Question 1 1. Which of the following statements best describes your view of our current health care system?

Our health care system is broken and needs a complete overhaul.

Overall, the health care system is working and needs only some minor adjustments.

Significant changes are needed to make our health care system work much better.

Candidate's Comments Under our current health care system, millions of Americans are uninsured or underinsured because of rising medical costs. Nearly 47 million Americans—including 9 million children—lack health insurance. Eighty percent of the uninsured are in working families. Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees. My health care plan will overhaul the current health care system by guaranteeing coverage for every American through partnerships among employers, private health plans, the federal government, and the states. The plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under my plan, Americans will be able to maintain their current coverage if they choose to, and will see the quality of their health care improve and their costs go down. My plan also addresses the large gaps in coverage that leave 47 million Americans uninsured. Specifically, my plan will: (1) establish a new public insurance program, available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) create a National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees or towards the cost of the public plan ; (4) mandate all children have health care coverage; (5) expand eligibility for the Medicaid and SCHIP programs; and (6) allow flexibility for state health reform plans.

Question 2 2. In a recent survey, a majority of Americans (81%) say they are dissatisfied with the cost of health care in this country. As President how will you address health care costs for Americans?

Candidate's Comments My plan will provide affordable, comprehensive and portable health coverage for every American while allowing the typical family to save up to $2,500 every year on medical expenditures. The savings in costs will be achieved through: Investing in health care information technology, which will reduce unnecessary spending in the health care system that results from preventable errors and inefficient paper billing systems; Improving prevention and management of chronic conditions; Increasing insurance industry competition and reducing underwriting costs and profits, which will reduce insurance overhead; Providing reinsurance for catastrophic coverage, which will reduce insurance premiums; and Making health insurance universal, which will reduce spending on uncompensated care.

Question 3 3. Do you agree or disagree that it is the responsibility of the federal government to ensure all Americans have basic health care coverage?

Agree

Disagree

Don't Know

No Opinion

Candidate's Comments I believe that every American has the right to affordable, comprehensive and portable health coverage.

Question 4 4. How well do you think the Medicare prescription drug benefit for seniors is working?

Working very well

Working well

Working somewhat

Not working well

Don't know

No opinion

Candidate's Comments I strongly believe that rising prescription drug prices must be tackled, and that seniors who participate in the Medicare program should have access to affordable and safe prescription drug benefits in a straightforward manner. That's why I will close the so‐called doughnut hole in Medicare prescription drug benefit program, and work to ensure that every senior receives an annual prescription drug report that details their prescription drug spending and outlines options for reducing annual spending on prescription drugs by switching to a new plan. Today, seniors are bombarded by too much confusing information about the prescription drug benefit, and a recent study has shown that many seniors are paying too much for the Medicare prescription drug coverage. As president, I will also employ a three‐tiered strategy to reduce the rising costs of prescription drugs for beneficiaries, all of which will impact the Medicare prescription drug benefit. First, I will support legislation permitting Medicare to negotiate prices for prescription drugs. I will repeal the ban on direct negotiation with drug companies and use the resulting savings, which could be as high as $30 billion, to further invest in improving health care coverage and quality. Second, I support drug reimportation. Pharmaceutical companies should profit when their research and development results in a groundbreaking new drug. But some companies are exploiting Americans by dramatically overcharging U.S. consumers. These companies are selling many of the exact same drugs in Europe and Canada for less than half the price that they charge Americans. I will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the United States. Third, I will encourage the increased use and development of generic alternatives. Some drug manufacturers are explicitly paying generic drug makers not to enter the market so that they can preserve their monopolies and charge Americans exorbitant prices for brand name products. My health care plan will ensure that market power does not lead to higher prices for consumers. My plan will increase the use of generic drugs in Medicare, Medicaid, my new public insurance plan, and the Federal Employees Health Benefit Plan, and it will prohibit large drug companies from keeping generics out of the marketplace.

Question 5 5. What strategies would you use to increase the focus on prevention and wellness in our health care system?

