The United States, four years after the devastating collapses of the real estate and financial sectors, shoulders a national debt of $16 trillion, maneuvers through vast changes in the health-care system and braces for possible changes to safety-net entitlement programs.

Against this backdrop, Virginia Foxx, a four-term Republican incumbent in northwestern North Carolinas 5th Congressional District, and her Democratic opponent, Elisabeth Motsinger, a member of the Winston-Salem/Forsyth County Board of Education, seek to deal with those national issues, among others.

Last week, in separate interviews, they answered questions about five key national issues, including military spending, the Affordable Care Act and illegal immigration.

Entitlements

Programs such as Medicare and Social Security should be strengthened and preserved so that they may continue to benefit future generations, Foxx said in an email.

Motsinger gave a similar response.

But they have different views on how these programs should be preserved.

Motsinger opposes proposed reforms that have in the past been favored by Foxx and recommended by Rep. Paul Ryan, R-Wis., the GOP vice presidential candidate and chairman of the U.S. House Budget Committee.

Ryan, in 2005, recommended a plan that would offer a privatization option for Social Security for younger people, and the 2010 budget he proposed had a privatization option, though his latest plan does not, according to an analysis by The Washington Post.

Motsinger said she is opposed to privatizing Social Security or creating individual accounts.

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Foxx, Motsinger clash on most issues

Nonprofit health plans are leading the pack in the annual health plan rankings from the National Committee for Quality Assurance, which Consumer Reports recently published.

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Nonprofit health care providers lead the pack

John Crudele

DEAR JOHN...THE ANSWER MAN

Dear John: I am a registered nurse who has been working in a major trauma center in New York City for the past 20 years.

I have a son who is 22 years old and does not have a job that provides health insurance. Before he was covered on my plan (under ObamaCare) we had to pay out of pocket for doctor visits.

The doctor visits are $150, and the procedures are more. We found it hard to pay the $150. I prayed every day that he was not a victim of trauma because where would we come up with the money to pay the hospital?

I would have to sell my house.

When is the right time for ObamaCare? Ever since I could remember, both Republican and Democratic presidents have promised some type of universal health care, and nothing has materialized.

I understand that the new health- care bill is not perfect, but we need to start somewhere.

Too many people are uninsured and are not getting medical care. And when they get medical care, the bill is never paid.

When the president, congressmen and senators get sick, they have access to the best health care in America.

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Health care: Who has to pay

A 59-cent sterilizing sponge and an additional minute to draw each patients blood have helped Memorial Medical Center save at least $2 million in health-care costs over the past two years.

More important, the modification Memorial adopted for testing patients blood for dangerous infections such as sepsis has meant quicker and more appropriate medical responses to those infections. Patients have suffered less as a result, and its likely that some lives have been saved, Memorial officials say.

Its provided physicians with the right information sooner, said David Neff, a Memorial project leader for operations improvement.

The effort to hone in on certain types of blood tests to make them more accurate the first time around is one of dozens of projects the Springfield hospital has undertaken to improve care at a time when the federal government and private insurers are starting to reward hospitals for quality rather than quantity.

Memorial recently learned it performed well in the first year of one of the first large pay-for-performance programs set in motion by the federal Affordable Care Act. The hospital also expects to receive a financial bonus in December through another such incentive in the health-reform law.

Readmissions low

Memorial was one of 17 hospitals in Illinois, out of about 130 ranked, that will receive no financial penalty over the next 12 months based on readmission rates for patients treated for heart attack, congestive heart failure or pneumonia.

Weve been working hard on this, and we track this, and weve done a number of initiatives, so we were certainly gratified to have this result, said Charles Callahan, vice president for quality and operations at Memorials parent organization, Memorial Health System.

Readmissions are one focus of the governments health-care reform efforts because they often result from uncoordinated care, both inside the hospital and after a patient is discharged. Almost one in five Medicare patients return to the hospital within a month, and until now, hospitals have been financially rewarded for that with additional Medicare payments.

Memorial could have faced a penalty of up to 1 percent of its base Medicare rates, or about $1 million annually, based on the percentage of patients readmitted within 30 days of discharge, with adjustments made for patients age, gender and medical history. The not-for-profit institution annually posts about $480 million in patient-service revenues; about $192 million of those revenues come from Medicare.

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Memorial works on efficiency to improve care, avoid health-reform penalties

Voters at a recent rally for Republican presidential candidate Mitt Romney cited not just disagreement, but outright fear of the new health-care law.

