As a member of the New Jersey Senate Health, Human Services and Senior Citizens Committee, I learned first hand how health care costs are changing the way the consumer can access the best health care practitioners, affordable insurance policies, and self-autonomy in health-related decisions. As a candidate for the United States Senate, I know there may be no greater challenge before us as a nation than to fix a health care system that is failing the patient and the practitioner, especially in light of the fact that too many Americans do not have health insurance. Improving affordability, accessibility and stability in the health insurance arena will require new approaches, such as availability of Health Savings Accounts (HSAs). HSAs empower individuals in their health care decisions and give them an asset that they own, control and use for their health care as they grow older. As a state senator, I sponsored a law that will enable New Jersey residents to now take advantage of HSAs in New Jersey, and also proposed new legislation that would make employers’ contributions to HSAs not just tax-free but also tax-deductible.

I support empowering individuals and families to choose and control their health care decisions and coverage, especially as they grow older. Enabling small businesses and the self-employed to join together in Association Health Plans and collectively negotiate better prices and services for their health insurance plans is a step in the right direction. I also support allowing individuals to have the same 100 percent deductibility for health insurance costs that are currently enjoyed by business.

2. For several years, Medicare Part B spending has risen more than the average rate of economic growth in the U.S., while physicians and other Part B providers under current law have to absorb these costs in the form of reimbursement cuts calculated by a Sustainable Growth Rate (SGR) formula. Congress has intervened and temporarily suspended the mandated reimbursement cuts for 2003 through 2006, which has been followed by continued growth in utilization and intensity of health care services, in Medicare Part B spending, and in beneficiary premiums for Part B services – a dynamic which CMS Administrator Mark B. McClellan, M.D., Ph.D. has called a "vicious circle of rapid growth in utilization and spending." There are currently two legislative proposals [HR 5866 and HR 5916] to replace the SGR formula. What do you think should be done to address this problem?

As an elected official, I would support programs that would improve physician pay rates in order to reflect increases in the costs of practicing medicine today. This would include finding and supporting the most efficient and productive plan to cover such increases. However, I would also fight the actual sources behind such rising costs, such as increased frivolous litigation, lack of choice and negotiating power for patients and physicians in dealing with insurance carriers, and an increase in unnecessary regulatory burdens on our physicians.

The bottom line is that all patients – not just Medicare patients – will be affected if the rising cost of practicing medicine continues to drive doctors out of the profession, either to an early retirement or changing professions entirely. But we obviously cannot afford, both literally and figuratively, to inhibit the remaining physicians by limiting the number of patients they are able to treat. Groups such as military families and the elderly will be affected tremendously, as will the baby boomers when they begin to enter Medicare in a few years.

However, if the costs of practicing medicine were actually devoted to practicing medicine (especially in a day when people are living longer and technology provides for the ability to treat more diseases), physicians would be able to provide the supply to meet the demand. Instead, our physicians are forced to make decisions as to how they practice, what they charge, and who they treat based on their fear of lawsuits and an expectation of large cash settlements. Or, they leave the practice of medicine altogether. My proposals for Medicare reform aim to strike at the root of the problem plaguing the health care profession – eliminating these lawsuits, allowing individuals more control over their health care plans, and allowing for smaller businesses to collectively negotiate health care plans for employees.

3. Consumer-driven health care – in the form of high deductible health plans and price and quality transparency initiatives – is being touted as a movement to hold down health care costs, provide more choice and autonomy to health care consumers, and lead to more competition on price and quality. What is your view on consumer-directed health care, and what role do you think the federal government should play in supporting it?

The power of the individual in our health care system is crucial to its success. When patients know that they’re in charge of managing their own coverage, they’ll make more of an effort to stay as healthy as possible. As a United States Senator, I will fight to protect the autonomy of individuals, families, employers, and physicians in selecting and negotiating health plans. This means preserving their right to choose among a variety of health care plans, which will improve negotiating power, service quality, and, most importantly, the physician-patient relationship.

This autonomy, however, cannot be limited merely to logistical service-related decisions. Every day, individuals are also making lifestyle choices such as eating habits, exercise regimens, and whether or not to smoke. If we are going to emphasize personal responsibility over our own health, Congress must also fulfill a significant role in this regard. I strongly believe that, as we strive to enhance new breakthroughs in an outdated, flawed health care system, Congress has the obligation to perform the three E’s: educating, enhancing, and enacting/enforcing.

Educating: We must start early in emphasizing individual responsibility for personal health, and therefore, our schools are the perfect place to start. Mandatory health classes, preservation of physical education, teaching children at an early age about the dangers of drugs, smoking, and excess drinking, and maintaining funding for healthy school lunch programs are a start.

Enhancing: Congress must also make sure that corporations provide accurate information to its consumers – whether it applies to the risks of smoking, alcoholic contents, or nutrition labels on boxes – if we champion individual responsibility for personal health care, then we must enhance their ability to make well-informed decisions about how they treat their bodies.

Enacting/Enforcing: Finally, Congress is the entity by which we must enact and enforce laws which treat our public health issues. As a state senator, I sponsored and supported legislation to ban smoking in public places within New Jersey, establishment of regional substance abuse facilities, and various other laws to address public health issues. Furthermore, we must enforce our underage drinking laws, our drug laws, and our laws which strike out against violence.

As your next United States Senator, I would support legislation that would provide the public with information and programs that allowed them to make the best lifestyle decisions possible.

4. Many in government and the private sector have talked about the importance of interoperable health information technology products – such as electronic health records and electronic prescribing systems that can communicate and share data with each other – in fostering networks so that consumers and health care organizations have secure and widespread access to that information. Studies have shown that it is not cost-effective for most physician practices to purchase those systems on their own. What role do you think the federal government should play in facilitating the adoption of this technology?