Candidate's Comments Increasing the focus on prevention and wellness is a critical part of my health care plan. Under my plan, we will realize tremendous savings within the health care system from, among other things, improvements in prevention and management of chronic conditions. A RAND study has predicted that roughly $120 billion can be saved by improving our efforts regarding prevention and disease management. My plan commits to promoting healthier lifestyles in schools, the workplace, and the home, as well as preventive services, disease management, care coordination, and other efforts. Too many Americans go without high‐value preventive services, such as cancer screening and immunizations to protect against flu or pneumonia. Providers are not adequately reimbursed for helping patients manage chronic illnesses like diabetes or asthma. Similarly, community‐based prevention efforts, which have helped to drive down rates of smoking and lead poisoning, for example, are under‐utilized despite their effectiveness. The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this, less than 4 cents of every health care dollar is spent on prevention and public health. Our health care system has become a disease care system, and the time for change is well overdue. I believe that protecting and promoting health and wellness in this nation is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce, and federal and state and local governments. Each must do their part, as well as collaborate with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt healthy lifestyles. Employers: I applaud the increasing number of employers who are offering worksite health promotion programs, which has included providing onsite clinical services, nutritious food in their cafeterias, and exercise facilities. Equally commendable are employers choosing insurance plans that cover preventive services for their employees. I believe that worksite interventions hold tremendous potential to influence American’s health and will expand and reward these efforts. School Systems: A generation ago, nearly half of all school‐aged children walked or biked to school. Today, nearly 9 out of 10 children are driven to school. And once there, children are not very physically active—only 8 percent of elementary schools require daily physical education. Childhood obesity is nearly epidemic, particularly among minority populations, and school systems can play an important role in tackling this issue. For example, only about a quarter of schools adhere to nutritional standards for fat content in school lunches. I will work with schools to create healthier environments for children, including assistance with contract policy development for local vendors, grant support for school‐based health screening programs and clinical services, increased financial support for physical education, and educational programs for students. Workforce: Primary care providers and public health practitioners have and will continue to lead efforts to protect and promote the nation’s health. Yet, the numbers of both are dwindling, and the existing workforce is further challenged by inadequate training about new health threats such as bioterrorism and avian flu, antiquated funding and reimbursement mechanisms, and limited access to real‐time information and technical support. I will expand funding—including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve working conditions— to ensure a strong workforce that will champion prevention and public health activities.

Question 6 6. Most agree that the use of standardized electronic health records (EHRs) will make the health care system more efficient and reduce medical errors. As President, do you think the cost of implementing EHRs should be paid for by the public sector, the private sector or some combination of the two?

Public

Private

Combination

Don't know

No opinion

Candidate's Comments It is essential that we modernize our health care system for the 21st century. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims. As President, I will invest $10 billion per year for five years to move the U.S. health care system to broad adoption of standards‐based electronic health information systems, including electronic health records. Small providers and those serving rural and underserved populations will be prioritized for financial support.

Question 7 7. The National Institutes of Health (NIH) is the agency that funds most of the medical and health research paid for by U.S. taxpayers. Since 2003, funding for the National Institutes of Health (NIH) has been outpaced by inflation. Which of the following statements comes closest to your view on funding for NIH?

Funding for NIH is not a priority.

Current U.S. funding for medical and health research is sufficient and other budget items are higher priorities now

The U.S. must increase investment in NIH as a critical strategy to improve health care

Candidate's Comments I strongly support increasing funding for the NIH. Even though biomedical research costs are increasing each year, annual funding for the National Institutes of Health (NIH) has not kept up. This isn't just counter-productive, it is a failure to keep faith with so many Americans who are in the fight of their lives against cancer and other diseases, and it overlooks our country's tradition of medical innovation.

Question 8 8. The Centers for Disease Control and Prevention (CDC) is charged with protecting the health and safety of Americans. In recent years, funding for core programs (such as chronic disease and injury prevention, tobacco control and environmental health) at the CDC has been cut. Which of the following statements most accurately reflects your view?

Funding for CDC core programs is not a priority

Maintain current funding levels for CDC core programs because other budget items take precedence.

Increase funding for core programs at CDC to improve public health

Candidate's Comments I believe that the CDC plays a critical role in our nation’s health care and national security infrastructure, and I will ensure the CDC has the resources it needs to fulfill its public health mission.

Question 9 9. The Agency for Healthcare Research and Quality (AHRQ) is the lead federal agency charged with funding health services research, which seeks to rapidly translate discoveries from research into medical practice and improve the quality, safety and effectiveness of health care. Since 2002, funding for AHRQ has been cut or remained flat. Which of the following statements most accurately reflects your view?

Funding for AHRQ is not a priority

Current funding for AHRQ is sufficient and other budget priorities exist

AHRQ funding should be increased as a strategy to improve health care quality and safety in the U.S.

Question 10 10. The Food and Drug Administration (FDA) is responsible for protecting the public health by assuring the safety and effectiveness of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics and products that emit radiation. Which of the following statements best reflects your opinion?

