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 ne