quit smoking or get their BMI within healthy range." Agree "Nationalize Oregon's ""death with dignity"" program. End of life care should not focus on keeping the patient alive at any cost; it should focus on keeping the patient comfortable, even if it might shorten their life by a day or two." Agree "Granting that a lot of people who ""opt out"" of our current system are young and healthy, I think ""universal participation"" by itself is likely to help control medical costs." Disagree "I think something akin to the Massachusetts model is a likely way to transition to an effective national system... If you have insurance through your work or as an individual policy, have part of that premium funnel through to the national catastrophic coverage plan. If you don't have such coverage, it's another payroll deduction, or an additional charge on your 1040." "I think the national program should just be a catastrophic cost insurance. Resources and incentives to help people take control of their own wellness is also a great idea, but the critical thing in my mind is that health care costs shouldn't bankrupt you." "Whatever final form the program takes, if there's a way for doctors to game it in order to get higher compensation, medical inflation will remain out of control. " 32387 08/30/06 CO Agree "* I agree that subsidy for the needy is a necessary part of this proposal. But, for the rest of us, to say we should purchase ""the policy that suits their needs"" is a fallicy. I don't know what I need until I need it. Of the policies I'm familiar with, the higher premiums for a low deductible add up to about the same amount of money as the higher deductible with its lower premiums. Pay now, or pay later - what a choice! I guess I can gamble that I won't get sick this year, but other than that, this is an empty choice. Just structure the whole system around income/asset levels. Keep it simple." Agree Agree "This recommendation is very very important. I don't believe that we can ""fix"" the broken health care system without improving quality and efficiency, which go hand in hand with each other. Lack of quality and efficiency is a major cost driver, not to mention dangerous to health and life." Agree "But, everything you say about end-of-life care should apply to health care at all stages of life. This is especially true for your statement that ""payment for providers needs to be less procedure-driven and take into account time spent talking to patients."" I'd add that there needs to be recognition in the payment system that providers also spent time thinking and problem-solving." Agree "* This is the recommendation that will draw the most political fire, as it is very polarizing. The public vs. private debate is already raging, and I don't know what hope there is of compromise. And, I am not sure it is accurate to say there is ""across the board agreement that overall the current health care system has major problems, or is in a state of crisis."" The people who do believe this, like myself, were drawn to attend the meetings and to make comments. But, what about those who didn't attend or comment? This will become a big issue." Disagree "* Cost-control and efficiency are very important parts of the financing picture. But, you are right in that it needs to be done in a transparent manner, based on scientific evidence. Employers are major payers today, so they need to be given choices that will allow them to move out of the business of providing health care without ""dumping"" their employees all at once on the government. I believe that payroll taxes for both employers and employees will probably be part of the financing system. But income tax should not be overlooked since the very affluent should also be paying." "I agree that a core benefits package needs to be established, but I wonder if it is necessary to set up a new group to do this. Could the present Medicare structure be used, or modified, for this purpose?" "Your statement of Values & Principles fails to mention quality of care. I think it should be included. Also, the statement on shared social responsibility should include the thought that individuals have both a responsibility to pay (according to their means) and a responsibility to be good stewards of their own health." 32388 08/30/06 WA Agree Agree Agree Agree Adequate pain control drugs should be provided to patients by doctors when necessary without fear of prosecution. Agree Agree Americans spend more money per person on medcal care than many countries and we are less healthy. I would hope the savings from a new and efficient plan whether a single pay plan from the government or a government/private plan would make health care affordable for all. The recommendations I agree with sound too good to be true.It would be great if our elected politicians would listen to what the people want instead of private interests which contribute heavily to their campaigns. 32391 08/30/06 KY Agree "* The goal needs to be the elimination of financial barriers to care. Shared responsibility by payers (individual, employer, state, local & national government)is essential - it cannot just mean high patient cost sharing. Barriers at the point of service, hi co-pays & deductibles, serve to reduce needed preventative services and drive overall costs higher. I am also concerned about the concept of protection for low income individuals and families - there must not be a two tiered system, or budgetary constraints at time of formation - or in the future - will reduce or eliminate the protection. A mixed public and private system (like Medicare) has the greatest potential to make a comprehensive set of services available to everyone. " Disagree "* The idea of providing high quality coordinated care through integrated an integrated community network sounds good. However, one of the major challenges has been left out, the integration of primary and speciality care or ambulatory care and hospital care. In a system that covers everyone with a high quality comprehensive health care package, the need for separate ""safety net"" programs disappears. According to the latest census figures, those with incomes between $50,000 and $75,000 lost health insurance coverage at the fastest clip in past year. This population group is unlikely to seek and utilize federally qualified community health centers. A patch work system hasn't worked in the past, lets be bold and try a new comprehensive system with everyone in, no one out." Agree "None of these goals by themselves will do much to improve quality and/or efficiency system wide. For instance transparency of costs/charges will mean little to the consumer, whose provider chooses treatment plans, admitting hospitals, and specialist referrals. If these proposed strategies were applied to a coordinated system , as the VA health care system has done, s single high quality system could promote coordination and provide for continuity of care without sacrificing choice." Agree "However, they do not go far enough. The principles and framework for palliative care, care vs. cure, can be applied to many with chronic diseases, and can be appropriate care model for years, not just last few months of life. " Agree "* This is your most important recommendation, and should be achieved by a time certain, no later than 2012. The IOM report in January 2004 suggested a new system should be in place by 2010. Early in the report HCWG talked about shared social responsibility, financial assistance makes me think of a welfare program that leads to prejudice, care that is delivered in a separate/different location and in a program whose budget can be cut when budgets need adjustment. I agree that benefits need to be ""sufficiently comprehensive to provide access to appropriate, high quality care without...financial security, certainly reflects the value of benefits that are broad in scope." Agree "* Linking financing strategies to principles of fairness and efficiency is very important. Financial efficiency must include reducing the paper work overload, administrative waste, sdvertising, and large number of competing and confusion insurance plans. Fairness, requires that financing is based on an individual's ability to pay, not health status.I believe there was a mention of a graduated income tax as a possible source of revenue, though I do not see it mentioned here. Survey participants strongly rejected making people pay more based on health behavior or health status." "* The cost problems in American health care results from 3 main sources: 1) prices for care in the U.S. are too high; 2) administrative costs of highly fragmanted private health care insurance are too high; 3) too many core services are not performed in the most appropriate clinical setting or institution. We must share responsibility for controling costs to develop a socially responsible system. The individual patient, even with better information to comparison shop, cannot be responsible for price cutting. " "* I am disappointed that the Interim Recommendations fo not reflect to a greater extent, the strong support expressed across the board (at community meetings and online) by over two thirds of the respondents, to ""create a national health plan, financed by taxpayers, in which all Americans would get their health insurance"". A strong preference was expressed for comprehensive benefits from which no one could be excluded, and for immediate action - not some indefinate date in the future. The expressions of the public must be given weight that reflects their significant input. Citizens were asked to participate with the understanding that their input would be valued. The new census report on health insurance, 46.6 million or 15.9% of the population uninsured, an increase of 1.3 million from 2004 to 2005 speaks of a need to move expeditiously. This number does not include the huge numbers of underinsured individuals. Please be bold, look to the 2004 recommendations of the Institute of Medicine of the Natio" 32397 08/30/06 WA Agree Agree Agree Agree Agree Agree "Cut defense defense spending. One was to do that is to get out of Iraq. The expenditures on that war are a complete waste of taxpayer money. It was a big mistake to attack Iraq. Regarding the Medicare drug program, start negotiating the price of prescription drugs with drug companies. " 32399 08/30/06 IL Agree "* We should have a public program. When it comes to profit, the population will be seen as a statistic and the lives and health of anonymous individuals will not be a priority, when in fact there is nothing more valuable than one's life and health and the lives and health of our loved ones. The program can work something out to avoid abuse of the system, so that people don't run to the doctor for every little ache and pain. For example, there can be a $10.00 co-payment per office and follow-up visit(s) re. the same complaint per quarter; i.e., for anyone who is not indigent. There could also be a small co-payment per night for any required hospitalization. We have to make sure we maintain the quality of medical services offered; that money continues to go into medical research and equipment, and that health service workers are paid well (but not exorbitantly). Despite what some people would have us think, other countries have shown that National Health Insurance Programs and excellent medical care are " Agree Agree Agree "This is important, especially for people who never had children, and don't have anyone left to look after their needs. An old person or terminally ill patient is not garbage and should not suffer if it can be helped. " Agree Agree 32410 08/30/06 ND Agree "THESE SENIOR CITIZEN'S HAVE AQUIRED AT LEAST A FINANCIAL PROTECTION. NOT ONLY FROM THE U.S.A.,THE MEDICAL PROFFESION CAN AND CARE FOR THESE WANDERING CITIZENS." Agree "PLUS REGULATING THE MEDICAL PROFESION, BY LOWERING EXAMS., THE PHARMACETICAL MANUFACTORS. THERE IS NO REASON AN ELDERLY PERSON WITH ALTIEMERS SHOULD HAVE TO PAY $300.00 PER MONTH FOR MEDICATION!!" Agree IT DOSEN'T CONCERN ITSELF TO CERTAIN PROGRAMS. A CITIZEN IS A CITIZEN. PURE LOGIC EXPLAINS THE DESIRE OF A CHANGE OF HABITS. Agree NOT EXACTLY WITH THERE CHOSEN ENVIROMENT. Agree YOU PAY TO LIVE IN THIS USA & REAP THE HARVEST WHEN THE TIME COMES!! No response 32413 08/30/06 WA Agree Too much disparity in this country between them that gots and them that don't. Mental Health should also be treated equally. Agree Agree No response Agree All medical specialties should also be treated equally. I do not belive non medical providers should be covered as they very often worsen care through lack of knowledge. Agree "New healthcare technologies is a grerat ideal, but very expensive. I do not think an individual provider should be made responsible for these computer upgrades." 32415 08/30/06 NJ Agree I Agree with this recommendation. Agree I agree with this recommendation. Agree I agree with this recommendation. Agree I agree with this recommendation. Agree I agree with this recommendation. Agree "Time, thought and financing strategies, consideration of all segments of this society must be considered." Most interested in the out-come for the high-cost protection and core benefits. What I am hearing still is the disparity between the have and have-nots. But the gap will-not be as wide. Thats encouraging. 32420 08/30/06 CA Agree There should be financial protection for medium income families who share so much of the health care costs and when faced with a long term illness such as Alzheimer's Disease or other long term problems frequently face being impoverished by the high cost of care. I would also suggest a change in the tax code to allow families to deduct costs of such care for income tax purposes. Agree Agree Agree Agree Agree The recommendations are basically sound and hopefully will lead to a better haeath care system for all Americans. Any program should be carefully monitored to protect against fraud and waste to include administration expenses. 32428 08/30/06 VA No response Agree Agree Agree Agree Agree 32432 08/30/06 WA No response No response No response No response No response Agree "This appears to be the most similar to medicare, which is a successful program with very low administration expenses. There are ways to improve medicare, especially the prescription drug plan which preimarily benefits insurance and drug companies. We need a single payer system but there will be much difficulty in the financing of the program. We should study other countries single-payer systems to avoid the mistakes that they have made." 32433 08/30/06 CO Agree We need a universal health care system that can provide quality cost effective care for all Americans. Disagree "We need to do more than just expand coverage within the existing broken system. We need to reorganize the healthcare system for all Americans, eliminating the duplication, inefficiencies and multiple layers of payment and administration of complex, overlapping programs -- to have a single system (that can be a public-private partnership), but needs to be well thought out and broad enough to really make a major improvement in the way health care is delivered in the United States." Agree "Again -- do this within a redesigned, well organized health care system." Agree "Agree, as long as this permits compassionate ""non-care"" as an option, with adequate pain medication that will support a person's choice to let the dieing process take its natural course and not have to be put through heroic proceedures, when not wanted." Agree Yes -- the sooner the better. Agree "It is fine to transition, as long as bringing the disparate parts together into a universal system is the final result." Start now!!!!! 32435 08/30/06 NJ Agree "I think Dental should be included, Because without good teeth this could cause many health problem. Now with a good set of teeth it would reduce many medical problems which are caused by bad teeth. Preventive medicine is a better way to go in the long run." Agree Agree Agree Agree Just As long as they are legal citizens. Agree We can not keep getting people from other countries that do not come into the states without being legal U.S. citizens first. They have children born here in which will cost much more then we can afford. The system will not work and it will go broke. "We only have one( big )problem and that is the People in D.C.(Congress) will not act on this unless there is some pork barrel for his or her area with some other attachment(Bill) to this program. If it was by itself ,it may work." A Healthcare plan should be made so that any person can get the same price rate as a Corp. for his or her family. Today a family cannot pay $8000.00 for family medical and dental protection and feed it's household too. 32437 08/30/06 WA Agree We pay the insurance companies three billion dollars to manage care every years. Get them out of the picture with single-payer health care. Agree Agree Agree Agree Agree Fixing the health care ystem is priority number one and getting my vote depends on it. 32448 08/30/06 MI Agree "* America definately needs a National Health Program. Out of pocket medical expenses should be mininal, with financial protection for low income individuals and families. I have worked for over 40 years and always had health insurance. For the first time in my life I find myself without health coverage due to losing my job and not being able to pay the COBRA premium each month. This is an extremely frighting position to find myself in! Americans need and deserve good health care and the President and Congress should do something about this issue immediately! The incentive should be for the U.S. to help foot for medical students and in return the medical students MUST work in a National Health Program for the uninsured for at least 10 years. This would take the cost of putting themselves through medical school and also reduce the cost of out-of-pocket expenses for the uninsured. THIS GREAT NATION OF OUR NEEDS A NATIONAL HEALTH PLAN NOW!" Agree I agree with the above as written! Agree I agree with the above as written! Agree I agree with the above as written! Agree I agree with the above as written! Agree I agree with the above. I agree with the above. "* Having GOOD health coverage is something every American has the right to (just like freedom of speech). We should not be cast aside because we cannot pay for health coverage, or loose everything we have worked for. 99% of the people needing free health care coverage are not trying to ""scam"" the system. Mr. President please give the American people not just ""GOOD"" but ""EXCELLENT"" health care coverage for all. I believe this can be done and in a way to benefit all Americans. Having good health care coverage is as American as ""apple pie""! Let's start working on this TODAY!" 32449 08/30/06 WA Agree No response No response Agree Agree "* Health care should be not for profit. Insurance companies, managed care compaies, and the like should profit from illness. Furthermore the business model does not really work for healthcare. Since healthcare has been treated this way we have ended up with far too many middle managers. Insurance companies employ legions of people who do not have a license to practice medicine whose job it is to stand between the sick person (the insured person) and their doctor. They frequently do not ""allow"" (do not want to pay for) what the doctor has ordered. Therefore patients do not get the care when they need it, as specified by their doctor and the patient gets sicker. The middle managers and insurance employees are supposed to look out for the corporate bottom line. If corporations did not stand to profit this way, we wouldn't need the mentioned employees and the patients could get the care ordered by their doctors. People who are ill should not have to worry that they will be unable to get insurance becau" Agree 32450 08/30/06 NC Agree I work everyday with people who work hard and are unable to afford health care insurance and their companies don't provide even the basics for them. I would rather pay $6.00 for a hamburger and know the restaurant was providint health care for its employees. Agree "Nurse-midwives already work with vulnerable populations. However, we wont be able to continue this work unless our reimbursement rate through Medicare is made equitable with physicians, physical therapists, physicians assistants, nurse anesthetists, and many others. Providers that are doing the work need to be supported and not prevented from caring for their patients. " Agree "Again, this is fine and good as long as the providers of record doing the work are supported equitably and not blocked by bureaucratic regulations and paper work that keep them from patient care. " Agree Agree "I agree with this as long as all qualified providers are represented. Panels need to incorporaten physician and nonphysician providers, and not use such endeavors to put up barriers preventing qualified providers from practicing. " Agree "Again, I agree with this recommendation as long as non physician providers are equitable represented on panels and among service providers. The evidence supports the cost effectiveness, safety, and patient satisfaction with midwifery services. These practitioners need to be able to practice without the legal constraints currently mandating supervision and reimbursement that is not practice sustainable." 32456 08/30/06 OH Agree Agree Agree Agree Agree Agree 32457 08/30/06 CA Agree With a record number of families without health insurance this country and administration should be embarassed. If not something is wroung. Agree Agree Agree Agree Agree 32458 08/30/06 OH Agree Agree Agree Agree Agree Agree 32459 08/30/06 MI Agree Agree Agree " Improve quality of care and efficiency and decerease costs by greater use & funding of practioners such as Midwives, Chiropracters, Nurse Practioners, Naturopaths, and Chinese Herbalists-they already have an excellent model of care which encompasses health education, disease prevention, health promotion and is patient/family centered." Agree Agree Agree 32460 08/30/06 NY Agree "National heath care exists worldwide to varying degrees of success, but every citizen of those countries has medical attention made availble for them. If we are to be a strong democracy and continue to be a world leader, we need to serve ALL the people. Health is the most basic human right." Agree "* I believe there should a national health care system that a specific unit is clearly respoinsible for, as receives funding accordingly. I would appreciate the idea of standard health to be expanded to incorporate so-called 'alternative' therapies. We need to look to the forward and allow people to explore therapies that apply to their lifestyles. While this may be difficult to decide what should be provided for, there should at least be a certain allowance for things such as Energy Healing therapies (i.e. reiki) and other therapies that are only gaining mainstream popularity. Health care should be equal for all." Agree "The only thing I would add is, again, the importance to provide alternative therapies that may not be included in ""evidence-based best practices."" Other things to be included: a way for the underserved to buy and eat organic products and food." Agree Agree Why do not already have free health care for all citizens? It seems insane that we can have such an antiquated health care system. We need FREE health care for everyone. Disagree "* I imagine the program would need to be funding via taxes to begin with. The Australian system seems to make a lot of sense: ""In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications."" I believe that those with the most money should help pay for those that have not, to prevent a further separation of the classes." "* As I sad before, I believe some very important therapies have not had a chance to be proven (i.e. Chiropractic medicine once was not taken seriously). There needs to be space for alternative therapies and look to the future for therapies that have not yet been unearthed. I agree that Mental Health is just as important as Physical health and therapy should be highly recommened for all people. You should be able to attend any qualified therapist. Also supplements, tinctures, teas, organic products, the like, should be covered." I cannot stress enough to keep an open mind for what is covered and that all therapies are fairly represented. 