Funding for FDA is not a priority

Current funding levels are sufficient for FDA to fulfill its mission

Current funding levels for FDA are not keeping pace with accelerated drug and device creation or the increasing globalization of food supplies and should be increased

Candidate's Comments The Food and Drug Administration is a critical protector of our food supply, and assures our medicines are safe and effective. It regulates a full quarter of the American economy. Yet the FDA is badly underfunded for its responsibilities. As our economy brings a rising tide of imported products, the FDA urgently needs expert staff and technology to more rigorously inspect imported food, drugs, and other products like pet food. The FDA must also be freed from the Bush Administration's ideological straightjacket to protect the public health on the basis of sound science. As president, I will end the delays in approving RU‐486, the pressures to silence internal drug safety critics, and the attempts to protect drug companies from product liability.

Question 11 11. How important would you say it is that the U.S. work to improve health globally? If important, please describe how you plan to increase our nation's role in promoting and improving global health. If not, please explain why.

Very important

Somewhat important

Not too important

Not at all important

Don't know

No opinion

Candidate's Comments I believe that because what happens in countries around the world ‐‐ from the resurgent Al Qaeda presence in Afghanistan and Pakistan to the spread of avian flu in Asia and elsewhere – can adversely impact U.S. national security, it is very important for the U.S. to commit to strengthening the pillars of just and effective governments in these countries. I believe America’s security is strengthened when we strengthen those weak states that are at risk of collapse, economic meltdown or public health crises. As president, I will double U.S. foreign aid assistance by 2012, and ensure that we work with other nations to improve international public health.

Question 12 12. Do you support or oppose increasing federal funding for state/local health departments and hospitals across the country that are expected to prepare for and respond to threats to our health?

Support

Oppose

Don't know

No opinion

Candidate's Comments Covering the uninsured and modernizing America’s health care system are urgent priorities, but they are not enough. Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs, improving the health of the American people, or handling for the next catastrophe. Currently, our public health departments’ workforce and finances are stretched too thin to carry out traditional public health functions, such as ensuring our water is safe to drink, the air is safe to breathe, and out food is safe eat. These traditional public health functions have evolved to include responsibility for disaster preparedness and responding to both natural and man‐made disasters. Accordingly, I will champion a renewed focus and the necessary resources to improve public health and prevention. First, working together, governments at all levels should lead the effort to develop a national and regional strategy for public health, and align funding mechanisms to support its implementation. Second, the field of public health would benefit from greater research to optimize organization of the 3,000 health departments in this nation, collaborative arrangements between levels of government and its private partners, performance and accountability indicators, integrated and interoperable communication networks, and disaster preparedness and response. Third, the government must invest in workforce recruitment as well as modernizing our physical structures, particularly our public health laboratories. And finally, the government must examine its own policies, including agricultural, educational, environmental, and health policies, to assess and improve their effect on public health in this nation. As president, I will prioritize all of these activities, to ensure a 21st century public health system and a healthy America.

13. Current evidence suggests that the U.S. is experiencing shortages and/or poor distribution of certain health care professionals. How high a priority would you say it is for policy makers to create more incentives to encourage individuals to pursue careers as: Physicians?

A top priority

High priority

Somewhat of a priority

Not too much of a priority

Low priority

Not a priority

Don't know

No opinion

Nurses

A top priority

High priority

Somewhat of a priority

Not too much of a priority

Low priority

Not a priority

Don't know

No opinion

Question 13 Dentists?

A top priority

High priority

Somewhat of a priority

Not too much of a priority

Low priority

Not a priority

Don't know

No opinion

Question 14 14. Do you support or oppose expanding federal funding for research using embryonic stem cells?

Support

Oppose

Don't know

No opinion

Candidate's Comments I believe we owe it to the American public to explore the potential of stem cells to treat the millions of people suffering from debilitating and life‐threatening diseases. Stem cells hold the promise of treatments and cures for more than 70 major diseases and conditions such as Parkinson’s and Alzheimer’s disease, traumatic spinal cord injuries, diabetes, and more. As many as 100 million Americans may benefit from embryonic stem cell research. As president, I would: Promote Embryonic Stem Cell Research: I’ve been a long‐term supporter of greater stem cell research and I introduced legislation while a member of the Illinois Senate that specifically permitted embryonic stem cell research in Illinois. Support Medical Advancement and Innovation: I believe every American should have access to potential new cures and that restrictions on federal funding for stem cell research have led many leading researchers in the field to move to other countries. I cosponsored legislation in 2006 introduced by Sen. Arlen Specter (R‐PA) that would have allowed greater federal government funding on a wider array of stem cell lines. Expand the Number of Stem Cell Lines Available for Research: In 2001, President Bush restricted federal money to embryonic stem cell lines that already existed. Estimated to be about 78 at that time, the number of viable stem cell lines available is now only 22. I support expanding and accelerating research using stem cells lines. I am a cosponsor of the current Stem Cell Research Enhancement Act that would allow research on more stem cells derived from embryos donated for in vitro fertilization. My plan would reverse the president’s policy that has allowed hundreds of thousands of frozen embryos, left over from in vitro fertilization, to simply be discarded instead of being used to potentially save lives. Ensure Ethical Standards: I understand stem cell research needs to be conducted with the highest ethical standards. The stem cell legislation I introduced in the Illinois State Senate established review of this research by the Illinois Department of Public Health. Also, the Stem Cell Research Enhancement Act maintains high ethical standards by ensuring that only those embryos that would otherwise be discarded could be used and that the donors would have to provide written consent for the use of the embryos. I also support greater research to explore the viability of adult stem cells and cord blood.