I dont think theres going to be enough money, said Karen Albright, a nurse from Parker, on a warm autumn evening waiting in line to hear the candidate. I expect rationing. They will say you are too old.

Armeda Freel, who traveled from Scottsbluff, Neb., to a rally in Lakewood, is on Medicare, the government health-insurance program for people 65 and older. She said she hurried to have surgery on the carpal tunnel problem in her hands this year because she fears it would be denied after the health-care law takes full effect in 2014.

I thought there was a chance they would say, Live with the numbness. Youre not going to die. Freel said.

Charles Patricoff, also in line, looked tanned, strong and younger than his 60 years, yet said he had suffered a major heart attack just three months earlier. He believes he might have been denied treatment under the new law.

They might have looked at me and my age, and said, Youve lived a full life. he said.

Romney and most Republican congressional candidates have promised to overturn the health-care law if they are elected. The law, passed in 2010, was upheld by the U.S. Supreme Court in June. If left intact, it will go into effect in 2014.

Colorado Public News asked two leading physicians in Colorado on opposite sides of the political fence whether these fears of the federal government interfering with treatment of their patients were justified. The answers were enlightening, and very different.

Dr. William G. Plested, president of the American Medical Association from 2006 to 2007, retired as a thoracic and cardiovascular surgeon in Santa Monica, Calif., to Bayfield. He is a severe critic of the health-care law.

In stark contrast is Dr. John Bender, president-elect of the Colorado Medical Society and a family medicine doctor with Miramont Family Medicine in Fort Collins. He does not see anything in the health law that would cause interference in the daily practice of medicine.

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Doctors disagree on health-care laws effects

Health care reform is a key issue in the November presidential election. We asked readers what they think it should look like.

Cady Gebhardt, 22, Dayton

I would like to see people who need health care be able to get it. But the people who dont need it shouldnt have to buy it. I dont feel like I need it, so I dont want to have to buy it, and I dont want to be taxed for it.

Jared Stephens, 23, Dayton

For the most part, I definitely agree with Obamas health care plan, but there should be more of an option in it, with different levels so that if Im making this much, this is the health care you get, so people at the younger end of the spectrum, who dont need all that health care, theyre not paying as much if theyre not earning as much. They should tailor it per the generations.

Colleen Wells, 63, Springboro

What I know about Obamacare scares me to death. I think theres a happy medium between Obamacare and what we need. I cant believe no one can figure it out. I dont think its fair theyre burdening small businesses with health care. Its keeping my son, who owns a small business, from wanting to hire more people because he doesnt know what hes going to be taxed with.

Asia White, 26, Dayton

As a single parent who works part-time, I qualify for Medicaid. It does play a major role for me. As long as the Democratic Party continues to see fit that low-income families can afford health care, then Im definitely for that. If the other party would make known that it has a better option, Id be forced to weigh my options. If I was middle class, then I could afford to have a different option, but right now, I cant.

Beverly Rowell, 49, Dayton

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Local residents divided over ‘Obamacare’

DECATUR Iris Lewis-Beasley knows all too well about the importance of health care.

Beasley, a trust administrative officer at Hickory Point Bank and Trust in Decatur, has had multiple surgeries on her knee, ankle and thumb after being involved in several car accidents.

Her daughter, Ilaina, recently had to have a benign tumor surgically removed after several visits to specialists.

But it was her experience with her 3-month-old-son in the mid-1990s that shaped Lewis-Beasleys views on health care.

What people care about this election season is the focus of a month-long series by Lee Enterprises reporters, who spent recent weeks talking to Central Illinois residents about what they want to see addressed by the presidential candidates. Lingering worries about health care, for instance, center on people concerned about both the availability and cost of appropriate care.

Lewis-Beasley was a teen in 1995 when she gave birth to her son, Caylin. Without access to quality health care, she received a medical card and relied on lesser care.

Caylin developed beta strep soon after being born, but the disease was not diagnosed or treated. It developed into meningitis and three months after he was born, Caylin was dead.

At that point in my life, I vowed never to be put back in that situation where I didnt have medical insurance again and that Id have to be dependent on the coverage you may or may not get because you dont have good insurance, Lewis-Beasley said.

Because of his death, Lewis-Beasley believes health care needs to change and focus on helping those in the community less fortunate than others.

I really worry about those people who are already in a high-risk situation, she said.

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Access to affordable, quality health care has Central Illinoisians concerned