32461 08/30/06 NH Disagree "* * Financial protection does not only concern low-income individuals, out-of-pocket health care expenses now threaten average-income Americans. Protection against ""very high health care costs"" is a code for high-deductible, catastrophic coverage, a policy supported by the administration. The majority consensus of the citizen-participants is that the system should not endanger ""individual or family financial security,"" cost control by high-deductible health plan equates with inadequate health care. Single-payer universal health insurance with cost control through global budget, and universal pool is the most feasible solution, not perpetuation of a fragmented for-profit system. " Disagree " The expansion of community health centers to serve low-income individuals, especially those who are uninsured, do not ensure that every individual have comprehensive health care. Community health centers serve a very important role, but should not be depended upon as a substitute for adequate health care coverage, as in universal health insurance single payer solution." Disagree "What we need is an expanded and improved Medicare for all. Under this system, global budget will control costs by drastically lowering administrative waste; health planning component will use scientifically proven care and medication; health education, prevention, mental health , dental and long term care will be available to all Americans, with no means test." Disagree "Equitable, accessible, affordable quality care throughout the lifespan is the CRY. Under a single-payer universal health insurance, long term care is available to all Americans, with no fear of losing their savings and domicile at their golden years." Disagree "Comprehensive, appropriate, high-quality care, NOT just a set of ""core"" health care services should be available to All Americans, as in single payer universal health insurance. " Disagree "Majority of the citizens participating clearly prefered an equitable, progressively-funded system of insurance for everyone. " "It appeared that when a distinction is made between high cost protection and core benefits, a red flag for tier system is evident. The high cost protection terminology was not discussed in the group I attended. Universal health care, single payer will cover All Americans with no means test. Most participants believe in this system. " "* The CHCWG who conducted the meeting in New Hampshire was disappointingly and obviously so determined to impose their views on the citizen participants. The framing of questions and the possible choices do not reflect original intent or purpose of this CHCWG. It is quite easy to conclude, based on this experience, that the particular people who will be reporting are proponents of perpetuating the current sick system, and are mouthpieces of the administration or of the insurance industry. I strongly felt they were not really there to listen to citizen input, but to hinder the establishment of a single-payer universal health insurance. " 32463 08/30/06 SC Agree we only want to know that insurance is there to peep us and we donot fall into the dounut hole and explain to us in plain english Agree helping the poor and low income is great so keep up the good work Agree about the cost stay as low as possible as we need that Agree good health is very inportion and we need it Agree every one shall have insurance and dentist plans Agree the plan is great if you carry it out mental health is very good keep cost as low as you can 32464 08/30/06 AZ Agree Agree Agree Agree Agree Agree 32466 08/30/06 WA Agree Everyone can understand this. Agree "The wording of this is way too complicated. Please simplify or you will lose people after the first bullet. What in the world is an integrated system? What is an initiative? I know, but the general public will not react favorably to such bureaucratic jargon." Agree The wording of this is way too complicated. Please simplify or you will lose people after the heading. Agree The wording of this is way too complicated. You have already lost the folks on the other recommendations. Agree Agree "I don't know how the insurance ""industry"" will be integrated. There is that word again." "These are all good ideas but really not clear except to persons who work in the context of that jargon. I have a PhD an my own jargon, barely understood by the public. You need to express the ideas more in the vernacular or nothing will really work to move the recommendations beyond this initiative." 32467 08/30/06 OH Agree There should be financial protection for ALL Americans: middle-class & upper middle class as well as the lower class. With our current healthcare system most of us just need to have one major medical crisis to cause financial ruin for our whole family. Agree I hope you will fully fund this program and not expect all of this to happen with little federal money and too few employees. Agree Agree Agree "ALL Americans must have these core services paid for by our government, and not just a select few. This is only fair. Most of us are only one major medical situation away from financial hardship for our whole family. These core health care services must include preventive health care and ALL medically necessary care. If not, people will put off the costly treatment and the problem will get worse and more costly when it is eventually delt with in the emergency room." Agree "The only way to reduce the rising healthcare costs is through a National Single Payer Health Care System. By eliminating the middlemen, insurance companies, we can eliminate one layer of profit and also drastically reduce the billing paper work. I support a cigarette health insurance tax, and also a health insurance tax on anything that is proven to causes an increase in medical bills over one's lifetime. I am willing to pay HIGHER taxes to support health insurance for all Americans. " "Core benefits must include all medically necessary care. Primary care, hospitalization, all prentive medicine, mental health care, basic eye exams, and basic dental work." "Americans deserve to have health care reform before 2012. We need REAL health care reform before 2012. Please do not let us down. I read 18,000 Americans die each year from a treatable condition because they did not have health insurance. You will be saving 18,000 lives each year by enacting a national health care system for all as soon as possible." 32473 08/30/06 NC Agree "All citizens need basic healthcare and financial protection from the cradle to the grave. I prefer a public/private partnership; private care is too dominated by business and medical stakeholders, government by bureaucrats. Government should set policy but let all types of providers compete to earn consumers' business in a fair market. " Agree "Fully support the integrated public/private community-based networks and centers, especially access to the working poor and uninsured, as long as they provide choices of a variety of providers and health promotion/disease prevention services as well as ""disease"" care. " Agree "Teaching hospitals are good sites, but so many chronic diseases require services from teams of health care providers across the lifespan, choose sites with the best training for multiple healthcare providers as teams. Also include services by all providers in the IT systems for medical records and best practices analysis. Focus on medical residents only will perpetuate a narrow-focus on disease; please expand the vision to healthcare, not just ""medical"" care!" Agree "This is a good start, but care of the disabled & elders, not just end-of-life care, needs to be restructured. Community-based care is fragmented, over-regulated, and poorly funded. Shift the focus to individually chosen services that enhance quality of life. Get the heartless business community to recognize sandwich generation dilemmas!" Agree "Yes, with the emphasis on health as lifelong, not crisis focused." Agree "Efficiency and quality improvements do not necessarily mean effectiveness, the right outputs. The current system focuses too much on efficiency and not enough on effectiveness of a system built around teamwork among multiple providers. Replace the principle of ""efficiency"" with ""effectiveness""." "Glad to see ""mental"" in the usual diad of services. I have reservations about defining ""health"" in terms that suggest only historically ""elite"" providers, not consumers or providers who no longer wish to build a system around a cartesian view of body/mind dualism. Of course physicians and dentists should be included, but consumers do not divide themselves into their body, mind, and teeth. Be sure you have people who see persons as wholes, not parts, on your non-partisan group. " "* Yes. I am a professional nurse familiar with the system changes (and abuses) of the past 60 years. I have a PhD in nursing systems and health care administration. I am also a Republican supportive of this administration. However, the ""safety"" system you envision is still too dominated by the past illness/disease focus, and not visionary enough about health promotion and quality of life. Please move beyond the ""medical system"" view to a truly person-centered ""health system"". Control needs to move from physicians and big business to consumers. The new system needs to provide teams of healthcare providers who all answer equally to consumers. The core will be nurses and doctors (medical or dental), but the current power structure is not serving well. Level the playing field for competition but set policy that covers all citizens. Recognize all disciplines as providers within the funding streams, and let the consumers decide what team of providers is effective for them. Last but not least, don't limit the outp" 32474 08/30/06 PA Agree Agree "I worked for a health care faculity.One of their Doctors still practices,while this facutily knowingly agrees the high spread of MRSA and VRE,thru his practise.I questioned the CEO at a meeting in front of 300 employees.Why do you alond this knowing over 75% of his patients had,or have contracted these disease,while at his practise.Answer he brings in revenue. I have contacted the CDC,I stand alone.Darby,Pa in swinning with these two diseases.The answer they'll get MORE FEDERAL FUNDING." Agree Only if someone is there to over look the crooks Agree I knew many families with no support system. Agree No response ".Where I worked,The records have to be look at.12 CEO's in 9 years,ccu open and closed,geriatric phyic,open and then closed.Funding for peds,and then closed.No soap for 3months to wash PT's with,pillow cases used for towels ans wash cloths.Vents that don't work,going off for no reason,complain until your blue.Answer a PT dies blaim it on the nurse,the vent never went off.If the goverment is going to help with the funding,whom is going to over see it?OSHA call the hospital ahead of time,just to let them know WHEN they will be inspected.I conplained know one listened.It is suppost to be a spot inspection." 32475 08/30/06 WA Agree We (in the U.S.) are way overdue. Agree Too many people are using emergency rooms for primary health care services because they have no other options. This detracts from trauma centers being able to function as they were designed. Community health care providers serving vulnerable populations would help alleviate this situation. Agree Especially if these programs help bring down the high cost of health care. Agree This would be a great relief to those who are terminally ill as well as their families. Agree It's just good sense! No American should be without healthcare. Agree "We are a very wealthy nation, surely there must be a way to devise a financing mechanism for health care security that is fair to everyone making a contribution. " I believe the evidence based science concerning core benefits should be arrived at from a consortium of unbiased and objective participants that have no overriding financial interest in the outcome. I think it's about time we took a systematic approach to figure out how all Americans can be provided with health care coverage. 32477 08/30/06 NC Agree Absolutely! Agree Excellent idea! Agree Yes! Agree Absolutely! Agree Without a doubt! Agree "I agree with the ideas stated in the 4 paragraphs above. (e.g. Financing strategies should be based on principles of fairness, efficiency, and shared responsibility and should draw on dedicated revenue streams such as enrollee contributions, income taxes or surcharges, “sin taxes”, business or payroll taxes, or value-added taxes.)" Sounds great! 32478 08/30/06 PA Agree "I think it's a good idea, especially since uncle Sam reneged on my earned Free care, after serving for 20 years in the military" Agree No comment Agree Good idea. Agree No comment Agree "Great idea, please support this recommendation fully" Agree Sounds good as it is. No comment. "None, it's all good." 32479 08/30/06 NY Agree We need to include protection from high cost nursing home care for the elderly and disabled. We need a way so people do not have to impoverish their spouse or lose all of their hard earned assets so they can receive needed care. Disagree "This sounds as though the low-income will have a different system of health care than wealthier and I cannot support that. Everyone should have access to comprehensive coverage. We do need ways to reach the vulnerable, so integrated networks may be good but only if all have access to the same comprehensive coverage." Agree "* Some of these suggestions are good, but the point on consumer cost-sharing seems to imply the use of health savings accounts or high deductible plans. If the goal is to use evidence-based practices in health care than the evidence has made it clear that HSAs do not lower health care spending and it is completely ridiculous to imply people use health care unwisely because they do not know what things cost. Health care is not the equivalent of shopping for a new toaster and the whole consumerism concept should be put to rest. The government programs are very good with one exception--they exclude coverage for abortion, even in cases where a woman's health is in danger. This is simply cruel and is not a good model. Insurance should not be a means by which some impose their values on everyone, especially when health is at risk. " Agree "This is good a recommendation, but we should also work to ensure that more people make out advanced directives. We should never see another situation like the Schiavo case where politicians and crazy zealots interfered in a private family decision. " Agree "* This is important, but it is important to define what is affordable. I am considered middle class and in a health plan now with $25 dollar co-pays and then tiered co-pays for medicine. My salary has not increased at the same level as the increase in local taxes, the rise of prices, gas and heat. I can no longer access any healthcare because the co-pays are unaffordable. I am a single mother and I have only $45 a week to feed me and my son. If I went to the doctor, it would come out of my food budget--so if I went to the doctor, we go hungry, this means health care is just out of reach. " Agree "There is an optimal health care financing mechanism--the public comments made it very clear that the American people want universal health care financed by taxpayers. It is time that insurance companies stop raking in huge profits at the expense of people's health. Every year, my premiums go up, coverage is cut and all the while the insurance company is reporting record profits that increase by the double digits every year. This is simply wrong." "* Every persons should have comprehensive health insurance--we should not have a two tiered system. Vision care should also be part of insurance coverage. Also, it is particularly important to me that a comprehensive range of services used by women are included in any package. For too many years birth control has been excluded from insurance. Coverage must also include abortion. We should not use health care as a way to impose one religion's moral teachings on others. I read the comments of the US Conference of Catholic Bishops and I think they are incredily intolerant and offensive. How dare they attempt to impose their teachings--which not even most Catholic women agree with--on the entire nation. I am Catholic, so I feel I have a say in this. This is religious intolerance at its worst and it has no place in a diverse country. While I know this is a divisive issue, medical decisions should be made by the individual not by politicians or churches, so include coveage and allow people to make their own privat" 32488 08/30/06 CO Agree Agree Agree Agree "Having just experienced the agonizing process of my mother's death, I think this phase of health care is crucial for all Americans." Agree "I have experienced life as a single mother with and without health insurance. I can assure you it is a matter of life and death. I know that uninsured people with no access to health care get sicker and die younger than insured people. This is criminal, especially with our level of knowledge and our national wealth." Agree It sounds reasonable. Good work and keep on advocating for these reforms. 32492 08/30/06 OH Agree "very high out-of-pocket costs and ""low income individuals and families"" are very subjective terms. There should be financial incentives to seek out early care so that illnesses do not become catastrophic, e.g. no deductibles for antihypertensives, statins, diabetes supplies, vaccines, cancers screenings, etc." Disagree "This structure adds far too much complexity to the system. Patients should be able to seek out the psysicians they want to see. Market forces would determine which providers would ""win"" and which would ""lose."" In this way provider network would remain private and competitive rather than establishing another socialized medicine network. The VA system is already our country's system of socialized medicine." Disagree "As with statement #2, this part of the plan promotes socialized medicine as a ""safety net."" I do agree with many of the statements in the subheadings, but this need not be done by expansion of federally funded health centers, expansion of Tricare, etc." Agree Agree "A single payer system would make the most sense to achieve this goal and ensure that all people have access to the same primary and specialty care, medications, and diagnostic and therapeutic services. INsurance companies could still exist, providing coverage for non-formulary medications, experimental terapies, cosmetic services, etc. " Agree "Everyone should be required to pay their fair share, businesses and individuals alike. ""Sin taxes"" would promote healthy behavior, esp. taxes on tobacco products, just as gasoline taxes promote fuel conservation and drive the market for fuel-efficient transportation. In any event, the taxes should be easily understandable and transparent to the citizens of this country, and money earmarked for the health care system should be used ONLY for that purpose." "* I would loathe having for-profit payers as part of the group. People with the proper financial skills will be a necessary part of the panel to avoid uncontrolled spending, but the core group should be conmprised of physicians, nurses and consumers, perhaps via representatives from the American Medical Association, the American Nurses Association and Consumers Union. This would place our health care system back into the hands of health care providers and patients, albeit on a systems level rather than the way our cottage industry health system has operated in the past." "I would suggest the country's system be administered through a single payer based on our current Medicare system. To avoid confusion with current Medicare, Medicaid, etc. I woudld suggest calling the new single payer ""AmeriCare."" " 32493 08/30/06 CO Agree Agree Agree Agree Agree "When we put the focus on 'what is in the best interests of the patient' first it will always be glabally cost effective. When, on the other hand, we put the emphasis on cost containment regardless of the patient's needs, we will inevitably lose." Agree This is going to be a hard fought battle with the insurance lobby. "We cannot continue to equate the value of human life in dollars and cents. Nor can we continue to allow an industry who's goal it is to make a profit be the deciding force as to whether a treatment, medication, etc. is ""necessary"". Not much is ""necessary"" if it is going to affect your bottom line. " 32494 08/30/06 CA Agree "* Yes I believe we need a national health care program that covers all aspects of coverage dental,vision and general health. Even if you had to pay a small percentage each month to have it. I have a 15 year old daughter and have been on workers comp for almost a year and have no insurance at all for myself or my daughter. Some thing needs to be done to help all people in the US The cost of medical or I should say the deductible is just outrages and prevents me from having it or using it because they want all the money up front for prescriptions which most people can not do." Agree Agree Agree Agree Agree "* I basically agree with all the comments above. Being 48 years of age and not having health insurance is very scary. I live in a rural community where help is hard to get. I also believe we need to look into some of the laws regarding Medical. Currently I live and rent a room from my ex-wife I pay rent and child support on a monthly basis and applied for medical for my daughter and myself and was told I had to include what my ex-wife made monthly also. We are legally divorced and this should have no bearing on anything at all, we live our own lives and in order for us to survive in today's world you need to do things that are in the best interest for your children and not always your self. Because of this I do not have medical at all and the share of cost is so high for my daughter it is not worth it.It makes it even harder since I have been out of work due to an injury and am no longer employed " 32495 08/30/06 WA Agree "I am a registered nurse. In my work in health care, it is obvious to me that lack of health care coverage can be a matter of life and death, due to increasing lack of access to health care by many of our citizens and due to the increased impoverishment of citizens by inadequate health care coverage." Agree Agree "We need to put provide quality of care for citizens in all parts of the country...evidence-based best practices are a critical element of issue. Money spent on health education and disease prevention and family planning will save our society much bigger bucks in the long run, not to mention the increased ""wealth"" of having a healthier society." Agree "As an R.N. I have witnessed incredible waste in spending tax dollars in Medicare and Medicaid on costly high-tech care for patients who have little or no chance of survival. We must apply evidence-based best practices to quality care, (which can often be less expensive than the type of care and monetary incentives to use expensive equipment), at the end of life." Agree Agree Basic health care should provide a guarantee that family planning will be available and accessible to all women. 32496 08/30/06 WA Agree "Several years ago I read a comprehensive article by Congressman Jim McDermott explaining how a not-for-profit, single payer healthcare system would work. I believe the three points above can be achieved, but it would have to be with a not-for-profit system. I don't think we could ever achieve the goals listed above with our current for-profit, market based system. Our current system puts MONEY first and WE THE PEOPLES healthcare a distant second." Disagree "Safety net, safety net, safety net....it's just more welfare. I respectfully disagree with the above. I am a very strong supporter of not-for-profit, single-payer, unniversal healthcare. No system is perfect, but I believe our for-profit system has got to go. I can't prove it but I'm fairly certain that alot of people would still slip through the cracks and not have health coverage with the ideas listed above." Disagree "Unfortunately, I had to put I disagree because it sounds like the above points would be executed under a for profit, market based system. The second bulleted item above makes a reference to ""underserved and uninsured populations"". With a single payer, universal system EVERY AMERICAN would have health coverage....period. " Agree Certainly any improvement in this area I support. There are billions of dollars of our treasury currently being spent on the wrong things... in the wrong places. If that could be stopped funding would be there to enhance this apsect of our healthcare system. Disagree "I had to disagree with this recommendation. It state: ""Financial assistance will be available to those who need it"". Hmmmm....again, sounds like the old band-aid routine. With a not-for-profit, single payer, universal plan everyone would have health coverage, whether working or not, rich or not, sick or not. " Agree "Lets see....maybe if we stopped spending billions of dollars on killing people or on figuring out new ways to kill people there would be enough money to help support a healthcare system. Also, I would just refer back to experts who support and understand how a universal plan would work. I know that the HMO's and drug companies marketing campaigns cost consumers $500,000 billion a year.... " "Yes, certainly getting the ball rolling on changing our healthcare system and what it would look like is long overdue. Having said that I also would include providing coverage for Naturopathic care. " "My apologies for repeating myself, but I must once again say that I am a very strong supporter of a not-for-profit system of healthcare. No system is perfect, but clearly our current market based system is on self-destruct. Alot of the problems in our healthcare system would just about vaporize if we had a non-profit system, IMHO." 32498 08/30/06 WA Agree "* Universal coverage should be considered a basic human right. Compared to other industialized nations, the US has failed to provide adequate health care to its residents. Not providing universal healthcare has resulted in greater financial costs as more people are forced to use emergency rooms for care that could have been prevented had they had access to affordable healthcare. As a medical social worker I have witnessed the detriments to resticted healthcare access and the legitimate financial fears faced by low-income families. No one should have to choose between healthcare and food or other basic necessities. This program is long-overdue. I am concerned that healthcare costs will continue to increase dramatically if a private program is adopted as opposed to a public program. Additionally, if this program requires employer contributions I would like there to be accountability for the large companies (such as Wal-Mart) who deliberately restrict employee hours so they do not have to offer healthcare" Agree Excellent idea Agree "As a medical social worker, I agree that there are many ways in which care can be better and more efficient." Agree "When my mother was dying, I was appalled at the way the hospital handled the process. Our nation definitely needs to re-examine end-of-life and palliative care issues." Agree "I agree all citizens (wheher or not they are documented) should have access to affordable health care. I am concerned about the statement ""everyone participates regardless of their financial resources..."" Not everyone has the financial means to contribute - these are the people who go without coverage today. There should be some sort of sliding scale or other means to exempt some from paying if they cannot afford it." Agree Government program to cover all citizens with options to buy supplemental private insurance. "I appreciate the inclusion of mental and dental health. These areas are vital, but often overlooked and not covered by insurance. It is important that evidence-based science and independent citizens be involved in defining the core benefits and NOT religion or citizens with a religious or political agenda. It is important that such issues as women's reproductive health and choices continue to be honored and respected." 