Question 15 15. Do you agree or disagree that mental health services should be part of all health care plans in the public and private sectors?

Agree

Disagree

Don't know

No opinion

Candidate's Comments I am a long‐time supporter of mental health parity. I helped pass the Illinois mental health parity law. And my national public health plan will include coverage of all essential medical services, including preventive, maternity and mental health care. I strongly support mental health fairness and parity of mental health coverage in all federal health programs. I cosponsored the Mental Health Parity Act of 2007 and I am a supporter of the bipartisan Paul Wellstone Mental Health and Addiction Equity Act of 2007. Similarly, I believe in prohibiting group health plans from imposing treatment or financial limitations on mental health and substance‐related disorder benefits that are different from those applied to medical or surgical services. I am also committed to ensuring that Americans with disabilities or mental illness receive Medicaid and Medicare benefits in a low‐cost, effective and timely manner.

Question 16 16. Comparative effectiveness research compares two alternative treatments for the same condition to see which works better for the average patient. Many feel Medicare and private insurers should only cover the most effective treatment. Others feel, since comparative effectiveness only determines which treatment works best on average, the ultimate decision as to what treatment to be used should be left to doctors and not the government or insurance companies. Which is closer to your own view?

Comparative effectiveness research should be used by insurers and government to deny coverage for treatments that are less effective on average

Comparative effectiveness research should be used to inform patients and doctors but the decision on which treatment to use should be made by patients and doctors, not government or insurance companies

Don't know

No opinion

Candidate's Comments One of the keys to eliminating waste and missed opportunities in our health care system is to increase our investment in comparative effectiveness reviews and research. Comparative effectiveness studies provide crucial information about which drugs, devices and procedures are the best diagnostic and treatment options for individual patients. This information is developed by reviewing existing literature, analyzing electronic health care data, and conducting simple, real world studies of new technologies. I will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have accurate and objective information to make the best decisions for their health and well-being.

Question 17 17. Do you agree or disagree with the following statement? "The U.S. is in danger of losing its global competitive edge in science, technology and innovation." If you agree, what approach would you take to change this trend?

Agree

Disagree

Don't know

No opinion

Candidate's Comments I believe that the U.S. has the potential to lose its global competitive edge in science, technology and innovation unless we take steps to change the current trend. My plan will: Increase Federal Investment in Research. I support doubling federal funding for basic research in the physical sciences and engineering research. Federally‐supported basic research generates the innovation to create markets and drive economic growth but federal investment, as a share of GDP, has dropped by half since 1970. Make the R&D Tax Credit Permanent: I want to make the Research and Development tax credit permanent so that firms can rely on it when making decisions to invest in domestic R&D over multi‐year timeframes. Deploy Next‐Generation Broadband: I believe that America should lead the world in broadband penetration and Internet access and that we can get true broadband to every community in America through a combination of reform of the Universal Service Fund, better use of the nation’s wireless spectrum, promotion of next‐generation facilities, technologies and applications, and new tax and loan incentives. As a key step to achieving full broadband access, I believe the Federal Communications Commission (FCC) should provide an accurate map of broadband availability using a true definition of broadband instead of the current 200 kbs standard and an assessment of obstacles to fuller broadband penetration. Produce More Math and Science Graduates: We must strengthen math and science education to help develop a skilled workforce and promote innovation. I will work to increase our annual number of science and engineering graduates, encourage undergraduates studying math and sciences to pursue graduate studies, and work to increase the representation of minorities and women in the science and technology talent pipeline, tapping the diversity of America to meet the increasing demand for a skilled workforce. Reform Immigration: I support comprehensive immigration reform that includes improvement in our visa programs, including the H‐1B program, to attract some of the world’s most talented people to America. However, I would like to see immigrant workers less dependent on their employers for their right to stay in the country and would hold accountable employers who abuse the system and their workers. Ensure Competitive Markets: We need a business and regulatory landscape in which entrepreneurs and small businesses can thrive, start‐ups can launch, and all enterprises can compete effectively. I support the principles behind Sarbanes‐Oxley reforms and believe compliance should not be overly burdensome for smaller firms and start‐ups.