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Assist us to alert legislators & other consumers of your health care issues & suggestions for options.
Please complete the following form.

No information regarding any individuals who complete this form will be provided to any organization whatsoever.
Only statistical tabulations & suggestions will be provided to state & federal legislators.

Health care quality can be improved, availability can be broadened, and the caliber of providers should be held to high standards.

Health care problems and failings have become everyday political issues with politicians speaking out more during election seasons and less following their election. Employers including large corporations, small businesses, and sole proprietors, must frequently evaluate options, assessing their impact upon costs, employees, and operations. Employees must consider health care insurance premiums, features, and medical leave offerings in their employment decisions.

Today's health care providers, insurers, drug companies, delivery systems, and procedures have evolved over time. The system has obvious strengths and weaknesses. Health care reform must appropriately improve the general good without impairing the already high caliber of many aspects.

The information you provide below will be combined statistically and anonymously with other individuals' information. Trends and totals will be provided to legislators to support their assessments, and thereby help improve the health care industry where appropriate.

Health Insurance

Health Care Insurance -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Health Care Insurance -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Health Care Insurance -- Cost

Good

Adequate

Not adequate

Areas needing improvement:

The US health care system provides the highest quality & most available medical care in the world to all who need it whether they access it using a doctor's appointment, hospital clinic, or emergency room.
In actuality, currently everyone in the US can receive medical care anytime it is needed.

The US health care system needs some limited reforms. Specific problems that should be corrected include:

Please check each that you agree with.

Insurance Reform: Insurance should be owned by individuals and not connected to their employers.

Tort Reform: Those huge, sometimes frivolous multi-million dollar lawsuits, should be controlled.

Families & Individuals In Poverty: Government should provide a safety net to ensure that these people can get insurance if they want it.

Other reforms:

The ObamaCare plan includes insurance coverage for all citizens. All citizens will be subject to the plan's Article 1233 which states that a 26-member panel of experts will determine who is eligible and who is not eligible to receive costly medications, transplants, and life-extending procedures including surgeries. Do you support the Obama administration's efforts to pass the health care bill as it is currently proposed?

Strongly support these changes

Support these changes with other reforms

Against ObamaCare as it is currently proposed because it determines who will receive life-saving medications & procedures, and mandates end-of-life conditions

List other reforms you want:

Do you currently have a health insurance policy?

Yes	No	My health care insurance is provided by my employer.
The insurance company is:		About how long have you had this policy with this provider?

What is your age group?

Health Care Providers

Hospital Care -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Hospital Care -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Emergency Hospital Care -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Emergency Hospital Care -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Doctor care -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Doctor Care -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Nursing Care -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Nursing Care -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Assisted Care Facilities -- Quality:

Good

Adequate

Not adequate

Areas needing improvement:

Assisted Care Facilities -- Availability:

Good

Adequate

Not adequate

Areas needing improvement:

Government Involvement

Regulatory Aspects -- FDA, the Federal Drug Administration:

Good

Adequate

Not adequate

Areas needing improvement:

Regulatory Aspects -- The Federal Level:

Good

Adequate

Not adequate

Areas needing improvement:

Regulatory Aspects -- The State Level:

Good

Adequate

Not adequate

Areas needing improvement:

Regulatory Aspects -- Local Services:

Good

Adequate

Not adequate

Areas needing improvement:

If appropriate, provide a first-hand health care experience -- positive or poor -- that highlights the need for reform or for little change.

Please describe your issue:

Include adequate & reasonable detail regarding the events that led to your situation.

Please include any suggestions you have to improve this issue.

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Optional: Last Name:

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Where did you learn of HealthCareReformIssues.com?

Wall Street Journal

A Friend

A doctor or health care worker

USA Today

A search site named:

A government employee

News magazine

A blog named:

Other:

Upon receipt of your health care reform issue we will review and, if appropriate, include it in the package destined for legislators who are deciding the fate of your health care system.

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