the Tough Questions: Of Ourselves and of Our Candidates
to Ask Ourselves
our healthcare system is headed in the future, we should ask ourselves
some important questions along the way. We are each a patient or
potential patient, voter or potential voter. We have a role in deciding
what our healthcare system will look like in a year or ten years,
but we also have a responsibility to figure out what we're willing
to do to get there.
you'll find questions to consider as you figure out what kind of
healthcare system you want in America. Background on these questions
can be found in The Issues sections of this site. You can also follow
the links in the questions for more information.
Do we have a moral obligation to provide healthcare to everyone
as needed or is healthcare a commodity that should be subject to
the same marketplace influences as other commodities?
What should the government's role be in providing access to healthcare
According to a study in The Journal of the American Medical Association,
nearly 40 percent of physicians have manipulated insurance
reimbursement receive needed
care. For example, physicians have exaggerated patients' symptoms
to allow them to stay in the hospital longer, and changed patients'
diagnoses for billing purposes.
In our current healthcare system, is this justifiable or unethical?
Do insurance companies and HMOs
use unfair practices to control spending?
Should employers be required by law to offer health
insurance to employees?
Should employees be required by law to participate in employers’
Should everyone be required to have health
insurance, much as drivers are required to have auto insurance?
Our system of health insurance
is linked to employment. Coverage is usually provided by the employer,
with some contribution from the employee. We now have many people
working part-time, or freelance, or working through other non-traditional
health insurance continue
to be linked to employers (our “employer-based system”) or is there
another preferred approach?
Who should decide when a healthcare service is medically necessary:
the doctor who is treating the patient or the insurance plan
who is paying the bill?
“Evidence-based medicine” tries to reduce variations in practice,
reduce inappropriate care, and reduce waste by using results of
studies of large groups of people as the basis for medical guidelines.
On the other hand, some feel that it is bad medical policy to apply
general rules to all cases and that medicine requires that the physician
use his or her knowledge of the particular patient in deciding on
the course of treatment along with the patient. What do you think?
Some feel that healthcare is a commodity like VCRs or computers
and that it should be distributed according to the ability to pay
in the same way that consumer goods are. Others feel that healthcare
is a need and that it should be distributed according to need. What
do you think?
Currently, individual health insurance
policies are much more expensive and/or do not offer the same services
as group insurance. However, in most states the law does not allow
people to form a group for the purpose of getting health
Should individual policies cost the same as group policies? Who
should pay the individual’s additional cost? (the individual? the
government? the insurance company?) Should it be legal for people
to form a group themselves, such as through the internet, for the
purpose of getting a group insurance policy?
How much, if anything, would you be willing to pay every month so
that everyone could have access to basic medical care? Nothing?
$25/month? $50/month? More? What should “basic medical care” be?
Who should decide?
the Tough Questions…of our candidates
questions below are presented courtesy of the League of Women Voters
Education Fund (www.lwv.org) and the Henry J. Kaiser Family Foundation
(www.kff.org). It contains excerpts from a nonpartisan public education
initiative to inform citizens, stimulate dialogue, and give the
public a greater voice in the health care debates during the 2000
following are sample questions you may want to consider in beginning
the dialogue with candidates on healthcare reform:
Do you think that all Americans should have health
Should the federal government help people who don't have health
If yes, should the federal government make a limited effort to provide
health insurance for
some of the uninsured, or make
a major effort to provide health
insurance for everyone?
Do you favor a specific proposal to reduce the number of uninsured
If no, why? Is this because you don't believe the government
should address the problem? Or for some other reason?
If yes, please describe the features of this proposal, especially
how it reduces the number of uninsured.
What share of the uninsured
would be covered as a result of the proposal?
How would the proposal affect those who already have health
How much would the proposal cost, and how would it be financed?
If you don't favor a specific proposal, would you support expanding
public programs like Medicaid,
the State Children's Health
Insurance Program, or Medicare?
Some advocate permitting early retirees to buy into Medicare.
Do you support this approach? Should the government provide subsidies
to help low-income early retirees pay their premiums?
Some advocate replacing the current system, which gives employers
tax incentives to provide insurance, with a new one that offers
individuals tax subsidies for purchasing private insurance. Do you
support this approach? Why or why not?
What is the best way to ensure that consumers in HMOs
and other managed care plans
are treated fairly and get proper care?
Should the federal or state governments-or both-develop and enforce
regulations that managed care
plans must follow?
Should the managed care industry
monitor itself and set voluntary standards for managed
care plans to follow?
Should a nongovernmental independent organization develop and enforce
standards that managed care
plans must follow?
Should health plans make it easier for consumers to see medical
specialists, for example, allowing women to see their ob/gyns without
referrals? Should medical specialists like ob/gyns be allowed to
act as enrollees' primary care providers within health plans?
Should health plans be required to provide an independent external
appeals process when someone is denied coverage for a particular
Do you support patients' rights to sue their health plan for medical
malpractice? q What effect do you think patients' rights legislation
would have on premiums and the number of uninsured
Do you think it would boost costs for people with health
Do you think employers might drop health coverage for their
workers, possibly increasing the number of uninsured?
With the Medicare population
doubling in the next 30 years, how should we pay for seniors' health
care needs in the future?
If the answer is the surplus, what happens if the surplus
doesn't materialize or goes toward other national priorities?
If the answer is higher taxes, what form of taxes would you
support (for instance, payroll taxes or taxes on tobacco products)
Some argue that Medicare needs
a major overhaul so that it resembles the private marketplace, where
competition among health plans helps control costs and foster efficiency.
Others counter that given the nature of the Medicare
population, a major restructuring would expose the most vulnerable
elderly and disabled citizens to great risks. What do you think
Should Medicare's eligibility
age-like that for Social Security be raised from 65 to 67?
If yes, are you concerned about the projected increase in
the number of uninsured
If yes, would you support allowing early retirees to buy into
Medicare? What is your
view on government subsidies in this case?
Should wealthier beneficiaries be asked to pay higher Medicare
If yes, what should be the income level for higher premiums?
Should prescription drugs be added to the Medicare
benefit package so that all beneficiaries have coverage for their
medications? What about long-term care
Many candidates have discussed the need to eliminate waste and fraud
in the Medicare program. Do you
think this is a widespread problem? What more should be done to
Drug Coverage for Seniors
Do you think seniors should have health
insurance that covers prescription drugs?
In your view, what is the best way to provide prescription drug
coverage for seniors? Why?
A Medicare expansion?
A program for low-income beneficiaries only?
An approach that encourages private insurers like Medicare
HMOs and Medigap plans
to offer such coverage?
Do you think the federal government should help seniors with their
pharmaceutical costs? If yes, how should the added cost to the government
Using the federal budget surplus?
Establishing new taxes?
How would you balance the need to promote research and development
of new drugs with the need to protect consumers and the government
from high prices?
If you had to choose which population to target for prescription
drug assistance, would it be seniors with low incomes or those with
catastrophic costs? Why?
Term and Chronic Care
Do you favor strategies for long-term
care coverage that expand public programs like Medicaid
If yes, should programs be limited to those with low incomes?
If yes, should programs cover nursing home care, home health
care, or both?
If yes, how should the additional cost to the government be
Do you favor establishing a new national program to meet the long-term
care needs of Americans?
If yes, would you support a social insurance model like Medicare?
If yes, would you support a block grant to states?
If yes, would you favor a program that helps people regardless
of income, or one targeted to those with low incomes?
If yes, how should the program be financed? If no, why not?
Some propose encouraging workers to buy private insurance to help
pay for long-term care expenses,
but many can't afford the additional cost. What would you propose
to help families that can't afford long-term