PBS- Healthcare Crisis: Asking tough questions

Asking the Tough Questions: Of Ourselves and of Our Candidates

Questions to Ask Ourselves

Wherever 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.

Below 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.

1. 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?

2. What should the government's role be in providing access to healthcare for Americans?

3. 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?

4. Do insurance companies and HMOs use unfair practices to control spending?

5. Should employers be required by law to offer health insurance to employees?

6. Should employees be required by law to participate in employers’ health insurance?

7. Should everyone be required to have health insurance, much as drivers are required to have auto insurance?

8. 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 arrangements.

Should health insurance continue to be linked to employers (our “employer-based system”) or is there another preferred approach?

9. 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?

10. “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?

11. 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?

12. 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 insurance.
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?

13. 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?

Asking the Tough Questions…of our candidates

This 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 elections.

The following are sample questions you may want to consider in beginning the dialogue with candidates on healthcare reform:

Health Insurance

• Do you think that all Americans should have health insurance?

• Should the federal government help people who don't have health insurance?

• 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 Americans?

• 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 insurance?

• 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?

Managed Care

• 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 medical treatment?

• 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 people?

• Do you think it would boost costs for people with health insurance?

• Do you think employers might drop health coverage for their workers, possibly increasing the number of uninsured?

Medicare

• 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) and why?

• 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 and why?

• 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 people?

• 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 premiums?

• 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 services?

• 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 address it?

Prescription 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?

• Tax credits?

• Do you think the federal government should help seniors with their pharmaceutical costs? If yes, how should the added cost to the government be financed?

• Raising premiums?

• 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?

Long Term and Chronic Care

• Do you favor strategies for long-term care coverage that expand public programs like Medicaid or Medicare?

• 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 financed?

• 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 care insurance?

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