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Citizens’ Health Care Working Group
Public Meeting

Thursday, September 22, 2005
Morning meeting

Portland, Oregon





Randy Johnson, Chair
Catherine McLaughlin, Vice Chair
Frank Baumeister, M.D.
Dorothy Bazos
Montye Conlan
Joseph Hansen
Therese Hughes
Patricia Maryland
Aaron Shirley
Deborah Stehr
Christine Wright


George Grob, Executive Director
Andy Rock
Caroline Taplin
Jessica Federer
Craig Caplan
Jill Bernstein
Connie Chic Smith
Carolyn Dell

Contract Staff

Tish VanDyke, Edelman Associates
Kristin Engdahl, Edelman Associates


Meeting Summary

Randy Johnson began the meeting at 8:30 a.m.; he indicated that Michael O’Grady was retiring and mentioned that Donald Young, Office of the Assistant Secretary for Health and Human Services (DHHS) might be appointed to be Secretary Leavitt’s representative on the Working Group. Randy Johnson offered some reflections regarding the preparation of The Report to the American People and additional work that was still needed. He discussed the time-table for the Report and indicated that the competitive contract that had been issued to provide assistance in helping make the Report more readable and not to add “spin.” He indicated that he, like most of the other members of the Working Group, would not yield his “proxy” vote on whether to approve the Report to the Report Committee because the intent of the Report Committee was to address the factual content while he was also concerned that the Report be compelling.

George Grob indicated that the draft Report had been shared with the two sponsoring Senators, Wyden and Hatch, to allow them to comment. Senator Wyden had asked that the portion of the Report addressing what the Congress would be do be strengthened and clarified; he also suggested slight wording changes to the questions in the report that were non-substantive.

Senator Hatch requested that the Report and the Invitation address biomedical research and possibly health services research; in addition, he commented that medical malpractice is not a driver of cost increases and suggested we remove this from the two documents. George Grob indicated that although medical malpractice was still discussed, it was modified to indicate that it was not a major driver of cost.

Catherine McLaughlin observed that while there was evidence that high medical malpractice costs were driving some providers out of selected markets, that there was less (or no) solid evidence concerning the effect of medical malpractice on broader health care costs to consumers.
She asked, “This is a good example of: if we as a working group want to have research integrity in our report, then there are certain things we cannot say even though we know some people out in the political world will be annoyed by that.”

The Working Group had an exchange about how to handle the subject of the effect of medical malpractice on health care costs. One approach was to have the report address—in the Quality and Access sections—the factual evidence about what is known about the issue (which is that it is not a major driver of cost but that there are certain areas of health care where cost locally is affected). Another approach was to not include the issue in the report at all because it would annoy some.

Concern was expressed regarding the appropriate role the Senators should be expected to play in the Report review process, especially concerning the fundamental question of who was controlling the content in the Report. The sentiment was expressed that authorship of the Report belonged to the entire Working Group, acting collectively and was nor or should not be a report of one or another individual.

The chairperson stated that the following options were available:

  1. Take the Report as prepared so far, pilot test it, announce it on October 6, and use questions from Invitation.
  2. Take the Report with Richard Frank’s refinements and staff and other edits, as possible; pilot test that, have October 6 press conference, and use questions from the Invitation (staff would get all these around to Members).
  3. Rewrite the Report, incorporate all comments into a new Report. The problem with this approach being that the comments from Members don’t all agree. Then, don’t pilot test it and don’t announce on October 6.
  4. Agree that we aren’t going to come to agreement on the report at all.

The Working Group discussed these options. It was reiterated that the nugget of a good Report was in the Report and that the changes needed were not extensive. The Report needed to be factually accurate, engaging, and reflect a sense of urgency, all at once. A Member asked about whether the Working Group would consider the Report dynamic and as something that would change as a resource on the web and whether the Invitation was really needed by October 6. Some Members were of the opinion that the factual accuracy and reliability of the information provided in the Report, and that could be modified over time, was the most important issue to address. It was suggested that the Report didn’t need to be pilot tested. Members commented that the Report would be read mainly by policy staff. It was commented that the public relations contractor was recommending that the October 6 “roll out” no longer be about the Report, but, rather make the press event about who and what the Working Group was.

Catherine McLaughlin added that it would be insufficient to make changes to address Richard Frank’s comments only and that the comments regarding addressing what was need in the system were also important.

