Health care reform is probably the most hotly contested issue in the country right now.

As lawmakers rally for support of proposed federal legislation at town hall meetings across America, citizens are calling for simple answers to complex questions.

The Business Journal held its own online “town hall meeting” earlier this week and got responses from readers on what they would do if they were in charge of health care reform.

Readers were asked:

“If I was in charge of health care reform, I would ... ”

De-link health care from employment. Employers who offer health insurance are at a disadvantage compared to employers who do not. In difficult times, employers may reduce or eliminate health coverage or lay off employees or not hire new ones. Employees also are disadvantaged by the employment link as they sometimes cannot afford to change employment due to health insurance problems such as pre-existing conditions or no insurance or waiting times with new employment. Also, employees lose their coverage if they are laid off, even though it is not their fault. Health care is a right for all citizens and legal residents. The Constitution states one of the purposes of the U.S. is to promote the general welfare of the people. Health care is certainly an important part of the general welfare of our country.

Dean Gordon

Increase competition amongst insurance companies by opening state borders. Stop the pharmaceutical companies from advertising prescription drugs to the public (about 30 percent of the cost of our drugs). Allow individuals to purchase drugs outside the U.S. to increase pressure on drug companies to lower drug prices. Institute reforms which would keep insurance companies from denying coverage because of pre-existing conditions or cancelling while their client is ill.

Try to get the focus off of insurance through employers and consider reforms which would increase portability and shift responsibility to the individual, such as government refundable tax credits to be used for insurance purchases.

Increase the use of health savings accounts. Institute tort reform to bring down medical malpractice insurance costs and eliminate unnecessary defensive medicine practices. Study the German system, where the government pays and the private sector runs the system — with nonprofit insurance companies.

Victoria Salisch

Find a way to offer — not force — those who do not have health insurance affordable coverage. The very poor have assistance thru Medicaid. It's the working poor to middle income people who fall through the cracks.

Individuals and small companies should have the ability to pool together or participate with large co-ops to improve the buying power and affordability. Forcing employers to act against their bottom line is wrong. Give them affordable options and more will participate. Encourage citizens with tax credits or other incentives, not penalties.

Claudia Stanley

I would implement single payer universal health care that would be comprehensive, including dental, mental health and other holistic health care services. This would be done through the consolidation of administration and overhead currently spent on costs, including worker’s compensation and current Medicare payments.

Charles L. Krugman

Research how to combine workman’s compensation funding with health insurance funding, auto insurance bodily injury funding, Medicaid, Medicare, etc. and see how one insurance policy could insure for total health insurance. Once legislation was passed to deal with this new insurance coverage, I would then let it operate for a least five years before trying how to insure those who want to be added at no cost.

I would also research why many employees have to get tested for drugs to get a paycheck while the unemployed can enjoy drugs and not have to worry about drug testing.

Bill Myers

Be sure there was a public option available to all people, regardless of pre-existing conditions. Also, there should be no cap on the health care spent for a particular illness for a person.

People losing their jobs would be able to enroll in the public option, which would be a seamless transfer over.

Martha Ann Carruthers

Do not have all the answers, but I would start with the system currently in place. Eliminate inefficient agencies, start looking at the governmental agencies that are currently in place, require them to do what they were created to do. Start to cut the fat, make sure the pieces that are in place are actually working. A huge downfall of government agencies and employees of those agencies is they become complacent, working towards what's always been done, as opposed to doing what they're supposed to be doing and doing it efficiently.

Scrapping the current health care system and creating a universal health care system is not the answer. "Efficient government" is an oxymoron. The idea of the federal government running health care is absolutely pure idiocy — just another arena our president has no experience in, another power grab. Social Security is almost bankrupt due to those who have no foot in reality making all the decisions. Watching this country implode is heartbreaking to me.

Lori Hunter

Begin to work on a national health system which would include all. During the transition period, a single payer system similar to Medicare would allow a much higher percentage of health care dollars to go to the provision of services, rather than spending approximately a third on administration and insurance paperwork as we do now.

Leni V. Reeves, M.D.

I would begin by reviewing our present system issues. I would then set up committees to find out what can be done with the current system to improve it. Next, steps would be taken to minimize fraud by removing the existing health care abusers and fining them or giving them the maximum jail sentence allowed by law and removing them from ever participating in the system. I would then explore changes to the existing system by meeting with business leaders and all relevant "stakeholders" to review viable solutions, alternatives and options to augment the good parts of our system with minimal government involvement. I would then select the best options and alternatives to the present system by using in part, the following criteria:

1) Keep new changes simple and able to be explained with a minimum of ambiguous verbage.

2) Each new selected program would be justified by a cost benefit analysis to taxpayers. Finally, selected programs would have to benefit the most uninsured at a reasonable cost to all.