32500 08/31/06 WI Agree Agree Agree Agree Agree Disagree 32511 08/31/06 CA Agree The most powerful nation in the world should be able to boast that all its citizens receive health care without loosing all they have worked for and in the case of low income earners without loosing what little they have. Disagree Everyone should be receiving the same quality of health care. The integrated community health network that is being recommended by its very nature creates inequity. Disagree This sounds very similar to the integrated community health network except there is an emphasis on social health programs to facilitate it. The problem is the same however in that the plan cannot help but create inequity. Agree I honestly believe that everyone should receive the same service but in the absence of that this would be a humane alternative. Agree This sounds like the recommendation is close to a single payer health program that is being tried in some states. This recommendation with some work I would find this concept very supportable. Agree "I like this concept. I don't believe that we need to tap as many tax resources as is being recommended here in order to achieve its goals. If everyone contributes the cost for each individual would be less and therefore more affordable to the vast majority. If there is one billing process to one agency the system would have increased efficiency, less waste and it would discourage abusive and fraudulent claims." This sounds very appealing and progressive. I am sure it would not be perfect but I am also sure that it would be better than what we don't have now. 32513 08/31/06 WA Agree "I understand, and there is a researcher at the University of Washington who has researched this, that a country that provides health care for all citizens has better health care outcomes than a country that doesn't. Apparently the perceived net of care provides societal support as well as direct health care. Colloquially speaking, people feel more loved by and important to the society." Agree "One major exception: the ""private"" is a problem. For-profit (such as insurance companies) or religiously-based organizations cannot operate in the general public good as their goals are limited. They should be omitted from any public planning and left as totally optional and unnecessary for good health care." Agree "* Major exception: Privacy and choice should have priority in all cases except where deadly, communicable diseases are concerned: No secret tagging, nor secret studies, nor secret RFIDs. No student doctors for the poor only. No exposure nor selling of personal information. People must be able to control what happens to them and to their information. No compulsory clawing through an unbearable endless bureaucracy to satisfy the needs of controlling gate-keepers or button counters. Respect for people, PLEASE. Religious prejudices against birth control, abortion, or what have you, should be limited to those with religious prejudices, and not foisted on those who think they are hooey. Science rules." Agree "Again, the ""private"" is a problem. For-profit (such as insurance companies) or religiously-based organizations cannot operate in the general public good as their goals are limited. They should be omitted from any public planning and left as totally optional and unnecessary for good health care. Religious prejudices against self-chosen physician-assisted suicide should be limited to those with religious prejudices, and not foisted on those who think they are hooey." Agree All Americans should have single-payer governmental health care and not have to support insurance companies nor subsidize pharmaceutical companies as has occurred with the Medicare fiasco. Agree "* All Americans should have single-payer governmental health care. Not having to support insurance companies nor subsidize pharmaceutical companies, as has occurred with the Medicare fiasco, should cut the costs down considerably. If we can afford to waste billions on killing innocents in Iraq and sending arms and herbicide around the world, if we can give tax breaks to the richest Americans, if we can afford to let corporations go tax-free or off-shore, if we can afford to subsidize gas and oil and giant farms, if we can spend billions of dollars to send men (and women) pointlessly into space while polluting the land and air, if we can afford to propagandize America, Central America, Cuba, South America, and all the rest of the world, if we can afford to fight the ""drug war"" and now the ""terror war"" all around the world, perhaps we could just pull in our belts a bit and do something to provide health care for the poor schnooks that pay for all that waste, death, and stupidity. Publically-financed e" "Again, leave the ""payers"" out of this group, if by ""payers"" you mean insurance companies. We've already paid them enough. Their primary goal is to make profits. Let's not have a Medicare prescription fiasco again. One has only to look at that fiasco to understand that decisions must be made for people, not for profit. Selling the people out for corporate profits only makes people furious, cynical, and depressed -- not good for health. It's expensive too." "Yes: Single-payer -- the government. No special deals for private interests. Privacy, freedom, and choice are essential." 32515 08/31/06 WA Agree "A professor at the University of Washington has researched this and says that a country that provides health care for all citizens has better health care outcomes than a country that doesn't. Apparently the perceived net of care provides societal support as well as direct health care. Colloquially speaking, people feel more loved by and important to the society." Agree "One major exception: the ""private"" is a problem. For-profit (such as insurance companies) or religiously-based organizations cannot operate in the general public good as their goals are limited. They should be omitted from any public planning and left as totally optional and unnecessary for good health care. " Agree "* Major exception: Privacy and choice should have priority in all cases except where deadly, communicable diseases are concerned: No secret tagging, nor secret studies, nor secret RFIDs. No student doctors for the poor only. No exposure nor selling of personal information. People must be able to control what happens to them and to their information. No compulsory clawing through an unbearable endless bureaucracy to satisfy the needs of controlling gate-keepers or button counters. Respect for people, PLEASE. Religious prejudices against birth control, abortion, or what have you, should be limited to those with religious prejudices, and not foisted on those who think they are hooey. Science rules." Agree "Again, the ""private"" is a problem. For-profit (such as insurance companies) or religiously-based organizations cannot operate in the general public good as their goals are limited. They should be omitted from any public planning and left as totally optional and unnecessary for good health care. Religious prejudices against self-chosen physician-assisted suicide should be limited to those with religious prejudices, and not foisted on those who think they are hooey. " Agree All Americans should have single-payer governmental health care and not have to support insurance companies nor subsidize pharmaceutical companies as has occurred with the Medicaid fiasco. Agree "* All Americans should have single-payer governmental health care. Not having to support insurance companies nor subsidize pharmaceutical companies, as has occurred with the Medicaid fiasco, should cut the costs down considerably. If we can afford to waste billions on killing innocents in Iraq and sending arms and herbicide around the world, if we can give tax breaks to the richest Americans, if we can afford to let corporations go tax-free or off-shore, if we can afford to subsidize gas and oil and giant farms, if we can spend billions of dollars to send men (and women) pointlessly into space while polluting the land and air, if we can afford to propagandize America, Central America, Cuba, South America, and all the rest of the world, if we can afford to fight the ""drug war"" and now the ""terror war"" all around the world, perhaps we could just pull in our belts a bit and do something to provide health care for the poor schnooks that pay for all that waste, death, and stupidity. Publically-financed e" "Again, leave the ""payers"" out of this group, if by ""payers"" you mean insurance companies. We've already paid them enough. Their primary goal is to make profits. Let's not have a Medicaid prescription fiasco again. One has only to look at that fiasco to understand that decisions must be made for people, not for profit. Selling the people out for corporate profits only makes people furious, cynical, and depressed -- not good for health. It's expensive too." "Yes: Single-payer -- the government. No special deals for private interests. Privacy, freedom, and choice are essential. Incidentally, it was only by chance that I heard you were doing this. There must be a more comprehensive way to get public input -- if, of course, you want it." 32517 08/31/06 WA Agree Shouldn't the most prosperous country in the world step-up to the plate and offer some kind of protection for its citizens? Agree Agree Agree Agree Agree 32521 08/31/06 WA Agree "* This and MUCH more is needed. I suffered health problems starting about 18 years ago. They prevented me from continuing my profession. I had no health insurance and still don't. I live in poverty, with no prospects, in late middle age. I tried public-health clinics, but they were a joke. I got NO appropriate referral to the kind of treatment (or even diagnosis) I would have needed to be restored to my profession. I have given up and only pray I can hang on and survive without medical treatment. Is this the kind of society America should be? " Agree "OK as a next step. However, to preserve the dignity of every American, we need universal health care that is a right of every citizen." Agree "I agree, but only provisionally -- until we have UNIVERSAL health care, with dignity, for ALL, as a right." Agree Very much agree. Agree "Strongly agree. I, along with many others, have suffered bankruptcy due largely due medical problems. I am now terrified of further problems, as I have no insurance, and no way to pay, and no credit." Agree "Get the insurance companies out of the health-care field as much as possible. They, and the administrative costs, are a HUGE financial drag." 32522 08/31/06 WI Agree Agree Agree Agree "* So many of us are insolated from the experience of witnessing death. It's not right. Many families simply put their trust in the medical profession and leave all of the end of life decisions go until the last minute. Unfortunately, the last minute is usually too late to do what's really necessary. Although a living will isn't what most of us want to think about when our parents become older, it is vital to have it done and done right. I consider my siblings very sensitive to this kind of thing and I am grateful that my elder siblings made sure a living will was done for my mother. However, I was not only surprized but SHOCKED to learn that one very important detail was left out of my mother's living will. Diagnosed with untreatable congestive heart failure, my mother was sent home to be with her family at the end. When my mother began to experience a lot of discomfort and pain, she made a request to receive morphine. Since morphine often times induces sleep, my mother was aware (according to my" Agree Agree 32523 08/31/06 TX Agree "People in this country, particularly our seniors who have worked and paid taxes all their lives, should never be forced to choose between medication and food or shelter. " Agree Agree Agree Agree Agree Preventative care should receive a top priority slot. It's rediculous and far more expensive to wait until a condition has progressed to treat it. 32524 08/31/06 NJ Disagree 1.The Majority of Americans are already covered. 2.The insurance companies need to be investigated for the excessive profits at the expense of polity holders. 3. There are multiple government programs for low income individuals who do not pay anything for their coverage which are paid for by the taxpayer already I.E. Chip etc. Disagree The government should stay out of health care period. Disagree The Governments own reports AHRQ and most recent VA study from Houston Texas confirms along with annalt of Internal Medicine August 15 states that their is no way the government can enforce this with any methods studied Disagree Their is no evidence based medicine. where is the evidence? Agree Health savings accounts iare the way out this mess. It will empower the patient where it should be. Disagree The government should reduce its involvement and add tax credits to Medical Savings accounts if they want this corrected Again keep the government out of health care. Again where is the evidence based medicine? The Government is embarking into a quagmire. I personally do not want the government intruding on my privacy or my families privacy. The government and private industry in the recent executive order is already violating HIPA Laws which will end up in the Supreme Court 32529 08/31/06 MA Agree We need universal health care coverage through a single payor system. Right now we pay way to much for the sub-optimal health care we get. Agree I agree as long as the goal is to work towards universal health care coverage/single payor system. Agree But the goal should be universal health care coverage through a single payor system. Agree I agree as long as it includes allowing people to remain at home whenever possible. We have become a nation that wharehouses its sick and elderly into nursing homes that provide inadequate care. Agree We also need a single payor system. I think we need a national health system like Canada has. President Bush's health savings account plan should be discarded; it's not a good plan and is a distraction from what really needs to happen. Disagree "We need to switch from an employer based plan. The plan should be funded through progressive income taxes. And if you really want to be fair.... that means the income tax structure needs to be made more progressive than it has been over the last five years. One immediate thing that could be done is to get rid of the tax cuts that were enacted by this Administration for those people making over $200,000 a year. " "I checked that I disagreed because this question is seemingly asking so much and yet saying so little. If you really need to establish yet another commission, then is should study how best to implement universal health care through a single payor system like the rest of the modern world already does." "Yeah, your video says you are asking all Americans for their opinions, which is simply not true. I would not have heard about this survey if the blog I read occasionally had not posted it on its site today. So basically, your survey is pretty useless. When are we going to have a real debate in this country about our dismal health care system? A small, highly technical survey is just not sufficient. You also need a selection that says ""I do not know"" on each question. " 32530 08/31/06 MI Agree let's not forget about those who hold down 2-3 jobs and can't afford health care and do not fall under the poverty line. let's not forget the middle class who is really struggling Agree "You have made no mention on the faith based initiative. Why? What about health ministries in every faith community? Parish Nurses are formidable, affordable, and effective in the who health (mind, body, and spirit) outreach of the faith community. I know this because I am an RN serving as a parish nurse--paid full time. If you are serious about this health care changes, you will devote time and money to health ministries in the faith community!" Agree I reiterate--include the faith based initiatives--whole health ministries and parish nurses! Agree "AS I understand right now, hospice care is available to ANYONE, no matter their ability to pay. " Disagree "* ""All Americans will have access to a set of QUALITY core health care services."" I have found in my practice as a parish nurse that there are medical services being provided by substandard doctors, nurses, and care providers. Incentives for whistle blowing should be established to eliminate these fraudulent practitionrs (and I use practitioner for lack of another word at this writing). These fradulent workers order tests (especially those doctors who are visiting doctors) that are needed and then DO NOT PROVIDE FOLLOW-UP! yikes--talk about wasting money--and then disease processes continue, people think they are being taken care of, and then they come to me and I refer them to QUALITY CARE physcians and nurse practitioners. Regarding financial assistance--don't start a payment plan--these folks hardly have money to pay their rent, food." Disagree "Remember, there are people who are working 2-3 jobs just to get by. And don't forget the middle class--there is a struggle. Also, incentives--preventive care on the consumer's part should be rewarded. " "* I only disagree in this: health is defined to include: mind, body, AND SPIRITUAL HEALTH. How does the medical field address spiritual health? Well, if a physician or nurse practitioner would ask these questions--""do you think your current health status is related to a physical, mental, or spiritual concern? If spiritual, is God or a higher power part of your whole health? Do you have a place of worship? Is there a parish nurse there? If not, may I refer you to this place of worship where a parish nurse or health ministry works so that we can work together for your whole health?"" It is time for the medical field to include the spirituality of a person in the treatment of their whole health. A paradigm shift is needed to include humankind's spiritual being and its health which is connected to its physical and mental health. Please include the faith base organizations, especially PARISH NURSING and HEALTH MINISTRIES IN THE FAITH COMMUNITY. We are serving the needs of many sick people, but at the " 32531 08/31/06 MN Disagree "* The drug companies are already stepping up and starting programs to help people be able to afford their drugs. Maybe there needs to more regulations on HMOs so that they actually operate as non-profits like they are supposed to. As far as I know, they profit way too much. Focus on laws that curb the excess pay of officers of companies, or get rid of some of their tax breaks to help fund programs that already exist. Or, find ways to set up charities that provide money to those who need it. I know there are a lot of us out there that would love to support that. Sure there would be abuses, but that is because humans are evil unless controlled by God. If the program was private, I would be willing to hear about it. But I am not for a public program. I have low-income friends who have way better health care coverage than I, a middle to upper-middle class person have. Look at all of the funds that pour in - more than is needed - when people's storeies are broadcast on TV. I think this country needs to be re-edu" Disagree "I am all for the government helping to fund care ub rural areas, if we have the funds. But this network often serves to start treating everyone the same and not allowing people with unique issues to get they help they need on time. They are funneled through this certain path that degrades them physically and emotionally by the time they get the care they actually need." Disagree "* There is no way to have quality care and efficient care at the same time. You can improve one or the other, but not both. They are, in this case, mutually exclusive. The reason I say this is that if you come up with a set way that certain conditions are to be dealt with, there are a lot of people that are going to receive improper medical care that will harm them and then cause an even greater burden to the system than if more time had been taken up front to treat them properly. My grandmother does not like to get painkillers for dental procedures. If it becomes required that dentist give painkillers, my grandmother won't go to the dentist and then she willl cost the system more money than if they would accomodate her unique needs. My son couldn't get proper treatment at a urgent care facility because they were told by there board of directors that they were not allowed to diagnose kids under seven as having a sinnus infection ""because kids younger than seven can't get sinus infections."" Well, thankfull" Disagree Fundamentally restructuring the way it works would probably destroy its effectiveness. I am all for supporting private organizations who are doing this - it is a wonderful thing and much needed. Disagree "* Unfortunately, except for immigrants who understand how good we have it here and are willing to pay anything and work so hard to get whatever they have because it is even possible to meet such dreams in their country, most of us in America think that affordable equals free or next to nothing. Affordable means that now I can afford that plasma tv or to send my kids to private school. I believe that we should have affordable care for those who truly need it, as we do. But too many of us Americans throw our money away on entertainment. Entertainment is necessary and can be very good, but we are addicted to it and will give all of our money to it rather than take care of ourselves through proper health care. Just drive in any area of the US - no matter how poor or rich everyone has the hottest new tv and dvd player. Their house may be falling in around them, but they have top notch electronics. I think that could be a question on determining whether or not you qualify for care - how do you spend your money? If" Disagree "* Universal coverage is a nice idea, but it had better not come from a single payer, or health care around the world is going to suffer. Let's think about that for a moment. Where do the royals from Saudi Arabia come for health care? They are some of the wealthiest people in the world, coming from one of the wealthiest countries in the world. And I believe they have universal coverage in their country. So why do they come here? They come here because we have the best health care in the world. Why? Because it is driven by individuals who can be properly compensated if they work hard to develop new treatments. Does anyone flock to any country with universal health coverage? No. Why? Because the care isn't as good as the care you can receive here. There needs to be a lot of changes here so that more people can afford care. But getting rid of the competition and the drive to create new medical treatments is not the way to improve our care here. It will only succeed in halting medicine in its tracks. If w" "* Hopefully medical treatments will be improving and changing too fast for this board to do any good. I am only willing to support this board if they are volunteers. If they are not, then I do not want them wasting my money on such resarch. What do you think medical companies are doing all of the time? They are researching best practises to see what new treatments need to be developed and how those treatments can make best practises better. Also, they are constantly developing new treatments that create new best practises. For instance, my dad has a heart condition that was diagnosed 10 years ago. At the time, he was treated with the best pracise: drugs first. After months of emotional and physical trauma due to his poor reaction to the drugs, he finally received a pacemaker, which immediately gave him back his quality of life. Several months after he received his pacemaker, it was proven that the best practise of trying to regulate problems such as his with drugs was ineffective and unsafe compared to t" "* Let's find ways to support companies already doing this work. Let's find ways to support provate groups. Please let us not move to a single-payer system. Having worked in companies where a big new ""efficient"" system was put into place to help us work better, I am telling you - there is still room for a lot of human error. Nothing will ever be easy down here because of human error. Let's stop focusing on how we can help the government help us, and see if we can't just help each other. I think people would be amazed at what could happen in this country if they would just give $5 every week to help someone else. That's renting only two movies instead of three. I know there are people who can't give anything, but there a lot of us who could give a ton that didn't have to first go to pay people managing a new program. Let's educate people on how giving can actually make them wealthier. God actually promises that you will be wealthier if you give, not always financially wealthier, but definitely emotionally w" 32532 08/31/06 IN Agree Agree Agree Agree Agree Agree 32533 08/31/06 NE Agree "I agree that coverage for all Americans should be ensured. I do also believe that this problem has reached the status of an emergency, that we should try to solve it within the next two years (no target date is mentioned), and that the government is going to have to play a leading role." Disagree I believe that we should aim for a system of universal care funded by a progressive tax. Disagree "I don't disagree with making health care more efficient, but I think one part of that would be to combine all federal and state health programs, create a universal health care system, and fund it with a progressive tax." Disagree "The phrase ""at the community level"" disturbs me, for it tells me little about how this will happen. Again, it should be part of a standard health insurance packet for all individuals funded by a progressive tax." Disagree "You have somehow ignored the comment that Americans also believe that a national health program should be created. In reality, this means that the federal government must take the lead role in creating and funding this program. Anything else becomes too complex and unworkable." Agree "Health care should be funded through a progressive tax on all income. This would relieve the poor of the impossibility of paying for health care, provide the resources for providing universal health care, make our society more just and equitable, and show the world that when it wants to, America can actually solve its problems." "Please consider establishing some sort of national health care system funded by a progressive tax! It seems the most logical alternative to fixing a very broken system, and it would provide care for everyone." 