Our fundamental health care coverage system was based on the world of yesterday, not tomorrow. Health care providers today spend too much time on excess paperwork and needless complexities – time that could be spent treating patients so they can leave the hospital and return to their lives. Such unnecessary intricacies interfere with our ability to utilize technology to revolutionize how our doctors practice medicine. Interoperable health information technology products such as electronic health records and prescribing systems would clearly be a step in the right direction in allowing our providers to communicate faster and more thoroughly. Presently, however, the outrageously high costs of practicing would prevent most practitioners from purchasing those systems. The federal government’s role in guiding us into the next millennium of medicine must begin with attacking the sources of the problems plaguing our medical system: frivolous lawsuits, out of control insurance rates resulting from such, and our providers being forced out of the practice by bureaucratic dominance. This would give health care providers greater financial options to invest in health information technology products. In addition, Congress should foster legislation that would support the funding of such technology, at the very least, in our hospitals.

5. A 1999 report by the Institute of Medicine, "To Err is Human: Building a Safer Health System," put the subject of medical errors on the map and made patient safety a public issue. What do you think is the best approach to reducing medical errors and compensating victims of medical errors, while reducing the strain of skyrocketing medical malpractice insurance premiums on the health care system?

Enacting broad, meaningful medical malpractice reform to eliminate the unnecessary burden on health care providers should absolutely be the first health care issue addressed with new legislation in the U.S. Senate. Unfortunately, although the U.S. Senate voted to stop a filibuster on medical liability reform on May 8^th, they fell short of the 60 votes needed to move the legislation to the Senate floor because some Senators, like my opponent, are beholden to their trial lawyer contributors. My opponent Bob Menendez voted NO; I would have voted YES. America has the best doctors and health care facilities in the world. Health care dollars should be spent on patients in a hospital - not on lawyers in a courtroom or on unnecessary, complicated paperwork. Physicians should not make medical decisions out of fear of being sued frivolously, and they should not be driven out of their practice. Doctors must be able to hire the best staff in adequate numbers, be able to purchase the best equipment to treat their patients, and be able to devote the maximum amount of their time to their patients. Medical errors will not be reduced by forcing our physicians to practice under substandard conditions, with insufficient compensation, and under extreme paranoia of being sued.

Accordingly, I also support the principles of the Lawsuit Abuse Reduction Act, which is aimed at reducing the filing of so-called "junk" lawsuits. I have advocated for the establishment of Medical Malpractice Courts (also known as Special Health Courts), which would place medical malpractice cases into the hands of full-time judges trained and dedicated solely to addressing health care issues, who could define and then interpret the appropriate standards of care. I have already introduced the legislation that would pilot such a program in New Jersey and would support bipartisan legislation that has already been introduced in Congress that would provide grants to states which develop alternatives for resolving disputes involving malpractice by health care providers.

6. On the subject of medical malpractice reform, the American Medical Association and many physician groups support a cap on noneconomic damage awards (e.g., pain and suffering jury awards in malpractice trials) as a key ingredient to controlling skyrocketing medical malpractice insurance premiums, while also preserving patient access to high-risk medical procedures performed by physicians who are saddled with the highest insurance premiums (e.g., obstetricians, neurosurgeons, orthopedic surgeons, and general surgeons). The U.S. House of Representatives has passed such a bill several times, while it has repeatedly been defeated in the Senate. What is your position on the issue?

America’s health care system is only as strong as those who serve it – namely our doctors, hospitals and health care providers. We need to go after the costs that drive up insurance premiums and also drive practitioners out of practice. In recent years, the cost of health care has dramatically increased as a result of the surge in frivolous medical liability lawsuits. Frivolous lawsuits and an expectation of large cash settlements have clogged our nation’s courts and have bankrupted hospitals and other entities. This crisis has also caused many of New Jersey’s finest doctors and specialists to leave the state or their profession because they cannot afford to practice here. Although patients damaged by the negligence of any health care provider deserve some compensation for pain and suffering, I believe that the $250,000 cap on non-economic damages is both practical and necessary to prevent such high medical liability insurance costs.

7. Medicare has several demonstration projects looking at paying providers more for measurably higher quality care. What role do you think pay-for-performance reimbursement has in improving the quality of health care, and what role do you see the federal government having on the matter in the future?

The best doctors in the world are here in this country. They deserve to be properly compensated for practice costs in the Medicare program. My opponent, Bob Menendez, voted to cut $55.8 billion from Medicare by squeezing health care providers. I will not vote to put the onus on physicians to artificially lower the costs of care.

Diagnosing, treating, operating, deciding whether or not to operate, weighing risks, maintaining bedside manner, leading a patient through the recovery process. These are skills that physicians spend almost a decade of their lives acquiring. Therefore, physicians must retain the primary ability to decide how to treat their patients – not managed care plans, and not insurance carriers. Doctors should not be beholden to unnecessary complexities, such as paperwork, frivolous litigation, and limitations on insurance plans. If the federal government is to have a role in the health care system, it should be to protect physicians from such complexities, increase the autonomy of patients and physicians, enact legislation that promotes the wellness of the individual, and enable small businesses and the self-employed to join together and collectively negotiate better prices and services for their health insurance plans. Doing so will enable a much-needed and much deserved increase in compensation for our nation’s health care providers. And the benefits are cyclical – a physician who receives greater compensation for higher-quality care will have more incentive to invest in more advanced technology, supplemental staff, and better resources. That, in turn, will improve the quality of our health care system.

8. New Jersey and many other states are struggling to fund burgeoning Medicaid expenses, in part because of shrinking federal dollars. What can, and should, the federal government do to help states meet their Medicaid obligations?