Bernard Liscano

Definitely create a program that has a public option, single payer, or expand Medicare. As a retired nurse practitioner, I know firsthand people are dying unnecessarily due to our current health care system. If we are to have a strong nation, we must have healthy citizens.

Renee Potik

Free up the market for health insurance, so individual policies have the same tax advantages as employer policies, individuals are free to choose policies from any state, and everyone is encouraged to buy catastrophic coverage with health savings accounts to cover day-to-day expenditures.

Jared Gordon

Expand Medicare to all citizens and legal residents after clarifying what it covers, so it is truly "basic coverage." Private insurance could then be purchased by those who want to spend their resources on supplemental coverage to get a higher level of care.

Vern Crowder

We need a system that encourages more insurance companies to get into the health services field. This would make it more competitive to control costs. Currently we only have Blue Cross/Blue Shield and the HMOs like Kaiser that control the market and the high price of health insurance.

The insurance companies have become a bureaucracy that certainly adds to the cost of our premiums. One way insurance companies can balance out premiums would be to charge more for younger adults that make more money and require less health services. Then, on a sliding scale, reduce the premiums as adults get older and start their families. When they become seniors, most will be on Social Security. Employers should require employees to pay a portion of the premiums, especially those with dependents.

Paul Saito

Reform tort law, allow health care insurance to be purchased anywhere in the country, standardize medical reimbursement forms and create a competitive model that would allow people to shop for the highest quality, lowest cost service.

Don Watnick

Create incentives for healthy living and a healthy diet.

The cost burden of health care would be substantially reduced by simple incentives to keep weight down, eat a balanced diet, exercise and pre-need medical checkups.

The issue of public or private is a false issue. The public and private sector both pick up the cost of those who cannot afford health care. However, it's just a lot more expensive to treat uninsured people in high-priced, high overhead emergency rooms where they cannot be turned away.

I know a person who called 911 to get an ambulance to go to emergency because she had a headache, did not drive and was out of aspirin. Between the free ride, the mandatory tests and the staff time, the cost was over $1,000 dollars. We all pay for abuse like that.

Vic Pasnick

Work with insurance carriers to work out a plan that does not bankrupt the insured, promotes more qualified people to get into the medical field, does not socialize our nation, but creates and continues our basic beliefs in private enterprise. I would delve into the reason for the medicines being so expensive. Really, there has to be a solution that conservatives could come up with that does not bankrupt individuals or the country.

I am scared of the direction our country is going and don't understand the nincompoops who think Obama and his cohorts are leading us in any direction that could be advantageous.

Marilyn Sikora

Ensure that any measure was constitutional. I would then approach the issue by addressing the issues that are known to all as impediments to providers, such as malpractice insurance premiums and insurance companies that can issue policies state-by-state. After enactment, I would wait at least 18 months before doing anything more, then adjust what was done or move to the next issue for fixing.

Gary Pigg

Ensure that all citizens are covered by health care without pre-existing conditions. It is our right as human beings. Insurance companies should not profit on health care. There needs to be a nonprofit status of insurance companies. No one should make money on wagering if someone is going to be ill or not. Insurance companies should not be able to pull coverage because their "claimant" is ill. No one should lose their coverage because they have cancer and are too ill to work. Our current system is inhumane.

Lillian Fillpot

I would enact a single payer form of health insurance that would enable everyone to get the health care they need when they need it.

Medicare is a government program and it works very well. It needs some tweaking and it must pay physicians a decent revenue, but on the whole it works for the average person over 65.

Vivian Haas

Clarify and broadcast the effects of not doing reform, currently and in the near future. Our society is now paying the bills for use of emergency rooms as primary care and lost productivity in the workplace by those who are ill without adequate or any health insurance and who are not using preventive care or don't fill the prescriptions given to them because of prohibitive costs. These are often the working poor.

Mental health care should be part of the package (we are now seeing the local closing of mental health programs for children). Surely we can correlate the levels of school dropout and crime with inadequate health care through childhood and the child-bearing years, another bill society is paying now.

I would bring obesity and its related health costs to the forefront along with payment for nutritional guidance. We all pay now for the epidemic of obesity. These issues are not receiving a coordinated press/public review.

Not providing health care for all is not an option.

Gaylee Amend

If I was in charge of health care reform, I would start by explaining to the public why it is imperative that we adopt nationalized medicine.  

By starting with the facts, the plain and simple truth, I would ask this question... "Do you believe that the United States of America has the best health care system in the world? Then I would explain that if you answered yes, you are sorely mistaken. If you are also among the tens of thousands who believe we should never end the life of the unborn or of innocent children, then morally you can no longer be against nationalized medicine.  