32534 08/31/06 NC Agree Agree Agree Agree Agree Agree 32535 08/31/06 NC Agree Disagree "* The President and Congress must continue to expand the EXISTING COMMUNITY HEALTH CENTER-FQHC program into areas devoid of such access to healthcare services. THE EXISTING FQHC program is establilshed, stable, proven. It responds to local needs due to the requirement for consumer governance - VERY IMPORTANT! I would urge the President and Congress to follow the age-old advice ""Don't fix it if it ain't broken"". ""MODIFYING the FQHC ""concept"" and opening the door to other entities fragments and weakens the FQHC model. The fact is that FQHCs across the country can and will reach more of the uninsured/underinsured if resources are made available to do so. Thank you." Agree This is great as long as the attempt to promote technology and efficiency does not result in a reduction of the resources available to provide direct care to patients. Agree Agree America's FQHCs are the model for just such a recommendation. The program requires resources; annual base adjustments; capital investment. Let's continue to improve on what is working and not go off in another direction which we have seen happen in the mental health system...to the detriment of patients. Agree 32536 08/31/06 CO Agree Please keep in mind that there are those who currently do not qualify for either Federal medical care program who would not be able to anything in the example given and that the program must be set up so that the lowest paid workers are able to fall into the program. Why continue to use the Federal Poverty level? Why not use a sustainability level? Agree With the proviso that the private networks be non-profit so that they do not work with a motive at odds with the public networks and that the public networks are sufficiently funded to do their work well for the people that they are meant to serve. Agree "* A couple of points here: 1) evidence must be obtained on all populations in order toserve them well. Therefore, research must be well-designed and ALL clinical trials must be registered so that patients and clinicians can find them in a registry to find results, good or bad; a better job must be done of including diverse populations in quality trials and studies or evidence will continue to be absent. 2)I continue to have grave concerns about privacy regarding electronic medical records; in addition, med students must be taught to communicate with patients about their conditions far better than they do now and patients need access to their health information, including test results - REMEMBER that not everyone has access to computers in their homes!" Disagree "While I believe this is an important part of health care, I do not see it as a priority. I am a cancer survivor and will most likely at some point be in a situation of using these services; this seems like a PC recommendation - no need to break it out - it is part and parcel of health care!" Agree I sure hope these recommendations aren't in any particular order - this should be at the top of the list. Agree "One of the major issues I see facing us in restructuring the financing of the system is an about face in the expectations of many physicians/specialists and insurers (companies) who have historically made inordinatley high incomes with our privately based system. In those countries having pubicly based systems, docs do not earn $ at the same level as here; therefore expectations are completely different. If we were to go more publicly based, docs would have to change their thinking completely." Why is visual not included here? Generally it is not included in health care coverage except as an add on and it should be included. "* I am co-founder of a non-profit organization in Colorado that provides sustained non-medical financial assistance to breast cancer patients in treatment. We cover housing, food and groceries, utilities, transportation, child care, and health insurance premiums. Why? Because we know that patients DO lose their homes without such assistance; patients are reduced to eating Top Ramen while in chemotherapy; patients are known to have to send their children to live elsewhere because they can't afford to feed them; because we know that if you lose your health insurance once you've been diagnosed with a devastating illness, it will be hell to pay to get another policy (especially if you are self-employed); and finally, because we don't want to hear of anymore women who delay treatment because they fear any of the above. That, too, happens. We've got to fix things." 32537 08/31/06 PA Agree Agree Agree Agree Agree Agree All should have a co-pay policy when applying for medical treatment and that means ALL people should shoulder some responsibility. "If you intend to have a contnum of physicians, then they must be compensated fairly and pharmaceuticals must be made more affordable ast rthe source, that is at the manufacturing level. Thje govt. should use its buying power by getting bids on the products and then they distribute to providers." 32538 08/31/06 NC Agree I am one of the working poor. We suffer without health care as we have to choose between food or the doctor. Agree Agree Agree Agree I have gone without care for many years. That goes for dental care too. I have lost teeth due to the high cost of dental care. If I cant aford to get a cold treated how could I afford to have my teeth taken care of. Its a crime that millions of americans have to loose thier teeth because they cant afford even basic dental services. Agree This would be wonderful if the government would not botch it up like medicare please help us have access to reasonable medical and dental services. Dont let us fall through the cracks. 32539 08/31/06 WA Agree Agree Agree Agree Agree Agree 32540 08/31/06 CT Agree Needs to be a public/private partnership to keep costs down. Medicare and Medicaid waste far too much. In addition their expenses to fight fraud just barely touch the surface. Massachusettes like plan needs to be pursued Disagree "In practice, sounds like Big Govt taking over healthcare. How will this be funded? Taxes? based on Medicare and Medicaid track records, I don't support Gov't sponsored healthcare in the US. Even the military, who now contracts for healthcare, does it at a high cost - which threaten funding to cover personnel costs and new weapons/equipt" Agree Agree "i have concerns with the third bullet regarding ""community level funding"" of care individuals/families ""want"" for last days. Too broadly stated, with no spending caps indicated or sources of this ""community funding"" If the goal is to remove financing barriers to allow patients to die with dignity in familiar surroundings, then the recommendation should be worded to state that." Disagree "So healthcare is an entitlement? Who determines that ""affordable"" is and what services are included? Also, in light of the current immigration debate, what is the definition of ""American"" in this recommendation?" Disagree "As written, sounds good but is it really possible. Non-partisan? No politics in identifying what will/will not be covered? I just don't see it happening in the American culture. Sad." 32541 08/31/06 VA Agree Agree Agree Agree Agree Agree 32542 08/31/06 VA Agree "We see every day the devastation that comes from not having health insurance, not just to a persons health, but to their economic well being as well.F" Agree "FQHC's have a long history of providing low cost, quality health care and should be at the forefront of a national movement to expand access." Agree We are currently seeing 61% uninsured in our two sites and these recommendations would help us in further maximizing the most from our already strained resources. Agree "This is so important. We have had patients who, because they were uninsured, did not have many options for pallative care. This impacted not on their family, but their own peace of mind and their dignity. Everyone should have positive options when they are facing the end of their life." Agree "This is so important. A person should not have to die from a disease, such as breast cancer, because they do not have access to health care." Agree "If we don't begin, we will not reach a goal. It is past time we began to implement a health system that will insure all Americans have access. It will be on ongoing process that will require change, patience and flexibility." 32544 08/31/06 VA Agree "See ""additional comments""" No response "See ""additional comments""" Agree "See ""additional comments""" Agree "See ""additional comments""" Agree "See ""additional comments""" Agree "See ""additional comments""" "See ""additional comments""" "* The Virginia Catholic Conference (VCC) is the public-policy representative of Virginia's two Catholic dioceses. The VCC supports an approach to health care based on the principle that health care is a fundamental human right. That right springs from the inherent dignity of each person, which stems from our creation in the image and likeness of God. The availability of health care should not depend on a person’s employment situation, socioeconomic status, citizenship, or any other extrinsic factor. The VCC believes that government has a key role to play in the provision of health care to everyone living in the United States. Federal and state governments, along with the private sector, should support a health-care system that will meet several criteria to ensure that the system protects society as a whole while also emphasizing the needs of particularly vulnerable groups. The current U.S. health-care system does not achieve those results, making significant reforms necessary. The criteria for the" 32545 08/31/06 WA Agree "I agree with the concept, but not the proposal for implementation" Agree "The current community health clinics are underfunded and understaffed for the number of patients trying to access the system. Getting appointments for basic preventive health care, such as well child exams for young children, is challenging. Dental is even worse. If these are expanded, they need to be appropriately funded to meet the community need." Disagree "The programs quoted above are not examples of quality and efficiency and I thoroughly disagree with the premise that this is the way to imprvoe quality of care and efficiency across the entire health field. All of these are notoriously underfunded. Doctors refuse or limit their patient caseload of Medicaid and Medicare due to unreasonably low reimbursement rates. The military system is slow, inefficient and poor quality." Agree The aging baby boomers will swamp the current system in the near future. Dying is universal and should be handled with dignity and care. Agree "The challenge is how to assure that this access if quality and is truly Goal is good. Vision of implementation is poor. It is still an ""insurance model"" in which the private insurance industry will still drive our access to care. I was hoping for something truly different. " Agree "This whole proposal still revolves around an ""insurance model"" that places the burden on the individual. Did you look at countries that have universal health care access and see how they did it? This is still the same approach wrapped in a slightly different package. It continues to label the poor and the rich will still be able to do what they want. There is no innovation here." I am disappointed in the recommendations for implementation. I agree with the stated values and goals. This is still an insurance package and it still separates the poor from everyone else. "* I am an executive director of a program that works with poor families and their children. I just had to drop health insurance for all employees working less than 35 hours/week because the insurance company requires 75% participation rate, 75% employer contribution to premiums, and other requirements. I want a system that doesn't differentiate the poor from the non-poor. Poor people shouldn't have to go to community health clinics while middle class go to private doctors. This recommendation truly misses the boat of universal care that is delivered without discrimination and labeling." 32550 08/31/06 MD Agree It's about time - now do something! Agree Good plan - now implement it. Agree Agree Agree Let's see how the plan in Massachusetts is working. Agree Tax the health insurance providers. 32551 08/31/06 OR Agree Agree Agree Agree Agree Agree "* The Work Group has done extraordinary work. Your effort is the most inclusive, transparent, thoughtful attempt to change the direction of US health care yet attempted. All of the pieces of substantive reform can be found in your recommendations. My only suggestion is that you consider putting more emphasis on the tradeoffs that must be made if the health care industry is to be ""turned around."" Quality improvement, benefit design, application of technology can result in dramatic improvements in efficiency and substantial changes to the industry business model leading to significant savings. The savings from those changes must be applied to reducing costs to public, private and individual purchasers. Expansion of the health care system such as you have proposed with universal catastrophic coverage and expanded safety net systems is sensible but realistic only if Americans confront the changes needed elsewhere to reallocate resources. In our private lives we all make such reallocation decisions on a " 32553 08/31/06 CA Agree Agree "Here is an example: I was employed 31 years. Laid off. I cannot collect retirement for 2 years. Interim - can collect cobra, BUT, because I was laid off, I will not be allowed to ""pay"" for medical benefits with my prior employer's group health care programs, because I was laid off. There should be a Federal ""stop-gap"" legislation to prevent this type of Money-saver benefit to an employer!" Agree Agree Agree Disagree "There are enough groups already within the gov't to moniter, find an existing group to do the monitering, do not create more beauracracy." 32554 08/31/06 IA Agree Agree Agree Agree "Traditionally, most health care dollars are spent at the end of life. Hospice care is a right and people should have the choice to discontinue extensive treatments to avoid extravagant expenses." Agree Agree Mental health should be covered by insurances. "As boomers age, a strong voice will be heard from them as expectations will be high. Wellness will become a larger issue." 32557 08/31/06 TX Agree "I strongly encourage having a system that allows patient's choice, not a single vehicle to accomplish this goal." Agree "There must be some way to involve physicians in these efforts in a way to assure that citizens have access to that resource. Currently they can not opt to not particiapte in the broader community service, if it does not pay." Agree This recommendation needs to be implemented in such a way that honest providers are not overburdened by paperwork/red tape in an effort to weed out fraud. Agree "This is a criticial element in that much of current care is delivered in the last months of life, some of that providing care that is futile. Clear, evidence-based practices should guide the treatment and aid in appropriate choices." Agree Agree Universal coverage should not necessarily mean it is government-run. I support citizens' having a choice. "Mental disorder is truly an area that needs focus for provision of needed services, so I strongly support this recommendation, particularly that aspect. " 32558 08/31/06 MI No response No response No response No response No response No response "* It is the last day for comments and I couldn't let it pass without one. It would be a failure of the good work of this effort and it's nobel intentions if it continues to fail to acknowledge the cost, waste and risks created by our fragmented, multi-payor system. The people spoke loud and clearly in the forums and meetings that they are ready for a national health insurance program. To fail to acknowledge this strongly will make this large effort another failed one with little likelyhood to be of any lasting benefit to us--the people. It has been well studied that to cover all Americans we have to clean up the enormous over-head costs of the current 'system'. We can have great health care for all, affordably, if we acknowledge the data and call for a national single payer system. To fail to honestly report on this data will again make this entire effort mostly futile. To rely on continuing to 'patch up' our failed health care system with means tested 'safety nets' is a demonstrated cruel and undigni" 32561 08/31/06 MA Agree "However, health care should be provided through a program of universal health care, not simply a program of health insurance. So long as insurance is the model, then the companies providing that insurance will benefit ahead of the people who are covered." Agree Agree Agree Agree "Again, if health care is provided through a universal health care system that is not insurance based, then financial assistance is no longer an issue. Access is not enough; each American should be able to receive all non-elective care, preventative and otherwise, by right. No one should have to rely upon carrying an insurance card to ensure that they can receive care." Agree "When people and employers no longer have to worry about purchasing health insurance, one of the largest expenses and drains on the manufacturing and service economy go away. Whether it is through a combination of income, payroll or value added taxes, collecting a part of those savings should be sufficient to provide universal care." "The public-private group, however, should not include any private organization with a specific financial interest in a particular approach, i.e., insurance companies who would benefit from maintaining an insurance model." 32562 08/31/06 OH Agree The goal needs to include removing financial barriers to health care. A national program also should combine public and private elements - not either/or. e.g. Medicare combines private delivery with public coverage Agree "The integration and coordination has to be REAL - between ambulatory care and in-hospital care, between primary care and specialty care. " Agree The 5 areas included in this recommendation have to be integrated - not be limited as stand-alone goals Agree Don't limit this to palliative care - which is very important. The principles need to apply to EVERYONE with chronic diseases. Agree "This recommendation depends too much on a ""market approach"" to affordability i.e. ""consumer-usable"", ""information on prices."" PUBLIC POLICY TOOLS are needed e.g cutting administravive costs by eliminating so many different insurers and plans; capping share of premiums that can be used for admin., marketing and profit; federal negotiations to cut prices." Agree "Reduce the paperwork, administrative waste and all the confusion around cost. Financing should be based on ability to pay not on health status. People who use more health services should not have to pay higher premiums. A graduated income tax is one potential source of revenue" "Core benefits must include mental health, dental, visual, etc. - not services that are not mediaclly necessary, e.g. wrinkle removal. Also - cutting prices cannot e left to individual patients' comparison shopping." Affordable health care for all Americans must become PUBLIC POLICY as rapidly as possible 32563 08/31/06 AL Agree WE are the richest country in the world and yet we have more than 46 million uninsured people. Many of these are the working uninsured. I am a small business owner who does provide health insurance but it is a huge strain on my small business. Many businesses can no longer provide adequate health insurance and low-paid workers cannot afford to buy health insurance Agree In the long run preventive care is so much cheaper than treating illness Agree "Reduction of fraud is essential; however the current ""paperwork"" system is daunting and I believe decreases the willingness of some private health care providers to participate in federal programs" Agree I am a Hospice nurse in Alabama. Although AL medicaid has a hospice benefit we rarely are able to receive payment for hospice services even when the pt dies of cancer the payment is frequently denied. Medicare hospice benefit appears to work well - unfortunately if a patient is not old enough for medicare and don't have private insurance hospice care is freuently very difficult to get Agree We need a specific timeline for implementation Agree I agree; we need a specific timeline for implementation. Health Care must be made public policy and we must be able to encourage top quality health care providers to the public sector 32564 08/31/06 VT Agree Agree Agree Agree Agree Agree The fairest way to finance health care is to have people pay an income tax on health care. It should be based on income and everyone should pay according to their ability to pay. "All of these recommendations can only be implemented if the financing is realistic and costs are contained. The only way that can happen is to create one large risk pool for the entire country and have that pool be administered by the federal government or a contracted entity, much the way Medicare operates today. If profit is allowed to continue to dictate how people get care in this country then health care profits must be regulated." 32568 08/31/06 WA Agree No response No response No response No response No response "* We must not wait any longer to begin single payor healthcare system. The current profit centered system, controlled by the insurance and pharmaceutical industries is totally broken and not repairable. In addition healthcare quality is being harmed by the same system through the forcing practioners to become more productive, i.e., seeing more patients in a shorter period of time or producing a greater number of rx's per minute. The benefit of less time spent by a practioner to the drug industry is there is less time to consider and evaluate all the alternatives to care and the information provided by industry reps is accepted as correct and unfailing." 32569 08/31/06 WA Agree "We cannot call ourselves world leaders when 43% of us are without healthcare. Quality healthcare needs to be available to all of us, not just the wealthy." Agree Agree Agree "Death with dignity should be a right, something we can count on." Agree Agree "If people are appointed, the process needs to be sincerely bipartisan, so we don't have yet another committee led by people who are guaranteed to agree with what ever the Bush Administration's stance is." 32572 08/31/06 WI Disagree "* Guarantees against high health care costs can only come through the connection of actual costs to the consumer. Our current Congress and Administration needs to hear how valuable Health Savings Accounts are in helping the consumer of health care ""feel"" these costs, and how powerfully these costs (and savings) can mobilize them towards healthier behaviors. A policy that all Americans have affordable health care is noble, but it must never be stated without the understanding the this policy begins with every American citizen understanding how their own health behaviors contribute to this policy." Disagree " In ""The Future of the Public's Health in the 21st Century"" a powerful new model for a transformed Public Health System is presented. In the center of this model is the outcome of assuring the conditions for population health, and the stakeholders responsible for creating these conditions are all connected to the outcome in the center. This model fits perfectly with your value of shared social responsibility. Everyone, not just health care providers, has a role! " Agree Agree " When started early, people participating in Health Savings Accounts will be able to meet all of the unfunded health needs when they become older or disabled. This is especially critical because current lifetime unfunded health care needs for a couple turning 65 today are $200,000." Disagree "* I attended your session in Phoenix Arizona. I think there was great concern expressed at that session that the four questions (at a minimum) you were charged by Congress to answer limited the overall information you were able to mill from our group. For example, one person strongly tried to emphasize that enough money is already being spent on health care! We are way above all of the other industrialized countries by at least a factor of two. I think this is critical for Congress and the American people to know, and is not reflected in any of your interim recommendations. In addition, I do not believe your working group approached this effort with an understanding of what the determinants of good health (not health care) actually are (Evans and Stoddart 1994; Kindig and Remington 2006). Health care (access and reception of needed care) accounts for only 10% of health outcomes (premature death before 75 and morbidity described as fair or poor health). The health determinants of health behav" Disagree "* I think it is fascinating that Congress transformed the financing of health care by introducing Health Savings Accounts, and this happened in the same bill that directed you to ask us how health care coverage should be financed. I regret our recommendations do nothing to ask Congress to stay this course. I humble ask you to point out to Congress and the Secretary that our recommendations are relatively insignificant compared to what they have already done. Health Savings Accounts will transform health care financing, and Congress needs to be thanked for their vision! " "* I regret that your format of recommendations does little to prioritize for Congress what the health needs of America are for ""core"" benefit packages. In Phoenix, the people at our table desperately tried to emphasize the need for a comprehensive national tobacco control program, but the rest of the audience seemed not to remember that it remains the leading cause of death. The recently released Surgeon General's Report, ""The Health Consequences of Involuntary Exposure to Tobacco Smoke,"" only highlights the additional need for Congress to act to create a nation where every workplace is smoke free and where tobacco is regulated by the FDA." Please tell Congress that I am honored to have been asked to participate in giving them feedback on this critical issue. (You received a previous incomplete summary from me by mistake. I apologize for the inconvenience!). 