Sample Q&A's for Health Activists

I. Framing the Debate

1. Why is real, systemic health care reform needed in this country? Isn't the cure potentially worse than the disease?

  • There is a health care crisis. Middle class and working families are hurting. Health care costs are skyrocketing while benefits are being cut. Access to quality care is being eroded.

  • The problems in the health system are urgent. They hurt patients, communities and the economy. Health costs affect our budget deficit and make Medicare's problems worse. We must take on this crisis as our top priority since it affects so many others.

  • Real improvements are needed. Tinkering around the edges is not enough. And, allowing the White House and Congress to continue to ignore this crisis — and, in some ways, make it worse — is not an option.

  • This nation has risen to such challenges before. We can — and will — craft a solution to provide affordable health coverage for all Americans.

2. Does the public really support health care reform? In the past, people support health care reform until they see the details. What is different now?

  • Americans have a long tradition of supporting affordable coverage for all. Past efforts have failed but not due to a lack of public support.

    • The extent of the crisis is what's different today. Health care is viewed as the top national and personal economic threat.

      1. Almost 47 million individuals lack health insurance in this country, where four out five uninsured Americans live in working families.

      2. Since 2000 alone, health insurance premiums have grown by 87 percent, while wages have grown by only 20 percent. This increase is nearly five times that of inflation.

      3. Nearly half of all small businesses no longer provide health coverage for their employees.

      4. American businesses are having more trouble competing globally while shouldering the burden of America's broken health care system.

  • Americans understand: It's just wrong for anyone who works hard, pays taxes and plays by the rules to go without decent health care or to be driven into economic hardship because of health costs.

3. Why health care reform over other priorities, such as the budget deficit and defense?

  • The problems in the health care system are urgent. They hurt patients, communities and the economy. Health costs affect our budget deficit and make Medicaid and Medicare's problems worse. We must take on these crisis as our top priority since it affects so many others.

    • Furthermore, health care is viewed as the top national and personal economic threat.

      1. Almost 47 million individuals lack health insurance in this country, where four out of five uninsured Americans live in working families.

      2. Since 2000 alone, health insurance premiums have grown by 87 percent, while wages have grown by only 20 percent. This increase is nearly five times that of inflation.

      3. Nearly half of all small businesses no longer provide health coverage for their employees.

      4. American businesses are having more trouble competing globally while shouldering the burden of America's broken health care system.

  • The President and Congress are now considering equally large and arguably more controversial policies such as permanently extending tax cuts to the wealthy. Improving the nation's health should be on the agenda — and we must put it there.

4. Are rising health care costs hurting business?

  • American businesses are forced to choose between providing health benefits or jobs. The health care system in our country is broken and needs real reform.

  • Nearly half of small businesses no longer provide health insurance, creating a “race to the bottom” for workers? benefits.

  • The real answer is not incremental reform but real reform that provides small businesses with the same options as large businesses, addresses the cost problems and makes coverage affordable for all workers.

II. Fixing the Broken Health Care System

5. Should the system be completely overhauled or should we build on the existing broken system?

  • We propose bold goals that can be achieved through practical solutions. Our current insurance options, while far from perfect, work for over 80 percent of Americans. We should build on and improve them, not overhaul them, to provide affordable coverage for all Americans.

    • Four bedrock principles should provide guidance for reforming the system:

      1. Providing affordable coverage for all Americans

      2. Reducing costs

      3. Maintaining choice of doctors and plans

      4. Making prevention a national priority.

  • Progressives aim to promote practical, value-based solutions to major problems, not develop ideal but infeasible plans that cannot be enacted in the real world.

6. Where's the detail? What benefits would you require to be covered? What specific cost containment policies would you embrace? Without these details, aren't you just offering a vague promise? Are you really serious about reform?

    • I support four bedrock principles for reforming the system:

      1. Provide affordable coverage for all Americans

      2. Maintain choice of doctors and plans

      3. Reduce costs

      4. Expand preventive care.

  • There are a number of policies that can achieve these goals. Working with Congress once it has committed to engaging in the debate is the best way to determine details and develop a coalition to successfully pass legislation.
  • We need to learn from the past. As we learned from the Clinton experience, developing a plan in private and outside of the political process does not work. And we learned from Bush that you can advance a major policy like a Medicare drug benefit using principles rather than detailed policy proposals.

7. Isn't covering all kids real reform?

Providing decent, affordable coverage to all children is both good policy and good politics. It is the natural endpoint to the efforts begun in the 1980s and 1990s to give families increased health coverage options for their children.

  • However, it is not enough. Overall, more children are insured than at the beginning of this decade. But, the number of uninsured Americans has increased by almost 7 million adults since 2000. People approaching retirement are increasingly losing job-based coverage; young adults are less likely to be offered it at work; and sick adults have fewer options as Medicaid is cut back.

  • Now is the time to provide affordable coverage to all Americans.