According to two studies, the first by the United Nations, the U.S. ranks 33rd among all countries in terms of infant mortality rate (infant death). Even Cuba has a lower infant mortality rate than we do and ranks 28th in the world. If you would prefer to hear the statistics done by the CIA, their 2009 World Fact Book List ranks the U.S. 46th. Even Slovenia ranks 27 countries better at keeping babies alive than we are. The bottom line is we have 47 million American's who are uninsured and can't afford prenatal care or the cost of a pediatrician.
In a 2008 study by Forbes Magazine, of the top 15 healthiest countries in the world, the U.S. ranks 11th. An even more interesting fact derived from this study is the 10 countries that rank ahead of us all have national health care. In fact, we are the only country out of the 15 who don't have it.  

On a personal note: my husband, who is a citizen of the United Kingdom, had a heart attack here at the age of 43. Had we not had insurance, his medical bills could have totaled nearly a quarter of a million dollars. Our out-of-pocket costs were insane anyway. Had he had his heart attack while visiting his family abroad, however, his total cost for everything would have been $0. He has recently been told he is going to need $10,000 in additional health care. We don't have an extra $10k. So, for the price of a $500 plane ticket, he will head home to Wales, see his caregiver, visit his family and fly home. Total Savings to us: $9,500.

Why are industries allowed to promote foods that make us unhealthy and obese? We need to develop a health standard: if an item fails to meet its requirements, it can't be marketed. We also need an environmental standard: if an item doesn't meet it, it cannot be produced. It is just common sense, but it goes against the free market. This alleged freedom is destroying people's lives and the planet. But since some are getting rich off of it, our greed market allows it.

Common good should replace greed. Greed is a habitual illness, an ugly obsession that divides rather than unites. The idea of common good shares the wealth rather than hoards it. And lobbyists should not be allowed to buy influence on these things; it just doesn't make any sense the way things are now. Sharing is pretty revolutionary.

Ruth Austin

Focus on the needs of those who are able to carry health insurance now. The prices for the insured have risen dramatically due to the overabundance of those who are not insured. The reason for this is due to requirement for hospitals to aid those in need, whether they have insurance or not. At this point in time, it would be best to focus on a way to assure those who are insured have a national database to which they are enrolled in. This way, when the insured has health needs, they are able to receive such care immediately as the hospital and doctor may verify their insurance information. Unfortunately, there has to be a point in time where the insured stops paying for the uninsured. If this means having to turn people without insurance away, so be it. As the cost of health care becomes more affordable, insurance premiums will reflect such decreases, making insurance more affordable for many others.

Health care for all is a romantic dream that is ultimately the same as asking for world peace.

Justin Poore

Ensure availability of an American Plan — a public alternative to the insurance companies — to provide coverage for the uninsured with cost control, no preconditions, no denial of care, keeping care when you change jobs or get sick, an end to exorbitant deductibles and no lifetime caps. An American Plan would protect doctor-patient choices and put an end to insurer rationing of health care for profit-related reasons.

Insurance companies make life and death decisions, but are not accountable to citizens. Their profit-driven structure amounts to private taxation of the public: insurers in effect tax those of us who do have health insurance by the 20-30 percent of our premium payments that do not pay for our health care, but go directly to profits and to profit-protecting denials of care. We are taxed without representation, but we can't vote out the people who are taxing us. An American Plan would offer an alternative to private taxation and would reintroduce competition into the insurance market.

Patience Milrod

Push for universal single payer health care. If that wasn't possible, I would want insurance companies to be unable to drop people for pre-conditions, raise rates or drop people when they become ill. I would make sure the income of CEOs and other management was not more than $500,000. I would make sure every person was able to afford insurance; if they couldn't pay for it, there would be programs to help them pay. Every child should be covered, no matter what. Dental and vision must be included and at 100 percent of coverage. Health insurance should be covered at 100 percent or very, very close. All Americans should be able to expect at least the same degree of coverage as members of Congress, veterans and those in the military.

Vickie Fouts

Immediately create a national health care agency which would contract with all deliverers of health care and health care products to provide their services and products without charge to anyone in need in the U.S.

I would issue a declaration that to hold the health and well-being of any person hostage to the greed of the health care industry to be an abomination and a crime against humanity.

The national health care agency's structure would follow the outline of California Senate Bill 840 now sponsored by Mark Leno.

A person's health is at least as important as schools, roads, fire and safety, and libraries -- all of which are provided without charge.

Let us join the rest of the industrialized world in respecting the well-being of all people. It is unconscionable to burden the cost of health care delivery with a 35 percent overhead required by the bloated salaries and profits of the health care industry when Medicare runs very well at less than 6 percent overhead.

William Tranquilli

Understand we can't all be healthy unless all have affordable access to health care and that the for-profit health insurance industry is responsible for some of the major factors attributed to expensive and unequal health care.