32575 08/31/06 OH Agree We must address the costs of health care immediately. If we cannot decrease costs we cannot afford to increase access! Agree FQHCs provide excellent care at great prices; the value is excellent! Marketing the federal malpractice benefits may attract more physicians/providers to this mode of care delivery. Agree "* Recent studies (New England Journal of Medicine, March 2006) illuminate the lack of evidence-based care in the USA; this is unacceptable and must be addressed. Consumers need information to make wise, informed decisions about their care and currently that information is extremely limited. Additionally, some of the information is only available via the internet (only about 60% of the American people use the internet)and some of the information is available for a fee ($10-15.00)which some cannot afford. Health education is vital (see my ending comments), as is prevention and health promotion, however, without additional funding these areas suffer. " Agree "* I worked in a surgical intensive care unit for 4 years as a registered nurse. I can honestly say that advances in medical technology allow us to extend lives, however, often we do not improve the quality of life; leaving patients unable to perform the activities of daily living and this renders many dependent (some spending the rest of their lives in nursing homes). Communication between providers, patients, and families is crucial and often lacking. Ethics consultations early on may provide needed assistance in navigating this delicate area. Many families feel they have to ""do everything"" for their loved one without realizing the ""doing everything"" can cause their loved one to endure more pain and suffering in addition to costly thousands of dollars. Heroic measures at the beginning and end of life must be seriously addressed. More is not necesarily better for the patient, family, or health care system overall! " Agree "Health care should be a right not a privilege. This nation was founded on the principles of equality of opportunity, and inequality of outcome. Lack of health is an inroad to ones equality of opportunity." Agree "* We need to continue investigating our current tax policy with regard to not-for-profit hospitals and insurers, and the tax exclusion for employer-sponsored health benefits (US Senate Finance Committee, Spring 2006). If we alter the current tax code we could use the money to help pay for expanded access of all Americans and an interoperable Health Information Technology System. I agree with the work of Katherine Swartz on a federal reinsurance program to protect individuals from financial ruin due to high health care expenses. This program could be funded with money gained from altering the current tax code. I agree with the shared responsibility idea. Shared responsibility will most likely necessitate the use of individual mandates for health coverage. My concern with the individual mandate is with the cost of enforcement; it will be instructional to observe the experience unfolding in MA as they implement their individual mandate. We must tackle the ""quality"" problem in our health care system ASAP! I" Core benefits must be comprehensive and evidence-based. "* We must spend more time and energy educating the next generation about their health. Students in our public schools spend very little time learning about their own bodies and how to keep them healthy over the lifespan; Yet, without health it is almost impossible to be a productive member of society. We value math, reading, science, writing, social studies, and government in our schools...What about health? If ""Health"" were taught with the same amount of time/energy/resources as math/science/reading etc. we may be able to raise a generation of citizens that are more knowledgeable about their bodies and able to make better choices regarding health and wellness resulting in a healthier population overall. The ""built environment"" and ""social determinants of health"" must be considered when planning for a healthier population. We must realign some of our research dollars to address population health and how to achieve the healthiest population overall. We spend too little of our research dollars on population" 32576 08/31/06 ME No response Disagree "* Certainly, the FQHC model should be strengthened and expanded through additional financing of access points, but this expansion should adhere to the community-based principles that currently apply to FQHCs. First and foremost among these principles is the community governance of FQHCs. At their core, Community Health Centers are effective in their response to local needs, increase community access to health care services, and improve health outcomes for their catchment area because they are governed by a consumer-dominated board. This patient majority which has oversight of the policies and governance of this public trust is crucial to the ongoing vitality of our health care safety net and no reasonable policy would upset this hallmark of the health center program. " No response No response No response No response 32577 08/31/06 AL Agree Disagree Disagree Agree Agree Agree 32579 08/31/06 VA Agree The FQHC/Community Health Center model already provides health care that meets the three recommendations above and have been doing so for over 40 years. Disagree "* The recommendation to ""expand and modify the FQHC concept to accommodate"" other providers should be removed. FQHCs are community owned and operated. This is a major reason the model has worked for over 40 years. The community is invested in their health care. There is no reason to change the concept of something that works. Other providers who want federal support and have no interest in meeting current FQHC requirements should seek other means of gaining that support rather than changing and jeopardizing a concept that works. I encourage you to speak with the National Association of Community Health Centers for more guidance on this issue. " Agree I agree with all concepts in this recommendation. Agree Agree No response 32580 08/31/06 MD No response No response No response No response No response No response "* I am deeply concerned that the comments from citizens and organizations that have been received during the latter part of the 90 day comment period may not have been given a fair hearing. The ""new and improved"" version of the Interim Recommendations (with some important changes) were posted on the public website in mid-July. Here's what is troubling: by mid-August, your staff had already prepared a fairly polished, lengthy draft of the ""final"" version of the report to send to the members of the Citizens Health CareWorking Group for review. The CHCWG members met to negotiate and reach agreement on all the provisions in that draft at their August 28-29 business meeting... several days before the comment period was even over. The mid-September meeting of the CHCWG members is reported to be to finetune for sending to a professional printer immediately after so that the printed report will be ready for the required Sept 29th deadline for the President and Congress. Your staff is probably scrambling to m" 32585 08/31/06 OR Agree Disagree "public - private ""relationships"" are the context for liability shifting, which adds 30% to our overall medical costs. The resulting insecurity, confusion itself contributes to ill health." Disagree Gotta start fresh. We cannot Rube-Goldberg these many systems into a coherent whole. Add our built facilities into a freshly conceived whole system that makes no place for liability shifting and that accepts death as an inevitable end of life. Agree "Death comes at the end of life. Our alienated American family is preyed upon by ""the professions"" and the often late to arrive alcoholic lug nut that wants to make up for a lifetime of sleeze by having the state pay for throwing all kinds of technology at the bodily shell of Momma. The Culture, not merely the medical system must accept the inevitabity of death. " Agree "It is the civil, moral thing, within reason. Excluding transplants." Agree "We can make people sicker quicker that we can cure 'em. Health is different than health care. Dr Stephen Bezruchka has data that proves the a harmonious environment, ie equality of income results in better health and longevity and thus lower health care costs. During Ike's time the US was 3rd in longevity, now we are 29th. With MacArthur's income leveling, Japan leaped to 1st in longevity. Until we stabilize the slope, the avalanche will continue to bury us." Basic health care is a right. Transplants are not. Operations on the demented population is a waste. Investing big in bodies whose minds are gone is a disregard for the coming generation. "* Dear Health Working Group Member: I have read the draft recommendations and have these comments. I speak from having lead the team on health care and health care costs from the First Unitarian Economic Justice Action Group in Portland Oregon. As I am just made aware of this today with the deadline tomorrow I must dash this off and send this note from my own pen, there being no time for group process. The United States spends one half of the planetary medical budget. Over one half of what we spend is in the last two months of life. (The report's '96 numbers are lower, and a decade old.) Thus we spend one quarter of the planetary medical budget upon people who will immanently die. Is this wise? Health is different than health care. Death is an intimate part of life, yet this culture and the medical system sees death as a failure. In our history a 'good death' was to be aspired to. Today it is a feeding frenzy upon the alienated American family. Health is a product of diet," 32586 08/31/06 MI Agree I believe if the founding fathers were writing the constitution today they would provide universal healthcare rather than legal protection.Quality healthcare is the foundation and and basis for all the rights listed in the constitution. Disagree This onley provides jobs for more civil servants. It's a patch that will not provide the care that is needed. People will still have to qualify.Tons of paper work. Health care for profit has to end. Disagree "As long as you have health care for profit you are operating on a false premise. In other words the system will do everything it can to keep you well-yet the only way they make money is by you being ill, preferably chronically ill. More paper, more monitors, less healthcare. Currently the only credability regarding healthcare is on the web from foreign countries. Computer charting and records are available all over the world but they will not be accepted here because medical mistakes mean profit." Agree "End of life care is profitable. Long term acute care facilities are expanding every day. Medicare pays 30-50,000$ a month for long term acute care. Most of these patients will die (80%).What difference does it make if you die in June rather than Oct.The difference is 200,000$ to a long term acute care facility and 4 months of pain and suffering. Families are not infromed or educated regarding end of life options or the fatal disease their loved one has. It's not profitable to inform the families." Agree We need a non-profit universal healthcare system. Agree We pay the most for healthcare and get the least. We can pay for healthcar as long as the profit is removed. "* As a critical care nurse for over 30 years I know the truth-just ask the nurses what's really going on. Good insurance will get you surgery you don't need and bags of medication you don't need. Get rid of the profit. It is morally and ethically wrong for Companies/Doctors/Hospitals/Lawyers to profit from the pain and suffering of Americans. The system is so inflated now-if we do not do anything it will explode anyway. I came to the USA in 1960 from Canada and I'm going back when I'm 62 because I do not want to be another vistim of a healthcare system for profit. I've earned my SSI, and I'm taking it and running as fast as I can. I don't want to lay up in some long term acute care unit for months, rotting before I die. I don't want medication I don't need or surgery that I don't need. I have an adult son who is disabled but not disabled enough for any benefits. He has an IQ of 67 and is developmentally disabled but after going through numerous agencies and months of testing he doesn't qualify for anything. " 32587 08/31/06 TX Agree Agree Agree Agree Agree Agree 32588 08/31/06 VA Agree Disagree "* While overall, I agree with this, I DO NOT agree with modifying the Federally Qualified Health Center concept, expanding, yes. To modify the foundations on which the community health center concept significantly takes away from the whole idea of ""community"". The key provision I am specifically concerned with preserving is the 51% majority user board. This ensures that the very people for whom the services are targeted have a voice in their health care. I have over 10 years of experience working with community groups to address health care needs. Many efforts fail because the targeted community is neither included nor consulted about the services that are intended for them. This in turn wastes money, builds walls of mistrust and creates unnecessary barriers for community enrichment and empowerment. PLEASE alter this recommendation to maintain the FQHC concept as it currently stands. FQHC's have enjoyed strong, bi-partisan support for 40 years because these requirements have ensured that the services" Agree "Again, community health centers (FQHC's) have lead the way with many of the above recommendations and have been commended for their cost effective, patient focused practice. Health education is an integral part of the clinical visit. CHC's have lead the way through the Health Disparities Collaborative with best practices associated with improvements in chronic disease. Thus, maintain the FQHC concept as is and use it as a model of OTHER health care providers." Agree Considerable public education should be in place to teach respect and tolerance for how an individual and/or family makes decisions around end of life decisions. I ran nursing homes for 12 years and our commitment was to honor the wishes of the resident. Often more distant family and friends did not appreciate those wishes and created unnecessary hardships for those that wanted to comply with the residents' wishes. Agree "* Again, the community health center is an excellent model. ALL patients pay, but based on their household income. So for the poorest patients served, a nominal fee is charged - assuring that no one gets a handout, but rather is expected to invest in their own health and retains the dignity of paying something for such a valuable services. But health care must be affordable, because if people can't afford care, they delay entry into the health care system resulting often in more expensive and extensive care and potentially disastrous patient outcomes" Agree I agree and don't know what to offer as a suggestion - our country is so polarized and has a very short attention span. Creating a meaningful dialogue around this will be extremely challenging 32589 08/31/06 VA Agree Disagree "* While overall, I agree with this, I DO NOT agree with modifying the Federally Qualified Health Center concept, expanding, yes. To modify the foundations on which the community health center concept significantly takes away from the whole idea of ""community"". The key provision I am specifically concerned with preserving is the 51% majority user board. This ensures that the very people for whom the services are targeted have a voice in their health care. I have over 10 years of experience working with community groups to address health care needs. Many efforts fail because the targeted community is neither included nor consulted about the services that are intended for them. This in turn wastes money, builds walls of mistrust and creates unnecessary barriers for community enrichment and empowerment. PLEASE alter this recommendation to maintain the FQHC concept as it currently stands. FQHC's have enjoyed strong, bi-partisan support for 40 years because these requirements have ensured that the services" Agree "Again, community health centers (FQHC's) have lead the way with many of the above recommendations and have been commended for their cost effective, patient focused practice. Health education is an integral part of the clinical visit. CHC's have lead the way through the Health Disparities Collaborative with best practices associated with improvements in chronic disease. Thus, maintain the FQHC concept as is and use it as a model of OTHER health care providers." Agree Considerable public education should be in place to teach respect and tolerance for how an individual and/or family makes decisions around end of life decisions. I ran nursing homes for 12 years and our commitment was to honor the wishes of the resident. Often more distant family and friends did not appreciate those wishes and created unnecessary hardships for those that wanted to comply with the residents' wishes. Agree "* Again, the community health center is an excellent model. ALL patients pay, but based on their household income. So for the poorest patients served, a nominal fee is charged - assuring that no one gets a handout, but rather is expected to invest in their own health and retains the dignity of paying something for such a valuable services. But health care must be affordable, because if people can't afford care, they delay entry into the health care system resulting often in more expensive and extensive care and potentially disastrous patient outcomes" Agree I agree and don't know what to offer as a suggestion - our country is so polarized and has a very short attention span. Creating a meaningful dialogue around this will be extremely challenging 32590 08/31/06 VA Agree "We must not overlook the ""working poor"" who currently are not eligible for Medicaid, etc, and typically end up in more dire straights than those below poverty." Agree "I support the idea of expanding the concept of the FQHC, but I fear for an undermining of the current successes that might be taking place. This needs to be done in a supportive, balanced manner to avoid destroying progress that has been made." Agree "A focus on quality, evidence-based, accessible care is key. The focus on medical residents works for urban settings, but rural areas lack access to teaching centers." Agree Agree We need health care for all. Agree "Using an evidence-based model such as the one in Oregon with minor modifications make sense. It provides core preventive services, while not breaking the bank on illnesses/diseases that are highly costly with little return." 32594 08/31/06 WA Agree All Americans should share in health care costs through a single risk pool that would distribute the costs based on a progressive funding method. Therefore those who require the most medical care would not have to pay a higher share of income than those who are healthy. No response "While important to serve certain populations with special needs, community health networks should not be seen as ""safety nets."" We should not need safety nets if everyone is covered by a guarenteed health insurance system - National Health Insurance can cover everyone without increasing overall costs by eliminating the administrative waste and profits of our present employment-based, multiple insurer system." Agree Agree Agree "The ""core"" of services can be comprehensive when we eliminate the waste of our current public/private system by converting a to single National Health Insurance program that collects the funds (taxes) in a progressive way and pays our private delivery system. Means testing would be unnessary. " Agree "The obvious best solution is to convert to a single National Health Insurance plan thereby eliminating the administrative waste, profits, fraud, and ineffieciency of our private insurance industry. All of the improvements mentioned would be most easily achieved. Many studies have shown that we are already spending enough health care dollars to cover everyone comprehensively if we had such a system. Collect the funds through progressive taxation replacing the ineffiecient ""dedicated revenue streams""" Most efficiently implimented under a single National Health Insurance system "The most efficient, fair, and wise solution is to impliment National Health Insurance as in every other industrialized country. Our present system is a national disgrace in access, cost, and quality. NHI will come eventually so why not do the right thing now and end needless suffering?" 32596 08/31/06 OK Agree "However, I strongly disagree that there should be a national program to accomplish this. Any program needs to be community based. People have to get away fron thinking ""big brother"" will take care of them. We have to begin to re-create a sense of PERSONAL RESPONSIBILITY! The government has done its part to destroy this concept over the past 50 years and it will take some time to reinstitute this thought pattern." Disagree "* I strongly disagree with any additional involvement of the federal governement that has fed the current predicament. ONE SIZE DOES NOT FIT ALL! The only thing the federal government should be doing is enabling state and local government to serve their citizens. The feds can help establish a common framework, but should allow each state to function on its own, according to each state's needs and economic abilities. Medicaid funds should be raised loacally and stay local, not shipped to Washington for massaging and redistribution. If we have to live within our controllable budgets (State & local), we have an opportunity to succeed. Congress is incapable of finding rational solutions to ""common good"" problems, due to the polarized political process they engage in... Democrats and Republicans alike! " Agree "* I agree with parts of this statement. The Federal goverment needs to develop a standardized healthcare pricing and medical outcomes service to allow consumers to make qualified healthcare decisions. Evidence based medicines is and important ingredient. It is alos extremely important that ""alternative"" providers be developed. Physicians do not need to see everyone who comes in. We should be staffing many clinics with physician assistants, nurse practitioners, registered nurses, etc. to allow physicians to practice at a higher level. We need to train thes people in basic diagnostic procedures to ensure patients are referred up to physicians if they need it. I believe that the VA system should be studied as a model for electronic medical records retention and sharing. The estimates I have seen for the cost of a comprehesnive EMR system are incredible and I know from personal experience that these systems are NEVER COMPLETE. It would end up being another incredibley deep pit to pur money into, without hope of" Agree "Part of the problem comes from irrational expections and hopes of the relatives of end-of-life patients. It is difficult for people, including doctors, to ""let go"". Education is the key, but there needs to be some requirement that everyone who enters a hospital in the early stages of a diease to have a living will so that everyone knows what the patient wants." Disagree "* GOOD LUCK on this one. This is one of nicey-nice statements that sounds good but carries such a burden with it that it will never happen. It goes along with ""Why can't we all just be friends?"" and ""World Peace"". It is noble, but bears no resemblance to the realities of our ""political"" structure. Unless and until we are willing to set a budget for healthcare expenditures, this statement will ring hollow. GET REAL! Everyone wants and expects something different from ""set of core health care services"". In essence everyone wants their pet disease to be covered. If that is what they want, then they need to decide what they are willing to give up to get it. Either it will have to be terribly simplistic (best choice) or end up being NATIONAL HEALTHCARE, which the majority of our population does not want or need!" Disagree "* The current ""system"" is inclusive. It is just not efficient. Throwing more money at this problem IS THE PROBLEM! Every year we spend more money for less. Sure, a few people that would not have made it are saved by some incredible new drug or technology, but too much money is wasted on redundant or duplicative technology. For all the good they do, drug companies waste enormous amounts of money in distribution. THERE IS ENOUGH MONEY BEING SPENT IN THE SYSTEM. WE NEED TO FIND BETTER WAYS TO SPEND IT BY ELIMINATING WASTE AND DUPLICATION! Universal Coverage is not THE answer!" Would be ridiculously expensive and unnecessary. This sounds too much like an entitlement program and (duh)we should know by now the long-term results of providing more entiltlement programs. That is part of the reason we are at this crossroads. "* To be brutally honest, this appears to have been a waste of time and money. The interim report could have been completed by a bunch of liberal academics without holding any hearings. What the committee heard were the pleas of self-interest. Yes, we need to provide for the common good, but at the same time time we have to have a reality check. This system cannot be all things to all people (broad universal coverage)and it should not have its heart and soul in the hands of a federal government which has neither. Healthcare is currently provided on a state and local level, but largely financed or the cost is (un)controlled by federal spending. Is the federal government will to pay its fair share, so that we no longer have cost-shifting at the local level? The federal government cuts back on reimbursement rates on some and then gives money away like water under other healthcare programs. Providers are allowed to spend whatever they want to increase the cost and, yet, we cannot find out what they charge or whe" 32599 08/31/06 NV Agree Agree Agree Agree Agree Agree 32600 08/31/06 WA Agree And is administered efficiently in order to curtail costs. Agree Agree Agree Agree Agree "Keep the estate tax - we need funding in our system of government, why on earth would we give a huge tax break to the wealthiest citizens? Eliminate corporate welfare and tax breaks for multinationals. Eliminate the enormous windfall to drug companies in the prescription drub benefit and allow healthcare providers to negotiate prices ." Ensure in the process that undue influence can not be had by drug companies. Let us catch up to and surpass the healthcare systems of other first world countries. It is appalling that the wealthiest nation in the world would allow her citizens to be forced to choose between suffering injury and disease or facing financial ruin. 32605 08/31/06 CA Agree Agree Agree Agree Agree Agree "* On paper, these are all very well stated and well meaning recommendations. I would be very curious as to the end point condition of these recommendations following the battering by lobbyists, government molasses, various medical conglomerates who feel they would lose money by having a happier and healthier populace. It all boils down to who is willing to continue to stand up and tell the common sense truth about the whole picture and back up these very well meaning points. Non partisan decision making and appointments would be extremely refreshing - is that possible? Again, only by continuing to tell the truth about the issue at hand, not having the underlying issue of whether it will be profitable for Pfizer or Kaiser or whoever as the driving force. My preference is that these recommendations that you have made maintain their bite through to point of implementation and are not ground down to some watered down version that eats funds with its infrastructure and doesn't do a whole lot but continue to avoi" 32611 08/31/06 TX Disagree "This is socialized medicine, pure and simple. It has not worked in the best interest of the people it attampts to help, and hurts those who currently have insurance. Higher total costs to the taxpayer, delays in tests and treatments to the patients are hallmarks of this type of medicine. The part about changing end of life care is particulary scary. When do we start deciding when critically ill newborns need to have their care changed as well? " No response Disagree "I can't imagine anything the government does that has fewer people and less cost than a comparable private sector entity. Programs continue to grow, budgets get larger and there is absolutely no incentive for the government to work smarter. This proposal is a financial disaster and would be a terrible drain on the economy." No response Disagree Why? No response 32612 08/31/06 WA Agree Agree Agree Agree Agree Absoultely. This is the most critical piece. Agree "An increase in payroll tax is the best mechanism of funding this commitment, ensuring that everyone pays. Wealthy people that earn no wage income should have an income tax surcharge in place to ensure that they also contribute." 