8. Why not address health costs first? Can we afford to add more people to this expensive system?

  • No doubt, the health costs are a critical issue and must be a priority.

  • A reformed health system must run as efficiently as possible. There are a number of proven ways we can control costs and improve efficiency, ranging from creating incentives to avoid duplicative tests, to greater investments in health information technology to reduce administrative burdens and improve quality, to creating prescription drug formularies that are based on clinical effectiveness not per-pill pricing.

  • However, ending the inequities and cost shifting that occur when 47 million Americans lack insurance is an important part of cost containment. Eliminating uninsurance will improve efficiency and lessen unnecessary use of emergency rooms that results from our gap-ridden system.

9. What about personal responsibility? Should everyone pay into the system? Should individuals play a larger role in their own health maintenance?

  • In a system where everyone benefits from health care coverage, everyone should help pay for it and share responsibility for health care costs.

  • Personal involvement is especially important in promoting health. Health promotion and prevention can improve lives and decrease health care costs for everyone. A focus on wellness, not sickness, is essential for a 21st century health system.

III. Defending Against Counterattacks

10. Won't people lose the coverage they have today? Won't employers drop their current coverage? Will Medicare be eliminated?

  • A core principle of real reform is to maintain the choices people have today.

  • But people should have more coverage options. Allowing all workers and employers to obtain insurance through a new group-purchasing pool would lead to greater choice of plans and doctors.

  • And, Medicare would remain a critical part of any reformed system.

11. Won't health care reform inevitably result in higher taxes?

  • Americans are already paying the highest prices in the world for health care. Family incomes can't keep up with rising health care burdens. And American businesses are having more trouble competing globally while shouldering the burden of America's broken health care system.

  • In part this is because the White House and Congress have allowed health insurance and drug companies to reap large profits as businesses, workers and states have struggled to pay for health care.

  • We need to enact real reforms that provide affordable health coverage, tackle health costs and end cost shifting.

12. Isn't this another attempt to create a government takeover of the health care system?

  • Real reform does not have to be radical change. Real improvements can be made without government-run health care.

  • Progressives believe in practical and responsible solutions, based on existing public and private systems that allow patients to have more choices — not less — in their health care.

13. What about drug price problems? Isn't this the key to cost control?

  • A number of policy options exist to reduce prescription drugs costs, including allowing Medicare to negotiate better prices for its beneficiaries; developing better information on the price and cost effectiveness of similar drugs; permitting the reimportation of safe, FDA-approved drugs; supporting incentives to allow generic drugs to get to the market faster; and cracking down on misleading drug advertising.

  • But the fact is, drugs account for only 10 percent of our overall health spending. As such, drug policies should be part of a larger plan to provide affordable health care to all.

14. Isn't medical malpractice reform key to health reform? Doctors claim that this is driving up costs through unnecessary tests and “defensive medicine.”

  • I agree that we need to act aggressively to reduce the cost of medical malpractice insurance. We need to keep frivolous lawsuits out of the courts, crack down on aggressive lawyers and unscrupulous insurers, and try to prevent malpractice to begin with through improving patient safety.

  • But medical malpractice reform will not solve the health cost crisis. A broader set of changes are needed to reduce prices, excess utilization and cost shifting.

IV. Placing Opponents on the Defensive

15. Why not include consumerism and choices as provided through Health Savings Accounts into your plan? Wouldn't this be a way to both reduce cost and gain bipartisan support?

  • “Consumerism” is often a code word for high-deductible plans in combination with Health Savings Accounts. These plans do little to reduce costs since most health care spending is on people who will exceed the deductible anyway. Instead, these plans shift costs to people who need care and allow prices to remain high — and special interests to profit. Americans knows that this approach won't fix our broken health care system.

  • Similarly, “choice” is a code word for turning over choices to health plans, as seen in the Medicare drug benefit. While seniors have the option to enroll in dozens of plans, they may not have the choice of affordable access to the drug that their doctor prescribes.

  • These approaches won't fix the real problems in our health care system. Instead, they will only exacerbate the problems with the status quo. If we really want to fix the health care system, we need to ensure that all Americans have affordable health coverage, while we control costs, maintain choice and make prevention a national priority.

16. Would you support Association Health Plans, which are being advanced by the White House and small business associations? It includes the same concept of a group purchasing pool that most progressive policy makers support.

  • Actually, the legislation is less about small businesses than stripping away consumer protections for all people. It would erode insurance for people purchasing coverage in all insurance markets.

  • I support proposals that provide all small businesses with a greater choice of quality insurance through group purchasing pools. But the plan being promoted by the White House would allow such groups to cherry-pick small employers, evade state policies that apply to the rest of the small market and actually drive up the costs for small businesses excluded from the pools.

  • The real answer is not incremental reform but real reform that provides small businesses with the same options as large businesses, addresses the cost problems and makes coverage affordable for all workers.