Health care is about people, not money. Full emergency rooms make all of us potentially vulnerable. Charges of costs to patients are unacceptable in many hospitals. Billing systems are out of date for today's world. The cost as a percentage of GNP for health care is bankrupting the country. Salaries for top executives of health care facilities and insurance company executives contribute to the problems of health care. Workers already pay too much for the health care we have. Modeling the best of other countries health care systems is not lunacy, but patriotic.

Stop the madness. Reform now.

V.E. Kral

I would study the best of the programs other countries have for health care and create one with all their best advantages combined. It would be single payer, the government.

Nancy Marquez

Make sure no one was left out of the system and no one was prevented from having health care because of pre-existing conditions. I would make sure there was a way those who are poor or unemployed could continue to be covered and that no one -- not doctors, not drug companies, not hospitals -- could charge excessive amounts to those who are insured to cover those who are not.

I think health care should be a civil right for all Americans -- just like voting. Obama administration, don't give in. Keep fighting -- this was the change people voted for, even though they are scared of the budget growth. We will pay for it as the economy improves. Don't wimp out.

Diana Decker

Establish a system where everyone is covered, where it is portable from job to job or unemployment, where cost is based on income or lack of, where no one can be denied coverage for pre-existing conditions, where there is no doughnut hole in drug coverages, where patients choose there own doctors and medical facilities, where there is no insurance industry to decide on who in entitled to be treated, and where the profit motive is taken out of the equation of health care.

One of the best ideas that meets most of those requirements has been around for a decade and was vetoed by the Terminator in California: Senate Bill 840, former Sen. Sheila Kuehl's Single Payer Bill. It is now SB 810 (Leno) and it would actually save money for the state, school districts, county and city governments. The only groups that would not be to happy about a universal single payer system, of course, are those that profit from the current system: the insurance industry and Big Pharma.

Gene Roza

I would make health insurance mandatory, but allow persons who are unable to afford private pay insurance to enroll for coverage under Medicare by paying a premium based upon their income

I would create a national "Office of Insurance" with the authority to regulate health care and the insurance practices by imposing and enforcing rules which address the problems that have arisen under our system.

The Office of Insurance would be authorized to set reasonable insurance reimbursement rates. Insurers would be prohibited from paying less than the approved amount to a provider for service. Rules would be uniform without regard to whether the provider was "approved” or not.

The Office of Insurance would be authorized to establish and enforce uniform, expedited billing processes.

Richard Barron

Model health care after public education. There would be a single-payer government option to compete with private insurance and use the market and competition to drive costs down.

Individuals who wish to purchase private insurance may still do so as they do today. The government option would compensate primary care physicians more equitably compared to specialists and have an emphasis on prevention and early detection, again lowering costs.

The cost would be spread through income taxes on all individuals working in America without a maximum wage base or maximum annual withholding. This would make every employee in the U.S. responsible for health care, as opposed to the burden being placed on employers as it is now. Ideally, American workers would not see a change in their net take home pay, because the increased taxation would be offset by the elimination of benefit premiums.

Patrick Seitz

Work to increase the availability of medical care as it is meaningless to provide insurance if there are inadequate providers able to take it. Even families with health insurance often have difficulty finding a practice taking new patients and/or obtaining appointments as the providers are generally working at capacity. Nothing in the present bill increases the amount of medical care available and therefore will have little impact on increasing access to medical care. Having insurance without enough providers is like having a wealth of airline miles with a calendar full of blackout dates.

Celene Resong

Make sure all the people have access to health care, not just the politicians.

• Each child would be immunized from illnesses.

• Mental health services available to all, including those in jail, institutions, and schools.

• Invest in therapy; many wouldn't need expensive medications that cause side effects.

• Services to dentists would be accessible to every person.

• Underwrite the fees to gyms so people could use them.

• Make schools open up and be made available to the neighborhood for activities.

• Control the doctor's fee.

• Control the drug manufacturer’s fees.

• Make sure that every child has access to a school nurse.

As a member of Kaiser of Northern California, I am pleased with the outcome of my health treatment. Everything is available from head to toe, and I wish similar types of services were available to everyone, even those without jobs.

Above all, I would freeze health care coverage for the politicians until every woman, child and man has the same equal coverage.

M. Gloria Hernandez

Make it possible for every American citizen to have good and affordable health insurance, which could not be denied to a person because of a pre-existing health condition and could not be cancelled when a person develops a health problem or when a person leaves a job which had provided health insurance.

Eleonora DeWitt

•     •     •

Make your opinion count

You may have missed the chance to participate in this survey, but we still want to know what you think about health care reform and other important issues.

Send letters to the editor to  This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or Editor, The Business Journal, 1315 Van Ness Ave., Ste. 200, Fresno CA 93721.

 Please limit letters to 250 words. All submissions must include name, business affiliation and telephone number for verification. All letters are subject to editing for clarity, length, style and grammar.