32613 08/31/06 MN No response No response Disagree "* I'll address two related proposed key issues in this brief letter: - integrated health care systems built around ""evidence-based best practices"" - medical treatment limited according to consensus opinion on ""medical effectiveness"" ITEM The federal government has done a TERRIBLE job of looking out for health consumers' best interests with regard to regulations, as evidenced by the reprehensible performance of the FDA. A prime example is the approval of aspartame. The scientists said, ""NO"". Political influence said, ""YES"". Key people were fired; more accommodating new people were brought in; aspartame was approved. Question: Do you know which product that FDA gets more complaints about than ANY OTHER PRODUCT? Aspartame. The list of known aspartame bad side effects is as long as your arm. The critical lesson here is that when the federal government is involved, special interests with huge lobbying war chests end up calling the shots. Their financial interest is then served at the expense of Amer" No response No response No response "* The real problem is in the paradigm. We don’t have a health care industry; we have a DISEASE care industry. The present paradigm is to not take official action until a person has some nasty disease condition, at which point treatment (e.g., heart bypass operation) is often expensive, painful for the patient, and only palliative in nature. In the official paradigm, the focus is on disease. One noteworthy example of that is if a consumer takes vitamins to STAY HEALTHY, he has no opportunity to benefit on his income taxes. On the other hand, if he does not take responsibility for his health and develops a disease condition, then it is possible for him to get a benefit on his income taxes if the doctor prescribes enough expensive prescription drugs. The bottom line - The consumer takes proactive action to stay healthy; the government says, “No reward for you” versus The consumer does not take responsibility for his health; the government says, “We’ve got this special reward for you.” Should we " 32615 08/31/06 ME No response Disagree "* ""Certainly the FQHC model should be strengthened and expanded through additional financing of access points, but this expansion should adhere to the community-based principles that currently apply to FQHCs. First and foremost among these principles is the community governance of FQHCs. At their core, Community Health Centers are effective in their response to local needs, increase community access to health care services, and improve health outcomes for their catchment area because they are governed by a consumer-dominated board. This patient majority which has oversight of the policies and governance of this public trust is crucial to the ongoing vitality of our health care safety net and no reasonable policy would upset this hallmark of the health center program.” " No response No response No response No response 32617 08/31/06 WA Agree "I would prefer a SIMPLE TO NAVIGATE public program. I am suspicious of private programs as once profitability becomes a concern, the consumer suffers. " Agree Agree Agree Agree Agree "I would be willing to pay additional taxes for better health care coverage; however, our government needs to spend less on military aggression and focus on care of the citizens." 32619 08/31/06 WA Agree Agree "I have some concerns that this will just be one more level of administrative waste (time, money, endless paperwork) with no room for difference or creativity." Disagree "* To me, ""evidence based-best practice"" changes depending on the lens of the observer (or person in control). So this is a worry to me. This entire Recommendation concerns me in regard to the way in which this type of oversight traditionally manifests. Consider any county or state administrative office which channels federal and local funds to providers - rules and regulations, paperwork, out-of-touch decision making as the norm. This Recommendation sounds intuitively correct and yet, in practice, seems to simply create a layer of administrative mini-tzars who have no creative capacity within the system." Agree Agree Agree Agree that we should all share the burden of health care provision to all of out citizens. "I do hold concern that a broad range of medical approaches are included: allopathic, naturopathic, chiropractic and so on." 32620 08/31/06 VA Agree Disagree "* Federally qualified health centers as they are now comprised make up the most successful health safety net program in the country. The federal Bureau of Primary Health Care of the Health Resources and Services Administration, US Public Health Service, US DHHS, provides excellent oversight, technical assistance, research and monitoring of the over 1,000 community, migrant and homeless health centers with over 5,000 service delivery sites in every state and territory of the United States. The key to success of Community Health Centers (CHC) is community involvement and management; only the community to be served knows the needs of its members, and CHC's ability to respond to community ownership makes them unique in reaching vulnerable citizens. Taking away the requirement of 51% CHC users as Board members would change the concept and thus affect the success of CHCs in reducing health disparities. There already exist mechanisms around the country for research, best practice development and dissemination a" No response No response Agree No response 32621 08/31/06 CT Agree "I think protecting patients from high costs in one important aspect of a fair and equitable health care system. It is critically important that when the decision of public vs private is made, it should reflect the best evidence about what would be the most cost effective." Agree Agree Agree Disagree "I think this is too vague -- it should say ""affordable health care"" and access to health care" Agree "When looking at financing, the decision should be based on unbiased evidence of what financing mechanism is the most cost effective. It is my understanding that public systems, such as Medicare are the most cost effective." 32622 08/31/06 WA Agree "This is a no-brainer. A publicly funded, universal, UK-type plan is the only way to do this. The recent bankruptcy act did nothing to protect those impoverished by medical bills, and those bills are the main reason people have to file for bankruptcy. NO-ONE should be impoverished because of health care costs - in a country as rich as America, this is inexcusable." Disagree "Far better would be a universal, publicly funded health care plan. Only in the absence of this would community networks be necessary. The states should lead this effort; the feds waste far too much money on initiatives, panels, etc., typically staffed by individuals with links to big pharma, the AMA, etc. Instead, provide BASIC guidelines to each state, and the finances to do the job - no unfunded mandates." Agree "I agree with the steps, BUT. Set up a universal plan to complement Medicare, to cover all those under 65, and incorporate these steps into part of the whole plan. " Agree "* 100% agree. The failure to provide adequate pain medicine for fear of being sued is inexcusable. Also, keeping individuals in their own homes with adequate assistance to caregivers is both cost effective and by far the most humane solution. It works extremely well in UK, where my mother died, living at home, with daily visits from the support nurses for essential dressings and assistance, and the remainder of her care provided by us, her family. Cost: a couple of daily visits by a nurse doing the round of patients in similar situations plus a dressing or two. Savings: hospital costs of several $100 a day, including nursing care, doctor oversight, maintenance and overhead costs, and inflated costs for materials." Agree "100%. A publicly funded system such as that in Canada, anywhere in the EU, NZ, etc. is both cost effective and essential. America is rich; it is a moral disgrace that we do not provide basic health care for ALL our citizens, not just those who are rich or lucky enough to work for an employer who offers health insurance. " Agree "* Reduce military spending and use the savings to provide health care. This is a no-brainer. The Iraq war is a national disgrace and embarrassment, as are obsolete weapons supported as part of pork-barrel spending. It's high time this country cleaned its act up. Also, make a VERY small tax to ALL employees or self-employed, say .25%. For the adult unemployed of working age (18 - 65), mandate a nominal contribution of, say, $5 a week - shared responsibility, however small, is critical. To this, add a ""sin tax"" to tobacco, alcohol, gasoline, and all products containing corn syrup, refined flour or sugar, or hydrogenated oils; all of these items have been proven to contribute to increased illness and those who consume them should contribute more to their own care. A similar tax should be levied on all manufacturers/processors/distributors at some point in the distribution chain. Lobbyists for financial interests should have absolutely NO input into the determination of this tax, or any other aspect of t" "A core package is critical to the well-being of all individuals. My concern is that ""science based"" is not the religious-right science that discounts anything they don't want to hear or fund, such as family-planning or contraception. " "* A universal health care plan such as that in the UK works. I lived there for 34 years and experienced the program. Yes, there are problems such as waiting for non-critical services, crowded hospitals with little privacy, and hangers-on who do not contribute but take. However, on balance the system delivers all essential services to all who need it; no-one is denied coverage because of their inability to pay; no-one is impoverished or bankrupted because of major costs; and no-one waits long for critical care. A personal example; my mother who was diagnosed with breast cancer at 92. Too old for care you might think; to the contrary, she was offered immediate surgery, radiation, chemo, whatever method she believed to be in her best interests. DO NOT BELIEVE WHAT YOU READ ABOUT HOW AWFUL THESE SYSTEMS ARE - THEY ARE EFFECTIVE. " 32630 08/31/06 MI Agree "Health care costs continue to rise each year and more and more Americans are left with no money to pay for doctor visits and medications as premiums, deductibles and co pays accelerate." No response Agree Agree Agree This is the greatest need to be addressed. Agree "Individuals that are making under $25,000 should have access to health care with a minimum copay, for doctor care and medications, hospital care and dental care. There should be a $500 maximum for out of pocket for these individuals." 32636 08/31/06 WA Agree "Unclear what ""very high"" means. Also, a national program should not be private. Enough of market-based health care, please." Agree Make it simple. Medicare works so lets expand Medicare for everyone. Disagree Medicare for all instead of a fragmented system Agree These recommendations should be available for everyone. Agree Financial assistance would not be necessary if there was Medicare for all. Agree Shared responsibility should be income-based. Thank you for providing me a way to register my opinions. Go forward to make it public policy that all Americans have affordable health care. Expand Medicare. 32637 08/31/06 VA Agree Disagree "* Do not dispense with the current FQHC model, particularly the requirement for at least 51% consumer representation on the Board of Directors. It is the community representation that assures that health care services are responsive to individual community needs, and that services are both appropriate and acceptable to the patient population. Consumer representation in governance of FQHCs have been key to the success of the program in reducing health disparities for vulnerable populations in those communities that have FQHCs. The requirement is not an onerous one. Doing away with the requirement will open the door to organizations more interested in siphoning off federal funds than in responding to community need. Please do not recommend changing this fundamental FQHC concept." Agree Agree Agree Agree 32642 08/31/06 ME Agree Disagree "* Federally qualified health centers are Community Health Centers (CHC). The key word is ""community"". CHCs are serving vulnerable populations in their respective communities. A focus that has thrived because it is guaranteed by a CHC requirement to be governed by an all volunteer board of directors who live in the community served by the CHC AND receive their primary care at the CHC. CHC boards are dedicated to ensuring that serving the health needs of vulnerable populations within the community is an overriding mission. The CHC concept should not be modified because past and current accomplishments prove the effectiveness being governed by local consumers who have a direct voice in policies affecting the care delivered to them. " Agree Agree Agree Agree 32644 08/31/06 NY Agree * I was sick once. Very sick. Too sick to fight my insurance company. Managed care and the sleezy lawyers who write the policies and the sleazy insurance companies who let people die should not be involved in the legal language of insurance law. They are however as lobbyists to who buy off our politicians. What happened to the old days? You had a regular indemnity policy and your bills were paid. None of this UCR fraud inflicted on sick americans. Further it's always hard working middle class Americans who suffer. The poor get every type of subsidy and aid - even all the young non working americans on medicaid and public assistance and hard working middle class american can't afford good coverage. Disagree Please once again you always forget the hard working middle class americans who jobs only offer then low level HMOs or low quality POS plans and who don't cover families. Let's do remember the working population who can't afford good policies. Agree "* I read an article about Dr. Linda Peeno who is now a whistleblower for managed care and a medical ethics consultant wherein she admited to killing a man and talked about the lack of ethics in the medical insurance industry. I have a comment: I wish I personally knew how to create an organization where you pay membership dues and you have available to you honest lawyers (if there is such a thing) or lawyers who will fight HMS and managed care insurance companies for you while you are sick. Just try being sick, so sick you can't think straight and then having to file the appeals process with your Insurance company or even with the state. GET REAL! When is this country going to start defending the real weak people: hard working people - no poor people who don't work - when you work and you are sick and you have no medicaid and all other things: you go broke trying to get well" No response No response "* I hate this vague language ""affordable healthcare"" all americans are entitled to ""QUALITY"" insurance where you don't have to fight your in surance company the entire time that you are sick. I wan't ""quality"" honest insurance that insures me as readily as it takes my money for premiums and then I want it to be affordable (another vague term by the way). Is 600 dollars a month for a policy affordable to a person making 100,000 or more a year? YES...but not to a person making 40,000 a year and trying to live and pay bills. DEFINE: those who need it. That always ends up being ""poor"" non working americans and leaving middle class america as usual. " Agree "* Is it a solution for a hard working middle class american to have to come up with more money? Yes it's true I would be willing to pay a bit more to have a good insurance policy. Old Fashion indemnity where you did not have to figure every rule ou. Tell an insurance company that you are willing to pay more and they will charge you more and then write more hidden language and confusing language to make you think you got a better policy. Do away with the UCR. I want to pay more and have my insurance policy pay 90 percent of what is ""billed"" not 80 percent of some UCR number that the insurance company gets to come up with and have no accountability for." 32646 08/31/06 AL Agree Health care costs have spiraled out of control and the average citizen can not be expected to handle the out-of-pocket costs. Agree Agree Agree Agree Yes! Yes! Yes!! Agree 32647 08/31/06 WA Agree Agree Agree Agree Agree Agree 32648 08/31/06 NY Agree "As a medical doctor and patient, the need for universal coverage is essential to the survival of health care and it's ability to serve all who need it." Disagree The FQHC concept is one that has worked for over forty years. It's strength is in the board of directors having a 51% membership of users of the centers. This basic requirement need not be changed. Agree Health information technology and EMR are just two parts that are needed to improve quality and efficiency. ALL providers must embrace this new program but the federal government needs to be very clear and consistent in the implementing this change. Medical education needs to be redesigned to implement many of these goals. Agree THe legal community needs also to be involved in the process so that there will be little risk of misunderstanding and miscommunication between partners. Agree Agree Shared responibility is a very important concept but hard to implement. "One of the overwhelming issues for both of these items centers around malpractice suits and it's direct impact on the ability to do care in a cost-efficient and fair way. There needs to be an open and honest discussion about this particular concern. Currently,in this society, patients/lawyers act as if they were ""hitting lotto"" when there is an error or other unforseen outcome, however minor or unpredictable." 32650 08/31/06 CO Agree "* Clearly Americans are no different than individuals in the rest of the world in recognizing, as the United Nations Declaration of Human Rights pointed out in 1948, that health care is a right. Yet, equally clearly in this country we more and more treat health care as a privilege because we provide health care solely on the basis of ability to pay. Until all Americans have equal access to health care regardless of their own financial circumstances, we as a nation are violating the very tenents we urged the rest of the world to uphold." Agree "A unified universal health care program funded by a public trust, rather than by private insurance, would be the best possible framework in which to create effective medical networks which could spread health care across the country more evenly both geographically and economically." Agree "* Using existing resources in the government for advancing the development and implementation of strategies to improve quality and efficiency is a worthy and ambitious goal. However, controlling costs will only come when we recognize that a public trust is already a best practices model. When the Medicare public trust spends only 3% on administration while private insurances spend up to 30%, one does not have to be a whiz in mathematics to understand which approach controls costs. At the same time, giving the public trust the freedom we failed to give to the Medicare D program to negotiate the cost of goods and services would also control costs." Agree "At the present time an extraordinarily high percentage of our health care dollars is spent in the last two years of our life. While we as a nation should be able to provide hospice and palliative care to everyone who needs it, a unified national health program would allow us to make wiser decisions about how we allocate those health care dollars in those last two years of life. " Agree "I agree strongly with this recommendation. The set of ""core"" health care services should be so broadly defined that we never create a medical caste system based on those who could get every possible service versus those whose ""core services"" still leave them deprived of needed health care." Agree "* If we approach the problem of finance wisely, as most other nations have, we will find that we have created a system that does a much better job of controlling costs than we now do while still providing health care for all Americans. Wise financing cannot mean relying on employers or corporations for the bulk of our health care dollars, though employers and corporations should be part of the picture. For the vast majority of Americans, funding through a ""health care tax"" would be cheaper than the current funding through private insurance." I agree with this recommendation so long as we broadly define core benefits and do not continue to deny essential services to far too many of our fellow citizens. "To provide a health care system that is both viable and will provide health care for all Americans, we must be willing to get completely away from the old paradigm of privately funded insurance-based health care." 32651 08/31/06 GA Agree Agree "* A fair and equitable system will address the problems that come in many guises of “skimming the cream” of profitable procedures/patients. Especially in the current system, the search for market share or the pursuit of higher profit margins lead organizations to seek patients with good payment and avoid patients with poor payment. In end of life care, the rise of for-profit hospices which staff at the barest minimum allowable level cannot provide the “promised” level of care. This is most apparent in the realm of emotional and spiritual care. Too few and/or under-qualified social workers and minister/chaplains simply cannot spend adequate time with all needy patients. An additional financial concern at the state level is the issue of equitable payment by all government entities to providers---physician, hospital, and other. In Georgia, counties with few healthcare resources blithely allow their needy citizens to receive care in another county which does have resources but will not pay the prov" Agree Agree "* Support for adequate professional care relating to emotional and spiritual needs is significant aspect of healthcare that must be sufficiently recognized and supported in an equitable system. Research shows that a very large percentage of patients look to spiritual resources, especially prayer, in time of crisis. End of life decision making is fraught with spiritual issues of personal meaning and values, and bereavement support after death helps mitigate long term emotional crisis for survivors. Issues of personal meaning and values will be increasingly important as more and more genetics decisions face patients, families and providers. These and other issues transcend the biomedical model! Community clergy and volunteers have a role to play, but they cannot be integrated into these significant decisions in the same manner that professional, board certified chaplains can be. Payment sources must consider professional spiritual and emotional care as integral to appropriate care and thus warranting coverage" Agree Agree 32653 08/31/06 AZ Agree Agree Agree Agree Agree Agree 32654 08/31/06 GA No response Agree Agree Agree Agree Agree 32657 08/31/06 NY Agree "But---coverage for primary care and prevention should get equal attention, since that is what people will neglect if their funds are low." Agree Agree Agree Agree Agree Core services must include prevention and should include reproductive services for women. 