Connie Smith spoke about the purpose, concept and plan for the October 6 press event. She pointed out that the Report was a significant part of the event. Tish VanDyke stressed that the public attention to news is very short; she discussed the nature of the message that the Working Group was trying to get out—that this initiative is about real citizens; that it isn’t about typical lobbying interests. She indicated that we need to try and make the Report such that it will be of interest to a wider audience, including news makers, reporters, and editors. Part of the idea is to provide citizens a “snapshot” of the issues and of the work that the Citizens’ Health Care Working Group is engaged in. She asked about how the Working Group could most effectively reach people and she discussed the different vehicles for reaching different groups of citizens. She made the point that one can have great materials and information but that still left the question of how to get this material and information out to people. She said that people on the Hill (Congress) and the major news makers do not want a long or even a short report, but rather three pages with bullets.

Joe Hansen said that he’d always considered that the Report was going to be the “bedrock” of everything the group was going to do. Pat Maryland agreed that the Report was key to credibility to the rest of the work. She indicated that the members were dealing with many different constituencies and that it was essential that the Report be credible. Everyone needed to be comfortable that when they stood before a group of their peers, they had an accurate, objective, reliable Report covering the range of topics it needed to.

The group agreed to keep to the plan for an October 6 roll-out and with the importance of the Report and its contents.

George Grob provided his comments about the logistics and content of the enterprise. Regarding the press event, he expressed clearly that unless the Working Group had a package of items ready at the same time, a roll-out on October 6 would be not successful. This package needed to include: questions on the web site, a Report to hand out that looked like a Report, and a short accurate version of the longer Report (He indicated that the latter could be considered the official
Report required in the law; however, this was subsequently changed when it was agreed, that the short “report” could be referred to as the “Invitation,” a solution that the Working Group members accepted.). The (longer) Report, could then be considered the deeper resource document that would reside almost exclusively on the web.

Tish VanDyke suggested that an additional element was that the Working Group was issuing a call to action and that is what would be engaging to the audience in the context of the October 6 press event. She indicated that the Working Group was, in effect saying, that, “we want citizen feedback, we want people to go to the web and fill out the public opinion questions.” She indicated that it might be insufficient to post the Report only on the web; not everyone has the web. “New Orleans taught us how huge the gaps are between the haves and the have-nots, so we need another way to reach out to people. Something in hard copy is needed on October 6. The reason that the graphics material has appeared in the drafts in text only is because there has to be an agreement on the facts before providing the material to designers to complete the graphics.”

Members asked Tish VanDyke how important it was that the Report be provided at the press conference, as opposed to giving out only shorter documents. She replied that it was essential to at least have the shorter Invitation in hard copy to hand out and someone from the Working Group should still need to describe the (online) Report at the podium during the press event. Because of the way people read (or don’t read) long Reports, people need something that is visually engaging and that reads in a way that they feel that they can get snippets quickly. It is for readability purposes mainly that the way the Report is prepared is important.

Randy Johnson observed that the October 6 press event was still the group consensus and he indicated that the focus groups could test the Invitation. If we were not going to try to print the Report for the roll out, that would save some time. The Report was needed in final for printing by next Wednesday, September 27; this would require getting a draft by the Friday, September 23, afternoon. The items that would be tested with the focus groups included: the Report, the Invitation, the questions. Then materials would be sent out to the members. The proposal for press event was to have the Report on web and the Invitation in printed form.

The Working Group discussed this option. It was observed that “the story” on October 6 was going to be the questions (at the end of the Invitation). They would be the key to engagement with the public. There needed to be time to discuss the questions. Tish VanDyke indicated that the focus group would be looking at readability, usability, ease of use. The contractor would then provide a summary of comments back to the Working Group. If Working Group staff then thought changes were appropriate, the materials would be revised and this revision would be sent to Members to review and react to.

Members expressed concern about whether the questions being focus tested were the right ones to be asking about. Some Members indicated that these questions were sufficient. Others disagreed about the selection and structure of the questions and indicated that there were several questions about the questions. George Grob mentioned that there had been a longer set of questions developed for consideration that were sent to all the Members.

The Working Group members decided to change the plan and agenda for the afternoon and, rather than holding committee meetings, hold a Committee-of-the-Whole meeting to work through the Invitation.

The chairperson adjourned the meeting at noon.