Health, Biomedical Science and Society Initiative

Questionnaire to the Candidates

Note: The questions that follow are intended for the presidential candidates.

Preamble to the questionnaire

The Aspen Health Stewardship Project (AHSP) was established by The Aspen Institute in the fall of 2007, and as part of its charge, has created this questionnaire, which is intended for candidates to clearly explain their perspective on the American health care system, how they characterize its weaknesses, how they intend to reshape the system and how they plan to sustain their program.

Led by a diverse cross-section of national thought leaders, AHSP’s work is an innovative, non-partisan effort to frame a more multi-dimensional health care dialogue by focusing on the long-term, fundamental issues that will need to be addressed in order to fix America’s broken health care system. This effort seeks to educate voters about what it will take to achieve true reform. And, ultimately, it calls on the presidential candidates and policy makers to develop plans that will meaningfully address the barriers that are preventing the nation from successfully dealing with health care ? our most pressing domestic problem.

A major premise of this project is that surmounting the many barriers will require changing a culture in health care that is designed to protect and perpetuate the status quo. The current system makes it difficult, if not impossible, for Americans to be thoughtful, active and responsible stewards of their overall health. Cultural change also will require a shift in the focus of the public dialogue. Only by reframing the health care debate from one focused on the symptoms of the country’s broken system to one focused on causes, can the country have a more substantive discourse about the stewardship role each of us play in creating a healthier America.

To help us evaluate your proposals and their feasibility, please answer each question in as much detail as possible and return the completed questionnaire by March 15 to Michelle McMurry-Heath, project director, at michelle.mcmurry@aspeninstitute.org. All responses and our findings will be published and otherwise shared in a public forum. If you choose not to answer, we will use public statements and campaign documents to infer your position. If you have any questions, please contact Michelle McMurry-Heath (202/550-8830) or Noah Bartolucci (202/736-2535) at the Aspen Institute.

Thank you for participating in this important process.

Question #1

The United States spends more than any other nation on health care, both per capita and as a percentage of gross domestic product. Even so, in a recent study of 18 leading industrialized nations, the United States finished dead last for the number of deaths that could have been prevented through effective health care. What three fundamental aspects of the country’s health care financing and delivery model would you seek to change to create a more sustainable, just, and effective system?

Question #2

Overall do you feel that the United States spends too much or too little on health care and why?

Question #3

When people talk about the need for health insurance, they often neglect to identify the real problem: improving the health of Americans. And health insurance rates alone do not tell us much about insurance type, affordability or quality of care. Beyond the number of people with health insurance, how will you define and measure the success of your health proposals and their impact on health outcomes?

Question #4

While the country has a clear interest in improving the health of its citizens, the incentives built into the system do not seem to promote that desired outcome. For instance, physicians are sometimes reimbursed in a manner that rewards the volume of care delivered without regard for quality. How would your proposals realign incentives to change how insurers, providers and patients view their respective rights and accountabilities for health?

Question #5

Creating value in health care is of paramount importance, however, in our current system misaligned economic incentives thwart efforts to achieve this end. Please discuss how your plan will create and measure value to ensure it is a vital component in America’s health care system. Be certain to include specific metrics and case examples.

Question #6

It is thought that as much as 40 percent of health care costs are related to behavior, such as smoking, eating an unhealthy diet, lack of exercise and alcohol consumption. At the same time, public health experts have shown that these choices are influenced by policy, the accessibility of healthy options, and corporate and social marketing. How will you encourage healthy choices? How will you shape policy and incentives to encourage businesses to make choices that emphasize early health, wellness and prevention among their employees and customers?

Question #7

Simply having access to health care is not enough to achieve equity in health outcomes. Income level, race, gender and location are just a few of the factors that contribute to the health of Americans. For example, women are less likely to receive the cardiac care that they need and on average have outcomes worse than men. How would your health care system promote greater equity of health outcomes among men and women of different races, income levels and geographic locales including, but not limited to, access to traditional insurance?

Question #8

With the right information at their disposal, consumers could take greater charge of their health, wellbeing, and illness. To that end, what will you do to ensure that health information is readily accessible, meaningful, and accurate so that it helps people make decisions and take action?

Question #9

For years, health care technology has been developed for use by doctors and other health care providers. Still, we lack wide scale use of electronic prescribing, electronic medical records and other important health information technology tools. What specific incentives would you favor to enhance the adoption of health information technology? What will you do to encourage free and secure data sharing among providers for the benefit of patients?

Question #10

Given the rapid changes in how technology is used to deliver care and how biomedical breakthroughs are used to treat and predict disease, health care will need to be provided in innovative ways. What will you do to encourage innovation in biomedical research, the science of prevention and the delivery of care? How will you promote the use of these advanced technologies to improve health?

Question # 11

The range of health professionals needed is changing. Some groups have projected shortages in essential health providers ranging from nurses and primary care physicians to allied health professionals. What would you do to encourage entry into and retention within these essential health fields?

Question # 12

Do you feel that portability of health insurance is an important part of improving health? If so, how would you structure a portable health insurance system to make it affordable and effective?

Question # 13

There is a great deal of evidence that policy decisions in areas such as education, taxes, environment and labor can have as much of an impact on people’s health as policy decisions that address health directly. How will you measure the health impact of your non-health policy decisions?