32659 08/31/06 OK No response No response No response No response No response No response "* Citizens’ Health Care Working Group Recommendations Submitted by: The State Chamber, Oklahoma’s Association of Business and Industry August, 2006 The Citizens’ Health Care Working Group, created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, has sponsored hearings and conducted surveys throughout the nation over the past two years to develop proposed reforms to America’s healthcare delivery system. These recommendations shall be submitted to the President and Congress for consideration and potential implementation. The State Chamber, Oklahoma’s Association of Business and Industry, respectfully submits the recommendations contained herein to be considered by the Working Group when developing their final proposal. Improving America's healthcare delivery system is critical to both the business community and the general public. The focus should remain on assuring that healthcare programs and policies are adequate, efficient and affordable. Comp" 32662 08/31/06 MI Agree Also look at what hospitals bill for services!!! Agree Agree Agree Agree Agree 32663 08/31/06 AZ Disagree "National program doesn't work in Canada or Europe - unless you are willing to pay a HUGE increase in taxes, and then services are cut back. Canadian hospitals are restricted to the kind of equipment and services they can provide and patients have to wait months and travel distances for specialized tests." Disagree This sounds like years of inconclusive meetings. Disagree "Federal Government, including those listed and other programs not in health care field, adds layers of bureaucracy, increases costs with little or no improvement in benefits, and would imposes restrictions on doctors as to what care they could provide a patient that didn't fall within the guidelines. Feds often hire unskilled support or they don't train them properly." Agree "I agree in part only. Mercy killings no, support such as hospice care I am in favor of. Health care providers should be educated in sensitivity as well as care." Disagree No federal health care system. It does not work. Private industry should be required to have reasonably priced health care plans for individuals and businesses. My son has coverage with company he works for but he must pay an insurance premium each pay check PLUS the first $1200 of all his medical costs EACH YEAR before his insurance pays anything. This is just for one individual. He might just as well have no insurance and save the cost of the premiums. Agree "This could only be determined after a ""core"" benefit package has been decided upon. see below." This should be done BEFORE any funding is considered. "Federal government is NOT efficient, is NOT capable of running a health care program without costs rising year after year. Federal government COULD require pharmaceuticals to lower their profit margin. If these companies can sell same products cheaper to Canada and Europe then they can obviously sell cheaper to American customers." 32664 08/31/06 FL Disagree "We need to strike a balance between protecting Americans and avoiding moving towards near bankrupt practices of Canada, France, etc. " Agree Make sure the tax is not excessive. Agree Provide the public with quarterly tracking reports. Agree Provide tax credits for institutions that may want to help fund this. Disagree The tax implications with this recommendation are rather ominous. Agree Provide incentives for private industry to create single digit interest rated programs. This sounds tax neutral - a good plan. Strike a balance between compassion without excessive taxation. 32665 08/31/06 NY No response No response No response No response No response No response 32668 08/31/06 WV Agree All Americans should be afforded quality helath care at an affordable cost. Agree I wory immensley about my early twenty-something children who are faced with low paying positions with no/inadequate health care coverage. Agree Agree Agree It is the duty of our national government to help provide affordable insurance/health care coverage to those of us who are hard working Americans trying to make ends meet. Agree "As an Executive Director of the West Virginia Association of Free Clinics, I anxiously await the day that Free Clinics are no longer in business and our struggling patients are able to have the health care they have so long been waiting for. 333,000 individuals are uninsured in our State and will benefit from an insurance plan that is cost effective and affordable." 32669 08/31/06 OH Agree "I have an orphan disease in the autoimmune family. My husband's company has very good health insurance and we still pay almost $20,000 out of pocket per year between deductibles, out of pocket maximums and prescriptions. " Agree "* I don't know how you can monitor hospitals for care more closely. I have been hospitalized 10 times in the last 12 months in 4 different hospitals. Two of these hospitals had ""magnet status"". I know for a fact that they did not have the patient/nurse ratio required of the magnet program and yet they retained their status. It is very easy to play with numbers in order to obtain these awards and not provide the care required. When I am in the hospital one of my family members is with me at all times to guarantee that I get the appropriate care and that medical mistakes are not made. I think the bar has been set high but I see little evidence that it can be successfully implemented. I do not believe you have a sufficient handle on financing the changes. And it is already clear that the government does not have the ability to police health care facilities to ensure quality of care. One of the hospitals not maintaining nurse/patient ratios is the Cleveland Clinic Foundation. The hospitals I have been in ar" Agree see above Agree "* Hospice coverage is a total of $1,500 per year and I am close to the end of my life. Due to our current laws, once my insurance is exhausted I will go to a nursing home and my husband will immediately have to divorce me. That is the only way to protect his 401K. We have spent 15 years (we are 42) paying into a retirement account for him. The end of my life should not destroy the quality of his life at retirement. We also have no mental health coverage so we have no support system to deal with the emotional issues this has created in our lives. I didn't see mental health issues addressed in your report. " Agree Agree 32670 08/31/06 ME Agree Disagree "The third bullet should be amended to delete the terminology calling for ""modifying"" the FQHC concept. FQHCs have been nationally recognized as a stellar program that serves the underserved and uninsured and at their core is the requirement of an independent community lead and driven Board of Directors that is responsive to the needs of the community because they represent the community. Modifying the program would decrease its effectiveness and undermine the basis for funding." Agree Agree Agree No response 32671 08/31/06 OR No response Disagree "* Thank you for the opportunity to respond to the interim recommendations of the Citizens' Health Care Working Group (CHCWG). On behalf of the 25 Federally Qualified Health Centers in Oregon, I wish to express my concern with the recommendation to ""support integrated community health networks."" In particular, we disagree with the implementation point to ""expand and modify the FQHC concept to accommodate other community-based health centers and practices serving vulnerable populations."" Federally Qualified Health Centers, with patient board of directors, are at the heart of providing health care that empowers those receiving health care and gives them a direct say in how care is organized and delivered. FQHC's in Oregon were the medical home for over 203,000 residents in 2005, providing high-quality, affordable primary care and preventive services to our most vulnerable populations. The Oregon Primary Care Association is disappointed with this recommendation which will undercut the FQHC grass roots comm" No response No response No response No response "Hard copy of letter mailed on August 29, 2006 " 32672 08/31/06 DC No response No response No response No response No response No response "* August 23, 2006 Citizens Health Care Working Group Suite 575 7201 Wisconsin Avenue Bethesda, MD 20814 Dear Citizens Health Care Working Group (CHCWG): The ERISA Industry Committee (ERIC), the trade association committed to the advancement of employee retirement, health, and compensation plans of America's largest employers, applauds the efforts of CHCWG in reaching out to a broad swath of Americans, both healthcare consumers and providers, purchasers and insurers, in order to determine the optimal way to reform America’s healthcare system. And ERIC agrees that the system is badly in need of reform. Major employers purchase healthcare to cover tens of millions of American employees and their families, and have serious concerns about the state of healthcare in the United States. The need for reform in the healthcare market is great, but reforms must be tempered with caution; well-intentioned changes to the system have a real possibility of further compounding the problem, increasing the " 32676 08/31/06 CA Agree This is a very lofty goal and probably the most vague of all the recommendations. Much more work will be needed to better define it. No response Agree It will be important to set up a Quality Improvement program that includes an oversight committee to make sure that quality care is being delivered successfully. No response No response No response "A health care system will also need to address durable medical equipment and home health care options. Allowing these options may help reduce costs of hospital stays and other related expenses. Additionally, in the Values & Principles section, it may be more powerful if it included strong statements that this system will not discriminate against anyone regardless of age, race or preexisting conditions. A goal could also address medical services to be provided in a wide variety of languages." 32677 08/31/06 MI Agree "* I strongly agree with the above premises but with the condition that Americans would be guaranteed the right to choose their health service providers. In other words, I would not want to see a system where people are confined to a ""gatekeeper"" system where the primary physician is the only one who can determine/route a patient to more specialized medical care providers. In other words, I think the system can work only if people are given a wide choice of health care providers and are free to move from one doctor to another if dissatisfied." Agree Agree "Patients should know the cost of medical services before they are administered; the cost of health care should not be kept secret until the bill for co-pays and ""amounts not covered"" arrives in the mail! Fraud reported to insurers should be actively investigated rather than brushed off by disinterested employees handling the phoned complaint. " Agree "Medical tests (chest X-rays, scans, MRIs and other expensive procedures)given to patients nearing the end of life must be abolished. Palliative care must be improved without regard to the possibility that the patient about to die will become an addict!! We are kinder to our animals at the end of life than we are to each other." Agree Agree "A single payer plan would be the most efficient. Eliminating the middleman; i.e., the insurers, who greatly inflate the cost of medical care with complicated, non-standardized claims reporting would re-direct attention to medical care, rather than claims processing. " "Non-partisan is the key word. The group must not be connected in any way to Washington PACs, like major insurance companies, whose major concern is reducing claims and increasing profit." 32678 08/31/06 MT Agree "As a pediatrician, I believe it is important to care for all our children. When parents have to decide between food or medicine for their children, we all suffer in the long run." Disagree "Yeah, right, like the PHS is doing so well since Reagan demolished it!" Disagree Sounds good but experience leads me to believe that it will do little to help patients or physicians and a lot to help business. Agree Agree Agree "Let's tax the insurance and hospital corporations that have made so much money off the rest of us. Are you listening, Bill Frist?" "Even if we don't cover all the adults, we should cover all kids. National health insurance for everyone 7 and under would improve almost everything we worry about, including crime, poor school performance, etc." 32679 08/31/06 OR Agree Agree Agree Agree Agree Agree I believe that we should approach financing as a community--and leave political parties out of it.Let's have true discussion and prompt work towards a solution.TALK-Talk-Talk is improved by solid deadlines.There is NO reason to put all this off until 2020.Good grief !! I am concerned that Insurance and Pharmaceutical for-profit interests have had too great an impact on the quality of our health care. I believe that just as we have defined public education a right in this country--we should certainly see the health care of all citizens is also a right.Dr John Kitzhaber(of Oregon) is working on this problem--and your organization should be in close contact with his efforts to get citizen particpation in SOLVING our current Health Care Crisis..Over 46 million citizens do not have Health Insurance.This MUST be seen as more than a statistic..Every one of us should work to solve OUR problem 32681 08/31/06 MO Agree All Americans should have affordable heath care. There needs to be public intervention to prevent the increasing cost of health care to our citizens. Agree Health care should be easily accessible to all. Many rural areas are in need of community health clinics. Agree "Health education, increased communication, prevention, and promotion are essential aspects and needs in health care to control costs and improve the quality of care. " Agree The focus should be on quality of care at the end of life. Appropriate training and education allows better understanding and support for families. Agree "I beleive that all Americans should have access to health care, basic life essential health care. " Agree "Incorporating preventative care is going to be very important, especially when we are looking toward the future. " "There needs to be a greater focus on family and holistic health care, I believe that many health issues can be resolved without the extra costs of specialists and extensive testing. " 32682 08/31/06 NV Agree "We agree that individuals should be guaranteed financial protection against high health care costs. We hope that all Americans will be able to secure health insurance, and any movement to make health insurance a mandatory requirement needs to include assistance for low-income individuals. We were pleased to see that this was written into your recommendations. " Disagree "* We also support integrated community health networks. In Nevada, we have developed two programs that provide the working uninsured with access to primary and specialty care services, and collaboration with physicians, hospitals, and the public & private sectors has led to the programs’ success. Programs like these that ensure both patient and community responsibility need to be expanded across the United States. The Citizens Working Group is recommending that Federally Qualified Health Center (FQHC) benefits are provided to non-FQHCs as a way to encourage more community health organizations to participate in integrated networks. While we support any health organizations that are willing to provide low-cost services to their patients, we are opposed to this recommendation. The FQHC system is a proven cost-effective, high-quality way for low-income people to access primary care services. The success of the FQHC movement lies in its strict regulations that include a patient-majority governing board and " Agree Agree Agree "Lastly, we concur that there should be public policy that all Americans have access to affordable health care. While we were disappointed that the recommendations did not include any specific plans to accomplish this, we understand how difficult that can be without specific details. We do request that our leaders develop more specific plans than what are listed here, though. " No response "* We would first like to take a moment to say thank you for undertaking this overwhelming task. Navigating the complexities of the health care system can be a very arduous and confusing process, and we appreciate your willingness to do so. It was important that average Americans were able to provide their input on health care, as this is an issue that affects every person in the country at one point in his or her life. We support many of the recommendations, but we have one significant concern that we would like to see changed regarding Federally Qualified Health Centers, as you will see below. We agree that individuals should be guaranteed financial protection against high health care costs. We hope that all Americans will be able to secure health insurance, and any movement to make health insurance a mandatory requirement needs to include assistance for low-income individuals. We were pleased to see that this was written into your recommendations. We also support integrated community health networks" 32683 08/31/06 CA Disagree Disagree Disagree Disagree Disagree Disagree "* My husband and I participated in the Los Angeles event. WE WALKED OUT. FIRST- This event should have been publicized through the City of Los Angeles’ Neighborhood Council system. It is a system designed to reach block by block, but has turned into another political arm of MAYOR ANTONIO VILLARAIGOSA. Mayor Villaraigosa sat at a table in front of ours. He sat with the CENTRAL AMERICAN NEIGHBORHOOD COUNCIL who identified themselves that way with t-shirts that also displayed the City Seal. NO SUCH NEIGHBORHOOD COUNCIL EXISTS. It was all show—with a lie. Tsilah Burman, a Department of Neighborhood Empowerment (Neighborhood Councils) commissioner was the only one close to a Neighborhood Council. It was here you lost the opportunity to hear Los Angeles residents address health care needs by both citizens and immigrants with varying cultural and health differences. Those cultural differences can translate into cheaper healthcare because of traditions and/or folk medicine practices. SE" 32684 08/31/06 WA No response Disagree "* It seems that the FQHC model needs to be made stronger, not diluted. Health care calls for more resources and not the raiding of funds earmarked to care for the most vulnerable. As an advocate for health care I experienced first hand the issue of local politics when the local hospital and health district, as well as chamber in Clark County Washington colluded to keep a proposed FQHC out of the community. It was only because of the forces of grassroots folks, along with FQHC requirements, that they were able to establish a clinic to meet their needs. The institutional players insisted that there was no need, and when that was disproved they insisted that they would meet the need. Today there is an FQHC in Vancouver, Washington because of the existing guidelines and funding mechanisms. These should not be changed in order to have these institutional players raid the funds set up for true grass-roots community based health services. " No response No response No response No response 32685 08/31/06 AZ Agree Agree Agree Agree Agree Agree "* Aug. 30, 2006 Dear _______, Thank you very much for the opportunity to provide comment on the recommendations of the Citizens’ Health Care Working Group. As a hospice company, we’re especially interested in any organization that voices an interest in health care reform that considers the entire continuum and that takes the time to consider a broad-based vision for what it takes to provide people with humane, respectful, and technically clinically excellent health care. The bottom line is this: Your report got it right. By focusing on health information technology (including electronic medical record systems), public reporting, and evidence-based best practices, you’re helping to build a strong framework and ensure that quality remains a focal point for any health care financing methodology. Your recommendations to develop and expand integrated public/private community networks of health care providers also get to the heart of meeting consumers where they are – on a local level. " 32686 08/31/06 NY Agree "I believe this should be a public program. Private health insurance companies have administrative costs as much as ten times higher than those of the Medicare program. When private companies are involved, much health care money goes to stockholders and CEOs instead of being spent on health care. This is one reason why our health care ""non-system"" is so expensive." Agree "I believe this program should eventually be expanded for all, not only for vulnerable populations." Agree "* I basically agree except I have reservations about providing consumer-usable information about prices, cost sharing, and quality and efficiency. I'm not sure that this will help most consumers who do not select their health care provider or hospital on the basis of price. Also, average consumers often do not understand the many complex factors related to quality and efficiency. For a simple example, does the average consumer understand that a hospital's mortality rate for a certain disease may be higher because that hospital treats sicker, more vulnerable patients? Research has indicated that outcomes improve with proper nurse staffing. Strategies are needed to address proper staffing and the nursing shortage. " Agree "In addition, the availability of non-professional care (such as that provided by a nurse's aide) needs to be expanded so that those people who need continuous care and who want to remain in their homes will be able to do so. " Agree This availability should be expanded to include those living in this country as well as Americans. Agree "* I believe our current ""non-system"" is so much more expensive than the systems of other developed countries, first, because so much of it is ""for profit"". The private companies benefit when enrollees have the least amount of health care possible (recognizing that the companies do encourage care for certain conditions which, if not treated, will cost them more money in the future). The multiple insurance providers - Medicare, Medicaid, Veterans Health Care, private companies, etc - bring about a fragmented system which is much more costly than simply having a single provider. This is part of the reason why other countries can provide care to their populations at a cost so much less than what we spend in this country. Second, inappropriate denials of services by private companies are common. This not only delays care but causes primary health care providers to spend a great deal of time communicating with private companies to persuade them that particular services are necessary instead of using that time" 32687 08/31/06 CT Agree "* How can we cover all the health care cost? Is it possible to reduce the high cost for the researchs that that cannot bring benefit for health care providers, clients, and the common people ( from the National Health care report)? Is it possible to limit the overuse and the underuse vaccines that explained in the report? Is it possible to reduce medical error that cause problem to most patients in the hospital with the new system? All part of this money can be used for universal health system. " Agree These are very good ideas and I agree with these systems. Agree These are the realities that we face everyday. Agree The integrated approaches of the different opinions are important on the success of the universal health care system that we want to promote. Agree "I agree with these opinions. Since most of the time only the middle social economic groups who show up at the meeting, we need more information for any health care programs that do not work out as we expected or far way from their expectations. " Agree I agree these statements. But we still need to monitor after universal health care can be implemented. I agree with these statements. Most insurance do not covers all that has been explained in this program. 32688 08/31/06 MO Agree "This should include universal participation, with modest copays for all but the poorest. It should also include some indexing to personal income." Agree I agree with this. I believe it would be better accomplished by establishing national standards and providing support than by extensive government ownership of providers or institutions. Agree "* I largely agree with this. However, I have concerns about ""consumer-usable information"" on costs, etc. I am aware of institutions that have higher overhead because they provide more providers, and thus a better margin for safety and care. Cost controls should be related and perhaps indexed for medical outcomes and results of patient satisfaction surveys. Further, if patients are protected from high costs, variations among institutional costs are less important. By the same token, if payer reimbursement is adequate and universal, cost-sharing should end. If the system continues to depend on employer-negotiated insurance, reimbursements need to be standardized." Agree This are issues in which public-private partnerships could be especially effective. Agree "* Basic health care should be seen as a civil right, and not as a privilege. Planning should move the emphasis on reimbursement from paying for acute crises to incentives for preventive care, including expanded access to primary care. This could be most effectively provided by a single-payer system. This need not eliminate the private insurance industry. Consider the possibility of block grants to states who would negotiate contracts with insurers. Contracts would need to be multiyear, but scheduled review would encourage payers to maintain high levels of service. Coverage standards and documentation standards would need to be set at the federal level so that companies would compete on efficiency and quality of service." Agree "Financing should be primarily tax-based, as the system that incorporates the largest pool of participants. It should be indexed to total income, and not simply to wage income. All should be required to participate as well with modest copays. There should be exceptions made both to taxation and to copays for those below an appropriate income level. Exceptions for those with physical or psychiatric disabilities should be graduated according to the level of disability." "There should be provision for research for and manufacturing of ""orphan drugs,"" inasmuch as these can be preventive of even more expensive acute problems. Antibiotics are a good example. There should be parity between reimbursement for physical and mental health needs." "We can provide much more than we provide now, if we only have the political will. This must be thought of as a long term investment in the health and productivity of the American people. As in investment, we should be prepared to forgo short term measures in favor of long term goals - goals independent of and longer than one or even two election cycles." 32689 08/31/06 WA Agree We need universal healthcare with cost controls so that no individual or family loses everything to keep a loved one alive and well. In one of the richest countries in the world the state of our healthcare system is a disgrace. Disagree "This sounds too much like the federal government meddling in areas they don't belong. We have systems in place to do these jobs, if we will make them responsible for their actions or inaction." Agree "How much money could we save every year, simply by eliminating fraud and waste? The most important part of quality healthcare is prevention of disease. That needs to be funded 100%." Agree Most people know how they want to spend their last days or months. We must allow them to transmit those wishes to healthcare professionals. The support groups for end of life care should be funded to help the patients and their families. Agree "This is a no-brainer. Again, we should have universal healthcare." Agree "I don't believe that anyone should get their health benefits totally without cost. But the cost should be in proportion to their ability to pay. With the savings we could realize in controlling costs via Medicade, Medicare, etc. and the end of fraudulent behavior, we could come very close to paying for America's healthcare system." "The core benefits should be those that allow people to be healthy and prosper. They should help the ill and infirmed cope. If someone wants healthcare simply to satisfy vanity or whim, then let them pay for it." 32693 08/31/06 WA Disagree "I think a private program just continues the inefficiencies we have now. I think we should be able to provide universal health care similar to Canada. Too much money is being spent now on administrative costs, figuring out who deserves health care and on insurance companies overhead, and drug companies marketing. " Disagree "I've tried to get health insurance for a low-income friend, and the paper work is awful. Why can't everyone have health care like in Canada. too many people are trying to make money as is, and insurance executives are making too much money. " Agree everyone should be able to get medicare. and the emphasis should be on prevention. Agree Agree Agree "right now, the fact that you have to be working to get decent health care makes no sense at all. " 32695 08/31/06 AK Agree Why do our life expectancy and infant mortality rates not reflect the wealth of our country. I believe it is to a great extent due to the inequity of health care coverage in this country. As a nation we have a responsibility to work towards a just an compassionate distribution of health care to all regardless of income. Agree Agree Agree Agree Agree 32696 08/31/06 WA Disagree "This is, unfortunately, a compound question. I agree with the proposition that no one in America should be impoverished by health care costs. I disagree that any form of private program will work to achieve that goal." Disagree "To the extent that ""public/private"" means something like the Canadian single payer system, I agree. If this means expanding Medicare to cover everyone, I agree. If this means another way to funnel money to private insurers and HMOs, I strongly disagree. " Agree "Of course, the federal government should also use its market position as a purchaser of goods and services--especially pharmaceuticals--to negotiate fair prices." Agree Agree "It should be public policy that all Americans have health care. The ""affordable"" part suggests that medical care is a market transaction. It should not be, as it is not in all the rest of the industrialized world. If every other industrialized country can provide health care to all their people, it speaks volumes if the United States cannot." Disagree "Given that the U.S. spends twice as much per capita on health care as any industrialized nation, there's no reason to frighten people with the bogeyman of paying more. If we can't figure it out on our own, perhaps we should actually study how the rest of the industrialized world finances health care, and follow their models." "Since all other industrialized nations already cover these things at much lower cost per capita than the U.S. spends, it is nonsensical to suggest that we have to carefully ration health care. If we want to claim that other systems are deficient (e.g., scare stories from Canada and Britain), we would need to spend only marginally more than they do to fix the claimed deficiencies. We'd still save money." "That the U.S. claims primacy in the world, but has 50 million uninsured people and another 50 million underinsured, is one of the great ironies of our time. How can we be so puzzled about something that other countries figured out long ago?" 32703 08/31/06 VA Agree Agree It is critical to insure that the FQHCs and Free Clinics are provided the necessary funds to expand/maintain their services before any for-profit organizations are offered financial support. Agree Agree Agree Agree 32704 08/31/06 AL Agree I'm not sure how this will be accomplished because I do not wish a larger welfare state. I believe the government should somehow curb the high profits and put reasonalbe limits on prescription drugs and health care cost. Disagree I agree that rural areas are suffering. Perhaps the government could ensure physicians and nurses are available on a routine basis by special programs for health care workers. Agree I agree with this plan but not at the expense of the physicians. Agree Agree My main concern here is the quality of health care. Military doctors are often considered very poor care because doctors who are very good can make more money in private practice. Salaries have to be competitive. Disagree Too many peolple involved. 32705 08/31/06 MI Disagree Coverage needs to be for ALL people for ALL costs. Univeral health care coverage is provided by ALL other industrialized nations who spend LESS money per person and get BETTER health outcomes compared to the USA Disagree "There will be no uninsured people for whome special health networks are required as soon as we implemant univeral health care coverage with single-payer national health insurance. Perhaps community health networks are needed in some cases, but the objective would simply be to have universal health care be accessible." Agree Agree All of this type of coverage will automatically be covered with universal health care. Agree This recommendation is automatically covered with univeral health care via single-payer health insurance. Disagree New revenues? Ridiculous! The implementation of universal health care coverage with single-payer health insurance will save the USA so much money via simplicity and efficiency that everyone will have outstanding coverage "There will be very little or no need for effort to define a core package. The core page of universal health care = EVERYTHING but elective surgery, such as cosmetic surgery." "* What concerns me most is that we do not have a system that covers averyone for all their health care needs, such as a single-payer health insurance system like Canada's system. We must cover everyone automatically like ALL other industrialized countries have been doing for years. The other countries spend less money per person and have better health outcomes. There is more than enough money wasted with our current system to cover everyone for all care from cradle to grave for ALL health care needs, except non-essential services such as cosmetic surgery." 32707 08/31/06 WA Agree "* I want a public program. Private programs have failed. CEOs are predator/profiteers beyond all reason and morality. Internal administration and high-profitle marketing is too costly. Let's do the right thing with a public program. And I do not agree that people who deliberately ruin their own health (chronic alcoholism, for example) should be shielded from financial consequences, but it may be too complicated to screen who is living responsibily and who is self-destructive. So for now, I say No One Should Be Impoverished By Health Care Costs. But also exercise reason as to what is a health care cost the public shares in. Elective Cosmetic Surgery? No. (Note--for burn victims and the like, such treatment is not elective--it is the compassionate thing to do and help pay for). Sex change operations? NO. Viagra? NO. Contraception? YES: all methods/technologies aligned with Best Practices. Allow elective abortion or elective sterilization? YES. There is a public good in managing population growth and not bring" No response "I don't know enough about this to responsibly comment. I would trust the Democrats to have the better answer rather than Republicans or Libertarians. Don't know much about other parties and I don't think the Green Party's thinking has evolved far enough re: health care to offer sound, in-depth direction, but I think Greens would be aligned toward doing what is best for people, not corporations and their political cronies." No response "Some of these programs I know almost nothing about. So I will refrain from commenting, except toi say of course we want fraud and waste to be eliminated." No response "* Another subject I don't know much about. But it is ridiculous to spend 990% of a person's lifelong health care budget in the last few months of life. We all will die and we need to change our culture such that death is not something we try to forever hold at bay. We need to accept that death happens and not take contorted approaches to prolong pseudo-life with high-tech and labor-intensive methods. We need health care that is not overly demanding of our natural resources and does not elevate Amercians way beyond citizens of 3rd World countries in terms of life expectancy and rash measures to sustain breathing, etc. longer than Nature would otherwise allow. Our founding visionaries did not envision a nation of artificially sustained citizenry. Let's not warehouse people such that their humanity is twisted into something else. Let's get on with allowing death to happen. " Agree YES. I prefer a Univeral Single Payer system. Heard a great presentaiton on this subject over 10 years ago. Thought the Clinton administration would revolutionize our health cares systen but obstacles could not be surmounted and agenda turned toward other objectives. Too Bad. Agree "We can strive for seamless and smooth transition but bear in mind that any transition is likely to have rough spots and not every issue re: transition can be anticipated. We need political will, detail-minded follow through, accountability, and committed, comptetentleadership. Please, no White House appoointees with fluffed up or even fraudulent resumes and a vaccuum of credentials other than crony points. " Female Federal employees should not be deprived of abortion as an option through a health plan offered by a federal employer. That was the case during my last two years as a federal employee in the 1990s: an erosion of prior service options. Let's get real. "* I am 56 and my only health care coverage is very pricey individual plan that was cunningly designed to avoid paying for just about anything I am likely to encounter. Having suffered through Adhesive Capsulitus for 18 months was a wake-up call that I have to get back into employment that offers sound benefits. That means either returning to the federal workforce (I was a DOE employee for alost 13 years (or a local/state government job in the State of Washington. Private sector is pathetic these days with avoidance of health insurance. In my 20s I travelled extensively and on rare occasion needed health care in a far-flung place. Even on the tiny island of Bora Bora (in French Polynesia) provided me the care I needed immediately. I got a cap on a broken tooth in Singapore, in 1977, for $4. And I didn't have to wait days or weeks: just walked right in and got treated. Cap held up just fine. USA can do better. Much better. Must do better. Sooner, not later. Thank you. " 32709 08/31/06 NY Agree "Financial protection should be broader than low income criteria as that you don't find out you're ""underinsured"" until too late. " Agree Don't forget that many of us are penalized for using our health insurance. Policies vary greatly by state. Agree Agree Having the experience of both parents dying of cancer means I know many oncology services and precribed drugs are not covered in health insurance policies. Both my mother and father procrastinated in reporting symptoms due to financial worries. As a retiree my dad was surprised to find his benefits package downsized. Agree I'm tired of physicians reluctant to spend time with me when I'm sick. Agree President Bush has already guaranteed universal health care for Iraq. Smooth and seamless transition is a unrealistic goal as that so many Americans are employed the multilayered managed health care system. I repeatly experience 'managed health care' working to keep health care from me when I'm in need. 32711 08/31/06 WI Agree "* Public financing of a national program will remove the added expense of a profit margin to the cost of health care. Remember the poster from the 70s? ""Health care for people, not for profit."" Access to quality health care should not be limited in any civilized society. If people are to thrive and reach their potential as individuals quality health care is imperative. If a country is to thrive and achieve it's potential, its citizens must be free from concern about whether or not they will be supported in a crisis related to their health or the health of their family members. We clearly have the means in this country to provide adequate care for all of our citizens. We spend more per capita that any other country and get much less than many other countries. It seems the motivation for profit and more bigger profit is what is in the way. A single payer system makes the most sense and I truely hope that that is the direction that we move in very soon. " Agree Currently the health care safety net barely exists. We are not providing care that is consistent and many times health problems progress to a chronic or critical level due to lack of access. Agree Agree My mother spent the last two months of her life in a hospice facility. Fortunately my family was able to afford the cost that was over and above the Medicare reimbursement. I cannot emphasize enough the significance of the care that my mother received during her last days. My mother and entire family were able to move through her transition with an ease and grace that would have not been possible without the support of the hospice providers. Every family should have the option to receive such care. Agree "It is an abomination that in this country people do not have access to quality health care, especially given that we spend more money per capita than any other country. Of course it should be our policy that every citizen receives quality care without a threat to their financial security." Agree Evidence and common sense indicate that a single payer system of health care financing is the most cost effective solution to the current crisis. "I agree that health includes physical, mental and dental health." I would like to thank the members of the committee for these recommendations. This document is a much needed clear and comprehensive contribution to the discussion. I hope that it is considered seriously by the administration and policy makers. 32712 08/31/06 CA Agree "I prefer a single-payer system, whereby doctors can still be private practitioners but are reimbursed by the government. A reasonable alternative would be to keep our multi-payer system, but expand Medicare to all ages, income groups, the healthy and the sick. People could have the option to get private insurance if they want to. This model is similar to the healthcare systems of France, Germay and the Netherlands." Agree Agree "* I think having a single-payer system is the best way to increase efficiency and quality, provided that the government funds it adequately. I generally agree with most of the bullet points, except I find the second to last one to be problematic: ""Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits."" I think this statement assumes that we will keep our solely private-insurance based health care system, when I think we shouldn't. Americans need to stop thinking of health care purely as a commodity to be bought and sold." Agree "End-of-life care should emphasize making a person's last days as comfortable as possible, and not focus so much on prolonging a life that no longer has any quality to it. Families who are taking care of dying loved ones need to be able to access help (financial and personal), and not be bankrupted by the cost of care. This means everyone should contribute to providing that help. We must also make sure end-of-life care is properly regulated, and end-of-life care workers are properly paid. " Agree "I believe health care should be a right of citzenship, not a privilege that is rationed based on income." Agree "I think we should use different kinds of financing (income taxes, payroll taxes, user fees, etc.). We should look at other industrialized countries as models." "We should make sure that any panel chosen to define primary care covered by the new system does not leave out certain conditions because of cost or other reasons. Again, we should look to other countries as models." "* I think if we don't do something now to change the way health care is delivered in this country, our system will help to bankrupt the U.S. We don't want to live in a country where half or more of the population has no access to a doctor, but if we don't change this system, that's where we're headed. We need to look at the systems of other industrialized countries as possible models. We should no longer depend on a system where employers are the main source of health benefits; businesses more and more won't or can no longer provide this. We are losing our competitiveness as a result. We must switch to a government-based system of funding, either a single-payer model or multi-payer with an expanded Medicare and an option to buy private insurance for those who want to. The time to do this is now." 32715 08/31/06 TX Agree Agree Agree Agree Agree Agree "The middle class people need help with healthcare! We are willing to give healthcare to someone from another country, but not willing to help the middle when they have lost their jobs or just can't afford it. Why no offer healthcare at a reduced cost depending on your income." 32716 08/31/06 Agree National program should be public to cover all Americans equally; protect against very high out-of-pocket medical costs for everyone; and provide sufficient financial protection for low income individuals and families (see full comments of ISMCH in statement below) Agree "* ""Integrated community health networks” are not just for safety-net providers serving low income persons in community health centers, but are a publicly accountable model for delivering the highest quality health care in the most efficient and effective way to all patients at the community level. Otherwise, the limited public dollars in the safety-net sector of our health care system will perpetuate the unequal access to medically necessary health care that the American people want to overcome. (see full comments of ISMCH in statement below)" Agree "* The quality and efficiency initiatives that the CHCWG embraced are frequently advocated by entrepreneurs who want to sell Health Information Technology to providers by making a business case for quality. This theme is often reinforced by pay for performance strategies that propose financial incentives for achieving higher quality measures. While quality initiatives can certainly be efficiently promoted through universal health care, ISMCH is concerned that these quality initiatives not be used to increase the gap in health status between those who are well-insured and those who are uninsured or under-insured. In fact, ISMCH is promoting a civil rights approach to health equity to ensure that the disparities in health and health care are closely monitored and efficiently addressed by health care reform.(see full comments of ISMCH in statement below)" Agree "* The CHCWG recommendations for “end-of-life” care are often proposed as simple ways to save Medicare dollars by avoiding high tech futile care that is frequently wasted on persons at the end of their lives. This may occur when health care providers see an opportunity to bill Medicare for unnecessary health care procedures that cannot be justified as improving a person’s health. This response to end-of-life care does not empower the individual patient to maximize the quality of his or her life when they may really want comfort care at home. ISMCH supports the CHCWG recommendations to expand coverage of palliative care, hospice care and other end-of-life services that comport with the wishes of the ill patient and his or her family. At the same time, ISMCH is very concerned that persons with disabilities at any age are not discriminated against by being deprived of any health care service that could improve the quality of their lives. Moreover, it is crucial that access to hospice care be availabl" Agree "* We are heartened that throughout the country the Citizens’ Health Care Working Group found that an overwhelming majority of the population recognize that our health care system is in major crisis, and that they look to government to ensure affordable health care for all as a matter of public policy. It is very significant that the overwhelming majority supported equal benefits for all. Of course, when people are asked to choose between a health care system that protects people from catastrophic costs on the one hand, or routine first dollar costs on the other hand, it may appear that there are divergent opinions. But if you don’t assume that our health care system can’t fulfill both priorities, it is clear that the overwhelming majority want government policy to ensure that affordable quality health care is available to all. (see full comments of ISMCH in statement below) " Agree "* Since the poor cannot pay as much for health care as the rich, most respondents recognized that the financing of health care should vary with income as would happen through a tax-financed health care system. It would have been more revealing to ask the general public whether they think that rich people should be able to jump to the head of the line in the health care marketplace by paying higher premiums or higher out-of-pocket costs. As to how much more people would be willing to pay for universal health care, this question is both inappropriate and misleading since the experience of many other countries reveals that there is enough money in the system to support universal health care, and that existing forms of cross-subsidization in the US are both highly inefficient and inequitable. It is regrettable that the CHCWG did not use its limited time and resources to explore this further. Similarly, the questions about public spending priorities also reflected the CHCWG’s preoccupation with maintainin" "* ISMCH is concerned that the CHCWG recommendations for universal health care not fudge on the definition of “all”, the definition of “affordable”, and the definition of “health care”. While we like the goal of health care that works for all, we are concerned that recommendations which limit access to “all Americans” plays into the anti-immigrant xenophobia that inhabits our country at this time, and is likely to undermine the structural changes that are necessary to provide health care coverage to all persons who live in the US. Secondly, ISMCH is concerned that the definition of “affordable” in a system of shared responsibility not impose a disproportionate burden on low income persons or persons with the highest health care needs. It is essential that the CHCWG not recommend an individual mandate without specifying the infrastructure at the federal and state levels that would be necessary to ensure both equal access to all medically necessary services regardless of one’s income, a" "* COMMENTS ON CITIZENS’ HEALTH CARE WORKING GROUP INTERIM RECOMMENDATIONS FOR UNIVERSAL HEALTH CARE The Institute of Social Medicine and Community Health (ISMCH) was pleased that Congress created a process for engaging the American public in a dialogue about reforming our health care system. In the past, health care reform has failed to address systemic changes in the fragmented health care delivery and financing system which has been driven by ideological commitments and lobbying interests that have enabled our health care system to remain the most profitable in the world without guaranteeing access to affordable health care for the whole population. However, we were distressed that the framework created by the Citizens’ Health Care Working Group (CHCWG) for the public dialogue seemed to be rooted in the assumption that there is not enough money to provide comprehensive health care to the entire population. When the US spends around twice as much money on health care per capita as any other countr" 32721 08/31/06 Agree Give us the coverage options and the responsibility to act for ourselves. This country has been built on having choices. Disagree The private sector still knows its communities best. Let the private sector develope the network. You cannot force an individual to accept health over a destructive lifestyle. The government tends to make all people victims. this is the wrong approach. Disagree Evidence-based is a fancy way of saying the patient is to be ignored. Why not just say you will be ignoring the patient and using a cook book. Agree "Health care providers must be given protection and allowed to medicate their patient appropriately, without fear fo reprisal." Agree I agree with access to knowledge. Agree "I am unclear about the ""multiple financing sources."" Is this Taxing?" "Accidents and major illness aside, the best health care is achieved through a preventive mentality. It appears our citizens would rather choose obesity. This is inconsistent with prevention. How do you force a healthy mentality?"